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Clinical Care/Education/Nutrition/Psychosocial Research

Mild Gestational Diabetes Mellitus and Long-Term Child Health

  1. Mark B. Landon1⇑,
  2. Madeline Murguia Rice2,
  3. Michael W. Varner3,
  4. Brian M. Casey4,
  5. Uma M. Reddy5,
  6. Ronald J. Wapner6,
  7. Dwight J. Rouse7,
  8. Joseph R. Biggio Jr.8,
  9. John M. Thorp9,
  10. Edward K. Chien10,
  11. George Saade11,
  12. Alan M. Peaceman12,
  13. Sean C. Blackwell13 and
  14. J. Peter VanDorsten14
  15. for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network
  1. 1Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH
  2. 2George Washington University Biostatistics Center, Washington, DC
  3. 3Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT
  4. 4Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
  5. 5Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
  6. 6Department of Obstetrics and Gynecology, Columbia University, New York, NY
  7. 7Department of Obstetrics and Gynecology, Brown University, Providence, RI
  8. 8Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
  9. 9Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC
  10. 10Department of Obstetrics and Gynecology, Case Western Reserve University–MetroHealth Medical Center, Cleveland, OH
  11. 11Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX
  12. 12Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL
  13. 13Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston–Children’s Memorial Hermann Hospital, Houston, TX
  14. 14Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC
  1. Corresponding author: Mark B. Landon, mark.landon{at}osumc.edu.
Diabetes Care 2015 Mar; 38(3): 445-452. https://doi.org/10.2337/dc14-2159
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Article Figures & Tables

Tables

  • Table 1

    Maternal baseline characteristics by mild GDM treatment group

    CharacteristicTreated (n = 264)Untreated (n = 236)P value†
    Age (years)29.2 ± 5.228.7 ± 5.50.31
    Glucose after 50-g glucose-loading test (mg/dL)158.2 ± 15.3158.4 ± 15.40.90
    Glucose in 3-h OGTT (mg/dL)
    Fasting glucose86.9 ± 5.786.5 ± 5.60.30
     1-h OGTT191.0 ± 21.2192.9 ± 19.10.13
     2-h OGTT172.5 ± 21.4172.5 ± 18.50.79
     3-h OGTT138.2 ± 29.1133.7 ± 31.60.15
    BMI at entry (kg/m2)30.2 ± 5.130.6 ± 5.40.44
    Gestational age at entry (weeks)28.8 ± 1.629.0 ± 1.40.34
    Race/ethnicity0.53
     Non-Hispanic black28 (10.6)27 (11.4)
     Non-Hispanic white84 (31.8)65 (27.5)
     Hispanic144 (54.6)132 (55.9)
     Other8 (3.0)12 (5.1)
    • Data are mean ± SD and n (%). OGTT, oral glucose tolerance test.

    • ↵† Based on the χ2 test for categorical variables and Wilcoxon rank sum test for continuous variables.

  • Table 2

    Birth outcomes by mild GDM treatment group, overall and by sex

    OverallMaleFemale
    OutcomeTreated
(n = 264)Untreated
(n = 236)P value†Treated
(n = 140)Untreated
(n = 121)P value†Treated
(n = 124)Untreated
(n = 115)P value†
    Gestational age at delivery (weeks)38.9 ± 1.839.0 ± 1.70.3038.8 ± 1.939.2 ± 1.70.0239.1 ± 1.638.9 ± 1.70.33
    Birth weight (g)3,283.2 ± 491.43,468.3 ± 546.4<0.0013,285.5 ± 507.23,557.6 ± 532.5<0.0013,280.6 ± 475.03,375.0 ± 547.50.08
    Macrosomia (>4,000 g)12 (4.6)32 (13.6)<0.0017 (5.0)21 (17.5)0.0015 (4.0)11 (9.6)0.09
    Fat mass (g)421.3 ± 173.3482.9 ± 210.2<0.001407.3 ± 152.7502.0 ± 213.8<0.001437.1 ± 193.3463.3 ± 205.60.16
    Fat mass >90th percentile9 (3.8)36 (16.7)<0.0011 (0.8)20 (18.4)<0.0018 (7.2)16 (15.1)0.06
    Cord C-peptide (units)1.2 ± 0.91.4 ± 1.50.061.1 ± 0.71.4 ± 1.80.061.3 ± 1.01.3 ± 1.00.48
    Cord C-peptide >95th percentile35 (14.8)48 (22.4)0.0415 (12.0)25 (22.3)0.0320 (17.9)23 (22.6)0.39
    Size for gestational age0.0030.0030.35
     Small16 (6.1)9 (3.8)10 (7.1)4 (3.3)6 (4.8)5 (4.4)
     Appropriate231 (87.5)189 (80.4)123 (87.9)95 (79.2)108 (87.1)94 (81.7)
     Large17 (6.4)37 (15.7)7 (5.0)21 (17.5)10 (8.1)16 (13.9)
    • Data are mean ± SD and n (%).

    • ↵† Based on the χ2 or Fisher exact test for categorical variables and Wilcoxon rank sum test for continuous variables.

  • Table 3

    Follow-up outcomes (binomial) by mild GDM treatment group, overall and by sex

    OutcomeOverallMaleFemale
    TreatedUntreatedAdjusted RR (95% CI)*TreatedUntreatedAdjusted RR (95% CI)*TreatedUntreatedAdjusted RR (95% CI)*
    BMI ≥95th percentile for age and sex55 (20.8)54 (22.9)0.94 (0.68–1.28)35 (25.0)30 (24.8)1.04 (0.70–1.55)20 (16.1)24 (20.9)0.79 (0.48–1.33)
    BMI ≥85th percentile for age and sex86 (32.6)91 (38.6)0.88 (0.71–1.10)49 (35.0)46 (38.0)0.94 (0.70–1.27)37 (29.8)45 (39.1)0.81 (0.59–1.13)
    Waist circumference >90th percentile for age, sex, and race/ethnicity31 (11.7)27 (11.4)1.05 (0.65–1.69)18 (12.9)15 (12.4)1.06 (0.56–2.00)13 (10.5)12 (10.4)1.02 (0.49–2.13)
    Impaired fasting glucose ≥100 mg/dL†12 (5.7)13 (7.2)0.76 (0.36–1.62)9 (8.4)2 (2.2)3.50 (0.78–15.7)3 (2.9)11 (12.1)0.24 (0.07–0.82)‡
    Elevated triglycerides ≥100 mg/dL 4–9 years; ≥130 mg/dL 10 years38 (18.2)29 (16.0)1.11 (0.71–1.72)18 (16.8)11 (12.2)1.31 (0.66–2.62)20 (19.6)18 (19.8)0.99 (0.56–1.75)
    Low HDL cholesterol <40 mg/dL27 (13.0)22 (12.2)1.03 (0.61–1.76)13 (12.2)8 (8.9)1.31 (0.57–3.00)14 (13.9)14 (15.4)0.88 (0.45–1.73)
    Hypertension ≥95th percentile or age, sex, and height30 (11.5)23 (9.8)1.23 (0.74–2.05)20 (14.7)13 (10.7)1.41 (0.74–2.71)10 (8.1)10 (8.7)0.97 (0.42–2.23)
    • Data are n (%) unless otherwise indicated. RR, relative risk.

    • ↵* All models adjusted for race/ethnicity and log maternal baseline BMI, except waist circumference >90th percentile for age, sex, and race/ethnicity was adjusted only for log maternal baseline BMI. The data presented by child sex are based on multivariable adjusted models that included treatment group, sex, and a treatment group-by-sex interaction term.

    • ↵† P = 0.007 for interaction between treatment group and sex.

    • ↵‡ P = 0.02.

  • Table 4

    Follow-up outcomes (continuous) by mild GDM treatment group, overall and by sex

    Adjusted mean (95% CI)
    Overall MaleFemale
    OutcomeTreatedUntreatedTreatedUntreatedTreatedUntreated
    BMI z score based on BMI percentile for age and sex0.33 (0.15–0.51)0.36 (0.17–0.55)0.36 (0.12–0.60)0.34 (0.09–0.60)0.30 (0.05–0.56)0.37 (0.10–0.64)
    Waist circumference (cm)*57.28 (56.30–58.27)57.56 (56.54–58.60)57.69 (56.40–59.02)58.02 (56.65–59.43)56.87 (55.52–58.26)57.10 (55.68–58.57)
    Fasting glucose (mg/dL)†88.41 (87.33–89.50)88.67 (87.56–89.78)89.64 (88.25–91.04)87.71 (86.25–89.18)87.11 (85.65–88.57)89.62 (88.12–91.12)‡
    HOMA-IR*§||1.05 (0.94–1.17)1.10 (0.99–1.24)1.06 (0.92–1.22)0.95 (0.81–1.10)1.05 (0.90–1.22)1.30 (1.11–1.52)¶
    Triglycerides (mg/dL)*58.91 (54.82–63.30)57.38 (53.33–61.73)57.99 (52.83–63.67)54.85 (49.73–60.51)60.15 (54.57–66.31)60.20 (54.45–66.56)
    HDL cholesterol (mg/dL)54.35 (52.42–56.28)55.10 (53.16–57.05)55.06 (52.60–57.53)56.65 (54.05–59.26)53.42 (50.81–56.04)53.43 (50.77–56.09)
    Systolic BP (mmHg)100 (98–101)100 (98–101)101 (99–103)100 (98–102)99 (97–101)99 (97–101)
    Diastolic BP (mmHg)60 (59–61)59 (58–60)60 (59–62)60 (59–62)61 (59–62)58 (57–60)¶
    • All models adjusted for race/ethnicity and log maternal baseline BMI; log waist circumference also adjusted for child’s sex (overall model) and child’s age in months; log triglycerides also adjusted for child’s age in months; and systolic and diastolic BPs also adjusted for child’s sex (overall model), child’s age in months, and child’s height. The data presented by child sex are based on multivariable adjusted models that included treatment group, sex, and a treatment group-by-sex interaction term. BP, blood pressure.

    • ↵*Back transformation of the log value.

    • ↵†P = 0.002 for interaction between treatment group and sex.

    • ↵‡P = 0.01.

    • ↵§Calculated as (fasting glucose [mmol/L] × fasting insulin [μU/mL]) / 22.5 (20).

    • ↵||P = 0.02 for interaction between treatment group and sex.

    • ↵¶P = 0.04.

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Mild Gestational Diabetes Mellitus and Long-Term Child Health
Mark B. Landon, Madeline Murguia Rice, Michael W. Varner, Brian M. Casey, Uma M. Reddy, Ronald J. Wapner, Dwight J. Rouse, Joseph R. Biggio, John M. Thorp, Edward K. Chien, George Saade, Alan M. Peaceman, Sean C. Blackwell, J. Peter VanDorsten
Diabetes Care Mar 2015, 38 (3) 445-452; DOI: 10.2337/dc14-2159

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Mild Gestational Diabetes Mellitus and Long-Term Child Health
Mark B. Landon, Madeline Murguia Rice, Michael W. Varner, Brian M. Casey, Uma M. Reddy, Ronald J. Wapner, Dwight J. Rouse, Joseph R. Biggio, John M. Thorp, Edward K. Chien, George Saade, Alan M. Peaceman, Sean C. Blackwell, J. Peter VanDorsten
Diabetes Care Mar 2015, 38 (3) 445-452; DOI: 10.2337/dc14-2159
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