Overweight status and intrauterine exposure to gestational diabetes are associated with children's metabolic health

Background: Offspring of women with gestational diabetes (OGD) have greater risk for obesity and impaired metabolic health. Whether impaired metabolic health occurs in the absence of obesity is not clear. Objective: The purpose of this study was to investigate the independent and interactive effects of intrauterine exposure to gestational diabetes and of children's current weight status on their metabolic health. Methods: Children aged 5-10 years (n = 51) with and without intrauterine exposure to gestational diabetes (OGD vs. offspring of non-diabetic women [CTRL]) were grouped into normal weight (body mass index [BMI] < 85th %) and overweight (BMI > 85th %) according to Centers for Disease Control growth curves. Lipid profile was obtained by fasting blood draw, insulin sensitivity (S-I) and secretion by liquid meal tolerance test, and body composition by dual-energy X-ray absorptiometry. Results: Despite similar average BMI percentiles among normal weight OGD versus CTRL, and overweight OGD vs. CTRL, OGD had greater total % fat and trunk fat adjusted for leg fat compared with CTRL (P < 0.05). Overweight children had lower S-I (P < 0.05) and greater basal, static, and total insulin secretion independent of S-I (P < 0.05). OGD was independently associated with greater static insulin secretion (P < 0.05) and the interaction between OGD and overweight was associated with greater basal insulin secretion independent of S-I (P < 0.01). OGD and overweight were each associated with lower high-density lipoprotein-cholesterol (HDL-C) (P < 0.05). Conclusion: Intrauterine exposure to gestational diabetes was associated with greater central adiposity and insulin secretion, and lower HDL-C, irrespective of current weight status. Future research should examine respective contributions of the intrauterine environment and of underlying genotype on children's metabolic health.