Gestational Glucose Intolerance and Risk of Obesity in Childhood and Adolescence.

Objective: An association between in utero exposure to gestational glucose intolerance ([GGI], abnormal glucose screening without gestational diabetes), and offspring obesity has not been consistently observed.

Methods: In a retrospective cohort, we studied the risk of obesity (body mass index [BMI] > 95th percentile), in 2-5, 6-10, and 11-18-year-olds exposed to varying degrees of maternal glycemia in utero: normal glucose tolerance (NGT), GGI (0 abnormal glucose values, GGI-0, or 1 abnormal value, GGI-1) or gestational diabetes (GDM >2 of 4 abnormal values). We used generalized estimating equations for logistic regression to estimate odds ratios for obesity in each glycemic category compared to NGT, adjusting for maternal age, parity, insurance, race/ethnicity, marital status, infant sex, gestational age, and gestational weight gain. A second model additionally adjusted for maternal 1st trimester BMI.

Results: We included 27,876 children and adolescents from 23,334 (83.7%) NGT pregnancies, 3,413 (12.2%) GGI pregnancies, and 1,129 (4.1%) GDM pregnancies. The prevalence of obesity was 13.5% at age 2-5, 20.3% at age 6-10, and 23.4% at age 11-18. Those exposed to GGI-1 and GDM had increased odds of obesity compared to NGT. Adjusting for maternal BMI attenuated this association in all age and glycemic exposure groups, but it remained significantly elevated in 6-10-year-olds exposed to GDM (odds ratio (OR): 1.21, 95%CI [1.01, 1.46] and 11-18-year-olds exposed to GGI-1 and GDM (GGI-1 OR: 1.44 [1.14, 1.81]; GDM OR: 1.28 [1.03, 1.59]).

Conclusion: Older children and adolescents exposed to GGI-1 and GDM in utero have a higher risk of obesity than those born to NGT pregnancies, even after accounting for maternal BMI.