Intrauterine exposure to diabetes is a determinant of hemoglobin A1c and systolic blood pressure in Pima Indian children

Context/Objective: Given the increasing rates of both childhood obesity and type 2 diabetes (T2DM), we investigated whether maternal diabetes status during pregnancy is a determinant of risk factors associated with T2DM or cardiovascular disease in offspring during childhood. Design/Participants: Forty-two Pima Indians, aged 7 - 11 yr, were identified retrospectively from maternal oral glucose tolerance tests as offspring of a diabetic pregnancy ( 22 ODM, eight males, 14 females) or offspring born before the mother developed diabetes ( 20 PRE, 12 males, eight females). Setting/Main Outcome Measures: Weight, height, body mass index, percent body fat, blood pressure, and fasting concentrations of glucose, insulin, hemoglobin A1c (HbA1c), total cholesterol, triglycerides, and high-density lipoprotein-cholesterol were measured while staying in an in-patient clinical research unit and compared in cross-sectional analyses. Results: After adjustment for age and gender, ODM had significantly higher concentrations of HbA1c ( ODM = 5.7 +/- 0.4, PRE = 5.0 +/- 0.4%, P = 0.002), higher systolic (SBP) blood pressure ( ODM = 118 +/- 13, PRE = 107 +/- 10 mm Hg; P = 0.02), and lower concentrations of high-density lipoprotein ( ODM = 41 +/- 9, PRE = 48 +/- 6 mg/dl, P = 0.03) than PRE. Maternal diabetes status during pregnancy persisted as a significant determinant of SBP ( beta = 7.50, P = 0.03) and HbA1c ( beta = 0.43, P = 0.002), independent of age, gender, and percent body fat. Conclusion: Intrauterine exposure to diabetes is a significant determinant of higher SBP and HbA1c during childhood, independent of adiposity and a genetic predisposition to T2DM. These data suggest that in utero exposure to diabetes confers an additional independent risk for the development of T2DM and/or cardiovascular disease later in life.