Association of Intrauterine Exposure to Maternal Diabetes and Obesity With Type 2 Diabetes in Youth: The SEARCH Case-Control Study

Cardiovascular and Metabolic Risk

Association of Intrauterine Exposure to Maternal Diabetes and Obesity With Type 2 Diabetes in Youth

¹Department of Preventive Medicine and Biometrics, University of Colorado Denver, Denver, Colorado
²Nutrition Department, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
³Arnold School of Public Health, Columbia, South Carolina
⁴Wake Forest University School of Medicine, Winston-Salem, North Carolina
⁵The Rollins School of Public Health, Emory University, Atlanta, Georgia
⁶Department of Pediatrics, University of Colorado Denver, Denver, Colorado

Diabetes Care 2008 Jul; 31(7): 1422-1426. https://doi.org/10.2337/dc07-2417

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Figure 1—
Percentage of youth exposed in utero to maternal diabetes (A) and maternal overweight/obesity (B) by case-control status and race/ethnicity. □, case patients; ▪, control youth. A: Non-Hispanic white (NHW) P = 0.01; Hispanic (H) P = 0.02; African-American (AA) P = 0.02. B: NHW P = 0.1; H P = 0.04; AA P = 0.001.
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Figure 2—
The association between offspring type 2 diabetes status with exposure to maternal diabetes in utero (A) and exposure to maternal overweight/obesity in utero (B) in sequentially adjusted multiple logistic regression models. Model 1: adjusted for offspring age, sex, race/ethnicity; model 2: model 1 + maternal obesity in utero (A) or maternal diabetes in utero (B); model 3: model 2 + maternal alcohol and smoking in pregnancy, maternal current age, parity, offspring's birth weight, breast-feeding, maternal education, household income; and model 4: model 2 + current offspring BMI Z score.

Table 1—

Characteristics of youth with type 2 diabetes and nondiabetic control youth

Variables	Type 2 diabetes	Control	P value
n	79	79
Age (years)	15.7 ± 2.8	14.4 ± 2.8	0.003
Sex (% male)	29.1	38.9	0.1
Race/Ethnicity (%)			<0.0001
Non-Hispanic white	27.9	55.8
African-American	54.4	27.9
Hispanic	17.7	16.3
BMI (kg/m²)	34.7 ± 7.5	24.0 ± 6.8	<0.0001
BMI Z score	2.1 ± 0.7	0.8 ± 1.1	<0.0001
Exposure to maternal diabetes in utero (% yes)	30.4	6.3	<0.0001
Exposure to maternal obesity (BMI ≥25 kg/m²) in utero (% yes)	57.0	27.4	<0.0001
Maternal education (%)			0.009
Less than high school	13.9	4.7
High school and more	86.1	94.2
Household income (%)			<0.0001
<$25,000	49.4	21.6
>$25,000	50.6	77.9
Maternal smoking during pregnancy (% yes)	11.4	11.1	0.9
Maternal alcohol consumption during pregnancy (% yes)	1.27	14.7	0.001
Birth weight (g)	3,218 ± 654	3,288 ± 620	0.4
Breast-feeding (% yes)	30.4	65.8	<0.0001
Paternal history of diabetes (% yes)	29.1	6.3	<0.0001

Table 2—

Proportion of type 2 diabetes in youth attributable to intrauterine exposure to maternal diabetes and overweight/obesity

Exposure category	Case patients	Control youth	OR (95% CI)*	PAF†
Not exposed to either maternal diabetes or maternal obesity	36.7	68.9	1	Unexposed
Exposed to maternal diabetes only	6.3	3.7	3.9 (1.1–14.5)	4.7
Exposed to maternal obesity only	32.9	24.7	2.5 (1.3–5.0)	19.7
Exposed to both maternal diabetes and maternal obesity	24.1	2.6	19.2 (6.1–60.8)	22.8
Overall proportion of type 2 diabetes in youth attributable to in utero exposure to maternal diabetes and obesity	47.2 (30.9–63.5)‡

Data are % unless indicated otherwise.
*
↵* ORs for the association between mutually exclusive exposure categories and case/control status, additionally adjusted for age, sex, and race/ethnicity.
†
↵† PAFs were calculated using the formula: P_i [(OR_i − 1)/OR_i], where P_i is the proportion of case patients in each exposure category and OR_i is the adjusted OR comparing each exposed group with the unexposed reference category (i = 0).
‡
↵‡ Calculated using the formula: Σ √P_i [(OR_i − 1)/OR_i].