The impact of pregnancy weight and glucose on the metabolic health of mother and child in the south west of the UK

Objective: to explore relationships between maternal pre-pregnancy Weight, third trimester glucose, baby birth weight, weight and metabolic health of the mother and children 5 years after birth. Design: an observational study set within a non-intervention, longitudinal cohort study looking at insulin resistance in children. Setting: a teaching hospital in the south west of the United Kingdom. Participant: 300 mothers and their five-year-old children from randomly selected Plymouth schools, stratified according to socioeconomic status. Measurements: were obtained from obstetric records maternal pre-pregnant weight, random and fasting third trimester blood glucose, baby birth weight. Five years later the following measurements were made of the mother and child: height, weight, glucose and insulin resistance. Findings: five years after the pregnancy, 33% of the mothers were overweight, with an additional 19% obese. In the children 13% of boys were overweight (4% obese), and in the girls, 26% were overweight (5% obese). In, the five-year-old children, Weight (r = 0.28, p<0,001) but not birth weight (r = 6.03, p = 0.573), correlated with insulin resistance. Maternal pre-pregnant weight was. related to both random and fasting third trimester glucos and to insulin resistance 5 years later. Third trimester fasting glucose, even within a normal range, was a better predictor than random glucose of the baby's birth weight (r = 0.39, p = 0.044) and the mother's future insulin resistance (r = 0.67, p<0.001). No maternal measures predicted insulin resistance in the child at 5 years. Conclusions: maternal weight had an important influence on the gestational environment, and predicted insulin resistance 5 years Later. Fasting glucose, even within the reference range, was a better predictor than random glucose of the baby's birth weight and the mother's future insulin resistance. Implications for practice: these concern the importance of pre-conception weight management, and support replacement of routine random glucose sampling during the third trimester with an earlier, fasting measurement. (C) 2004 Elsevier Ltd. All rights reserved.