Risk factors for childhood overweight in offspring of type 1 diabetic women with adequate glycemic control during pregnancy: nationwide follow-up study in the Netherlands.

  1. Maarten Rijpert, MD (m.rijpert{at}umcutrecht.nl)1,
  2. Inge M. Evers, MD, PhD2,
  3. Monique A.M.J. de Vroede, MD, PhD3,
  4. Harold W. de Valk, MD, PhD1,4,
  5. Cobi J. Heijnen, PhD, Prof1 and
  6. Gerard H.A. Visser, MD, PhD, Prof1
  1. 1Division of Woman and Baby, University Medical Center Utrecht, the Netherlands
  2. 2Division of Perinatology, Academic Medical Center Amsterdam, the Netherlands
  3. 3Department of Pediatric Endocrinology, University Medical Center Utrecht, the Netherlands
  4. 4Division of Internal Medicine, University Medical Center Utrecht, the Netherlands

    Abstract

    Objective. Pregnancy in type 1 diabetic women remains a high risk situation for both mother and child. In this study we investigated long term effects on body composition, prevalence of overweight and insulin resistance in children of type 1 diabetic women who had had adequate glycemic control during pregnancy (mean HbA1c 6.2%) and we related their outcome to perinatal factors, including macrosomia (birth weight ≥p90).

    Research design and methods. Anthropometric measurements were performed at 6-8 years of age in 213 offspring of type 1 diabetic mothers who participated in a previous nationwide study. HOMA insulin resistance was determined from a fasting blood sample in 155 of these children. Additionally, we studied BMI standard deviation score (SDS) growth trajectories. Results were compared to national reference data.

    Results. The prevalence of overweight in the study population was not different from that in the reference population. However, children who were born macrosomic showed twice as much overweight as non-macrosomic children. Macrosomia and maternal overweight were independent predictors of childhood overweight. Overweight children showed an increase in BMI SDS starting already after 6 months of age and had a significantly increased HOMA insulin resistance.

    Conclusions. In type 1 diabetic women with adequate glycemic control during pregnancy, long term effects on body composition and overweight in their offspring at school age are limited and mainly related to macrosomia at birth. Possible targets for prevention of childhood overweight are fetal macrosomia, maternal overweight and an increase of BMI SDS during the first years of life.

    Footnotes

      • Received April 3, 2009.
      • Accepted July 24, 2009.

    This Article

    1. Diabetes Care
    1. All Versions of this Article:
      1. dc09-0652v1
      2. 32/11/2099 most recent