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PRENATAL EXPOSURES AND GLUCOSE METABOLISM IN ADULTHOOD: ARE EFFECTS MEDIATED THROUGH BIRTH WEIGHT AND ADIPOSITY?

¹Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health

c.thomas{at}ich.ucl.ac.uk

ABSTRACT

OBJECTIVE: Birthweight has been associated with the risk of type 2 diabetes in several studies. We investigated whether prenatal influences on birthweight (gestational age, parity, pre-eclampsia, pre-pregnancy BMI, smoking during pregnancy and socio-economic position) were associated with glucose metabolism in midlife, and the role of birthweight-for-gestational age (BGA) and adult adiposity in mediating these associations.

RESEARCH DESIGN AND METHODS: Data from 7518 participants of the 1958 British birth cohort with information on HbA1c at age 45y were analysed. Associations between prenatal exposures and HbA1c6 were examined using a series of logistic regression models. The basic model consisted of all prenatal factors (except parity) adjusted for sex and family history of type 2 diabetes. Further adjustments included (i) BGA only (ii) concurrent adiposity only (BMI and waist circumference) (iii) BGA plus adiposity.

RESULTS: In the basic model, pre-eclampsia (OR=1.78, 95%CI=1.14-2.80), pre-pregnancy BMI25kg/m² (1.90, 1.45-2.47), maternal smoking (1.33, 1.04-1.71) and manual socio-economic position (1.87, 1.36-2.58) were independently associated with HbA1c at 45y. Adjustment for BGA had little impact on the prenatal factors/HbA1c associations, whereas adjustment for adult adiposity at 45y substantially reduced associations for pre-pregnancy BMI, smoking during pregnancy and socio-economic position.

CONCLUSIONS: Prenatal exposures were related to blood glucose levels in mid-adulthood. Associations for several prenatal factors were largely mediated through adult adiposity, but surprisingly not through birthweight. Prenatal exposures are likely to have the strongest effects on glucose metabolism indirectly, through their influence on adiposity.

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