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Original Articles

Low Birth Weight as a Risk Factor for Gestational Diabetes, Diabetes, and Impaired Glucose Tolerance During Pregnancy

  1. David J. Pettitt, MD and
  2. Lois Jovanovic, MD
  1. From the Sansum Diabetes Research Institute, Santa Barbara, California
  1. Address correspondence and reprint requests to David J. Pettitt, MD, Senior Scientist, Sansum Diabetes Research Institute, 2219 Bath St., Santa Barbara, CA 93105. E-mail: dpettitt{at}sansum.org
Diabetes Care 2007 Jul; 30(Supplement 2): S147-S149. https://doi.org/10.2337/dc07-s207
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  • GDM, gestational diabetes mellitus

Small size at birth as a risk factor for the development of diabetes or other metabolic disorders has been described in numerous populations over the past 2 decades (1–12). Most studies dealing with children or nonpregnant adults have reported an inverse linear relationship between birth size and the prevalence of disease (1–4,6–10), but the relationship among the Pima Indians from Arizona has been described as “U-shaped” because the high risk is seen in individuals with high birth weight as well as low birth weight (5). Several reasons for this relationship have been proposed (13) and a similar finding was subsequently reported among schoolchildren in Taiwan (11). Since the 4th International Workshop-Conference on Gestational Diabetes Mellitus, where the association between a woman's birth weight and gestational diabetes mellitus (GDM) or pregestational diabetes was first presented (14), there have been several similar reports in the literature. The purpose of this article is to review some of the recently published data on this relationship, which is well described in the general population but still less studied among pregnant women.

FINDINGS—

Table 1 presents results of studies presenting data on a woman's birth weight as a risk factor for GDM (14–21). Several of the studies are population studies that present the prevalence of GDM by birth weight (14–18), whereas others present the birth weight frequency distributions of women with and without GDM (19,20). These studies all found that the prevalence of GDM was higher in women who were in the lower birth weight category or categories. A significant relationship between a low birth weight and gestational or pregestational diabetes has been described among Native American women in Arizona and Washington State, among African-Americans and Hispanics in Washington and New York State, and among non-Hispanic whites from Washington, New York, Norway, Italy, Australia, and Malta (14–21). Interestingly, several studies (15–17,19), in addition to the Pima study (14), described a U-shaped association between birth weight and GDM (Fig. 1). The article by Moses et al. (21) reports, among women with GDM, that the mean 2-h glucose concentration at the diagnosis of GDM is associated with that woman's birth size. Women who had been small for gestational age at birth had a 2-h glucose concentration that was significantly higher than women who had been of normal weight for gestational age (21). There was a tendency for women who had been large for dates to have a higher glucose as well, suggesting a U-shaped association, but this difference was not significant.

DISCUSSION—

With the large number of reports in nonpregnant populations that low birth weight is a risk factor for the later development of diabetes at young ages, it was to be expected that it might also be a risk factor for GDM. As shown in this article, this has been a common finding, and several studies, some of them with very large sample sizes, have provided confirmation. Of interest is that several reported a U-shaped association with birth weight—a finding that has been uncommon in nonpregnant populations. These studies, the Pima Indian study, and the Taiwanese schoolchildren survey all share a young age of onset of diabetes. For decades, the Pima Indians have developed diabetes at relatively young ages (22). Today, type 2 diabetes is being found increasingly in younger members of other populations as well (23). GDM, since it is a condition of women of childbearing age, also develops at a relatively young age. One reason may be that for young people today, a large birth weight was more likely due to an abnormality during pregnancy, such as maternal diabetes in the case of the Pima Indians (5,22), that puts them at high risk for developing diabetes in contrast to the past when a large birth weight was more likely associated with overall general health of the mother and child and therefore was not a risk factor. The future may prove that this finding becomes more common in the general population over time. In particular, additional surveys similar to the Taiwanese study that relate childhood-onset type 2 diabetes to birth weight should be undertaken to provide more insight into this question.

SIGNIFICANCE FOR PREGNANCY SURVEILLANCE—

Universal screening for GDM was the recommendation of the American Diabetes Association from 1979 (24) until 1998 (25). The participants at the 4th International Workshop-Conference on Gestational Diabetes recommend that women who met certain characteristics (member of low-risk ethnic group, no known diabetes in first-degree relatives, age <25 years, normal weight, no history of abnormal glucose tolerance, and no history of poor obstetric outcomes) did not have to be screened routinely (25). Although this recommendation has not been universally accepted (26–31), for those who do follow these guidelines, a normal birth weight should be included in the list of characteristics a woman must possess to be exempt from routine screening.

In summary, women from diverse populations who were of low birth weight are at risk for the development of GDM. This observation is not surprising given the well-described health consequences of abnormal fetal growth that are apparent in very young children and persist into adulthood. Unlike the preponderance of reports among the nonpregnant population, during pregnancy, the risk for GDM is likely to have a U-shape, with excess disease developing in women whose own birth weights were either very high or very low.

Figure l—
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Figure l—

Prevalence of GDM in women according to their birth weight (note varying scales on both axes). A: Pima Indians (data from Pettitt and Knowler [14]); B: Norwegian women (data from Egeland et al. [16]); C: African-American women (data from Williams et al. [15]); D: women from New York State (data from Innes et al. [17]).

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Table 1—

Studies reporting GDM in relation to a woman's own birth weight

Footnotes

  • This article is based on a presentation at a symposium. The symposium and the publication of this article were made possible by an unrestricted educational grant from LifeScan, Inc., a Johnson & Johnson company.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted May 19, 2006.
    • Received March 28, 2006.
  • DIABETES CARE

References

  1. ↵
    Barker DJP, Gardner MJ, Power C: Incidence of diabetes amongst people aged 18–50 years in nine British towns: a collaborative study. Diabetologia 22: 421–425, 1982
    OpenUrlCrossRefPubMedWeb of Science
  2. Hales CN, Barker DJP, Clark PMS, Cox LJ, Fall C, Osmond C, Winter PD: Fetal and infant growth and impaired glucose tolerance at age 64. BMJ 303:1019–1022, 1991
    OpenUrlAbstract/FREE Full Text
  3. Hales CN, Barker DJP: Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesis. Diabetologia 35:595–601, 1992
    OpenUrlCrossRefPubMedWeb of Science
  4. ↵
    Valdez R, Athens MA, Thompson GH, Bradshaw BS, Stern MP: Birthweight and adult health outcomes in a biethnic population in the USA. Diabetologia 37:624–631, 1994
    OpenUrlCrossRefPubMedWeb of Science
  5. ↵
    McCance DR, Pettitt DJ, Hanson RL, Jacobsson LTH, Knowler WC, Bennett PH: Birth weight and non-insulin dependent diabetes: thrifty genotype, thrifty phenotype, or surviving small baby genotype? BMJ 308:942–945, 1994
    OpenUrlAbstract/FREE Full Text
  6. ↵
    Yajnik CS, Fall CHD, Vaidya U, Pandit AN, Bavdekar A, Bhat DS, Osmond C, Hales CN, Barker DJP: Fetal growth and glucose and insulin metabolism in four-year-old Indian children. Diabet Med 12:330–336, 1995
    OpenUrlCrossRefPubMedWeb of Science
  7. Lithell HO, McKeigue PM, Berglund L, Mohsen R, Lithell U-B, Leon DA: Relation of size at birth to non-insulin dependent diabetes and insulin concentrations in men aged 50–60 years. BMJ 312:406–410, 1996
    OpenUrlAbstract/FREE Full Text
  8. Clausen JO, Borch-Johnsen K, Pedersen O: Relation between birth weight and the insulin sensitivity index in a population sample of 331 young, healthy Caucasians. Am J Epid 146:23–31, 1997
    OpenUrlAbstract/FREE Full Text
  9. Carlsson S, Persson P-G, Alvarsson M, Efendic S, Norman A, Svanström L, Östenson C-G, Grill V: Low birth weight, family history of diabetes, and glucose intolerance in Swedish middle-aged men. Diabetes Care 22:1043–1047, 1999
    OpenUrlAbstract/FREE Full Text
  10. ↵
    Rich-Edwards JW, Colditz GA, Stampfer MJ, Willett WC, Gillman MW, Hennekens CH, Speizer FE, Manson JE: Birthweight and the risk for type 2 diabetes mellitus in adult women. Ann Intern Med 130:278–284, 1999
    OpenUrlCrossRefPubMedWeb of Science
  11. ↵
    Wei J-N, Sung F-C, Li C-Y, Chang C-H, Lin R-S, Lin C-C, Chiang C-C, Chuang L-M: Low birth weight and high birth weight infants are both at an increased risk to have type 2 diabetes among schoolchildren in Taiwan. Diabetes Care 26:343–348, 2003
    OpenUrlAbstract/FREE Full Text
  12. ↵
    Barker DJP, Osmond C, Forsén TJ, Kajantie E, Eriksson JG: Trajectories of growth among children who have coronary events as adults. N Engl J Med 353:1082–1089, 2005
    OpenUrl
  13. ↵
    Pettitt DJ, Jovanovic L: Birth weight as a predictor of type 2 diabetes mellitus: the U-shaped curve. Curr Diab Rep 1:78–81, 2001
    OpenUrlPubMed
  14. ↵
    Pettitt DJ, Knowler WC: Long-term effects of the intrauterine environment, birth weight, and breast-feeding in Pima Indians. Diabetes Care 21(Suppl. 2):B138–B141, 1998
    OpenUrl
  15. ↵
    Williams MA, Emanuel I, Kimpo C, Leisenring WM, Hale CB: A population-based cohort study of the relation between maternal birthweight and risk of gestational diabetes mellitus in four racial/ethnic groups. Paediatr Perinat Epidemiol 13:452–465, 1999
    OpenUrlCrossRefPubMedWeb of Science
  16. ↵
    Egeland GM, Skjærven R, Irgens LM: Birth characteristics of women who develop gestational diabetes: population based study. BMJ 321:546–547, 2000
    OpenUrlFREE Full Text
  17. ↵
    Innes KE, Byers TE, Marshal JA, Barón A, Orleans M, Hamman RF: Association of a woman's own birth weight with subsequent risk for gestational diabetes. JAMA 287:2534–2541, 2002
    OpenUrlCrossRefPubMedWeb of Science
  18. ↵
    Seghieri G, Anichini R, De Bellis A, Alviggi L, Franconi F, Breschi MC: Relationship between gestational diabetes mellitus and low maternal birth weight. Diabetes Care 25:1761–1765, 2002
    OpenUrlAbstract/FREE Full Text
  19. ↵
    Savona-Ventura C, Chircop M: Birth weight influence on the subsequent development of gestational diabetes mellitus. Acta Diabetol 40:101–104, 2003
    OpenUrlCrossRefPubMedWeb of Science
  20. ↵
    Bo S, Marchisio B, Volpiano M, Menato G, Pagano G: Maternal low birth weight and gestational hyperglycemia. Gynecol Endocrinol 17:133–136, 2003
    OpenUrlPubMed
  21. ↵
    Moses RG, Moses J, Knights S: Birth weight of women with gestational diabetes. Diabetes Care 22:1059–1062, 1999
    OpenUrlAbstract/FREE Full Text
  22. ↵
    Knowler WC, Pettitt DJ, Saad MF, Bennett PH: Diabetes mellitus in the Pima Indians: incidence, risk factors and pathogenesis. Diabetes Metab Rev 6:1–27, 1990
    OpenUrlCrossRefPubMedWeb of Science
  23. ↵
    American Diabetes Association Consensus Panel: Type 2 diabetes in children and adolescents. Diabetes Care 23:381–389, 2000
    OpenUrlCrossRefPubMedWeb of Science
  24. ↵
    Freinkel N, Josimovich J: Conference Planning Committee: American Diabetes Association Workshop-Conference on Gestational Diabetes: Summary and recommendations. Diabetes Care 3:499–501, 1980
    OpenUrlAbstract/FREE Full Text
  25. ↵
    Metzger BE, Coustan DR: The Organizing Committee: Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 21(Suppl. 2):B161–B167, 1998
    OpenUrl
  26. ↵
    Maternal and Child Health Branch, Department of Health Services, State of California: State Program Guide: California Diabetes & Pregnancy Program. California Department of Health Services, 1998
  27. Wilson JD: Gestational diabetes: universal or selective screening? (Editorial) Med J Australia 174:113–114, 2001
    OpenUrlPubMed
  28. Carr CA: Evidence-based diabetes screening during pregnancy. J Midwifery Women Health 46:152–158, 2001
    OpenUrl
  29. Baliutavièien D, Petrekno V, Žalinkevièius R: Selective or universal diagnostic testing for gestational diabetes mellitus. Int J Gynecol Obstet 78:207–211, 2002
    OpenUrlPubMed
  30. Corcoy R, García-Patterson A, Pau E, Pascual E, Altirriba O, Adelantado JM, de Leiva A: Is selective screening for gestational diabetes mellitus worthwhile everywhere? Acta Diabetol 41:154–157, 2004
    OpenUrlPubMed
  31. ↵
    Alberico S, Strazzanti C, De Santo D, De Seta F, Lenardon P, Bernardon M, Zicari S, Guaschino S: Gestational diabetes: universal or selective screening? J Matern Fetal Neonatal Med 16:331–337, 2004
    OpenUrlCrossRefPubMed
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Low Birth Weight as a Risk Factor for Gestational Diabetes, Diabetes, and Impaired Glucose Tolerance During Pregnancy
David J. Pettitt, Lois Jovanovic
Diabetes Care Jul 2007, 30 (Supplement 2) S147-S149; DOI: 10.2337/dc07-s207

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Low Birth Weight as a Risk Factor for Gestational Diabetes, Diabetes, and Impaired Glucose Tolerance During Pregnancy
David J. Pettitt, Lois Jovanovic
Diabetes Care Jul 2007, 30 (Supplement 2) S147-S149; DOI: 10.2337/dc07-s207
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