| ObjectivesTo explore the effect of gestational diabetes mullitus（GDM）on the physical development and insulin resistance of 3-year-old offspring.MethodsMothers and their progeny who were hospitalized by cesarean section or gave natural birth in Anhui Province Maternal and Child Health Care Hospital Linquan Hospital,Jan01,2018 to December 31,2018,and met the enrollment criteria were selected（GDM group included 149 mother-child pairs,Normal control group included 385 mother-child pairs）,and contact them by telephone,after obtaining the consent,tell them of the matters needing attention when coming to the hospital,and the guardian shall lead the children to the hospital within the agreed time,informed consent were signed.Professional trained medical staff performed physical measurement,and tested fasting blood glucose and fasting insulin（GDM group included 52 mother-child pairs,Normal control group included 52 mother-child pairs）,in addition,the results of previous oral glucose tolerance experiments,blood glucose control method during pregnancy,blood glucose monitoring data,maternal height,pregestational weight,prenatal weight,pregnancy history,delivery record（birth mode,pregnancy week,weight,gender,Apgar score）,feeding history,vaccination history and other data were improved,furthermore,previous physical examination data of offspring were collected and recorded on the Fuyang Maternal and Child Health Information Platform and in the physical examination manual.The information obtained was filled into the structured questionnaire.Differences in physical indicators,blood glucose and insulin resistance status between GDM and normal control group of the offspring were compare.Logistic regression analysis was used to analyse related risk factors in developing overweight or obesity of offspring.ResultsPart I1.GDM group’s maternal pregestational BMI was 22.8（21.2,26.5）Kg/m~2,offspring birth weight was 3700.0（3400.0,4100.0）g,proportion of overweight and obesity at 36months of age was 33.9%,and those are higher than in normal control group whose maternal pregestational BMI was 20.9（19.5,23.1）Kg/m~2,offspring birth weight was3400.0（3155.0,3600.0）g,proportion of overweight or obesity at 36 months of age was 14.5%.the difference between two groups was significant（all P<0.05）.Weight gain during pregnancy in GDM group was 15.0（12.0,19.0）Kg,weight gain during pregnancy in normal control groups was 15.0（13.0,18.0）Kg,and there was no significant difference between two groups（P>0.05）.2.In the physical measurements of offspring at age of 42 days,12 months,24months,36 months,GDM group weighed 4.9（4.5,5.3）Kg at age of 42 days,10.0（9.2,10.6）Kg at age of 12 months,12.8（11.9,13.5）Kg at age of 24 months,and 15.5（14.0,16.5）Kg at age of 36 months,and the height was 88.0（86.0,90.0）cm at age of 24 months,BMI was 15.9（15.1,17.3）Kg/m~2at age of 36 months.Normal control group weighed4.8（4.5,5.0）Kg at age of 42 days,9.8（9.2,10.3）Kg at age of 12 months,12.2（11.5,13.0）Kg at age of 24 months,and 14.5（13.5,15.5）Kg at age of 36 months,and the height was87.5（85.8,89.0）cm at age of 24 months,BMI was 15.7（14.9,16.4）Kg/m~2at age of 36months.Indicators above were all higher in GDM group than in normal control group,and the differences between two groups were significant（all P<0.05）.3.During the physical examination at 36 months of age,the weight of boys in GDM group was 15.6（14.0,16.8）Kg,BMI was 15.9（15.4,17.3）Kg/m~2.The weight of boys in normal control group was 14.8（13.8,15.6）Kg,BMI was 15.7（14.8,16.5）Kg/m~2,and differences between the two groups were significant（all P<0.05）.The weight of girls in GDM group was 15.4（14.0,16.0）Kg,BMI was 16.2（14.9,17.1）Kg/m~2.The weight of girls in normal control group was 14.4（13.4,15.4）Kg,BMI was 15.6（14.9,16.4）Kg/m~2,and differences between the two groups were significant（all P<0.05）.4.Prepregnancy obesity（OR=2.581,95%CI:1.199-5.557,P<0.05）,maternal GDM（OR=2.309,95%CI:1.296-4.115,P<0.05）are independant risk factors for developing overweight or obesity in 36-month-old progeny.Part II1.Prepregnancy weight（62.0（55.3,71.8）Kg）,prepregnancy BMI（23.4（21.5,27.2）Kg/m~2）,birth weight of fetus（3700.0（3400.0,4100.0）g）,cesarean section rate（42.3%）in GDM group were higher than those in normal control group(prepregnant weight（56.0（50.5,62.3）Kg）,prepregnancy BMI（21.5（19.5,23.5）Kg/m~2）,birth weight of fetus（3400.0（3162.5,3600.0g）,rate of cesarean section（21.2%））,and the differences were significant（all P<0.05）.The rate of overweight or obesity at 36 months of age（26.9%）was higher than that in normal control group（11.5%）,which was statistically significant（P=0.047）.2.Offspring’s weight at 36 months of age was（15.4±2.2）Kg,BMI was16.0（15.4,16.9）Kg/m~2,upper arm circumference was（16.7±1.2）cm,waist circumference was（51.2±3.0）cm,sum of fold thicknesses was（15.6±3.4）mm in GDM group.Weight at 36 months of age was（14.2±1.5）Kg,BMI was 15.5（4.6,16.3）Kg/m~2,upper arm circumference was（13.6±3.0）cm,waist circumference was（50.0±2.4）cm,sum of fold thicknesses was（15.6±3.4）mm in normal control group.The differences between groups were significant（all P<0.05）.Fasting blood glucose at 36 months of age was（4.9±0.4）mmol/L,insulin resistance index was 0.6（0.5,1.2）in GDM group.Fasting blood glucose at 36 months of age was（4.7±0.3）mmol/L,insulin resistance index was 0.62（0.5,0.8）in normal control group,and there were no significant differences between the groups（all P>0.05）.3.Offspring BMI at 36 months of age in group which were non-obesity before pregnancy was 15.7（14.7,16.7）Kg/m~2,upper arm circumference was（16.1±1.3）cm,waist circumference was 50.0（48.6,51.8）cm,left subscapular skin fold thickness was 6.6（6.0,7.4）mm,sum of thicknesses was 14.1（12.5,5.6）mm.Offspring BMI at 36 months of age in pre-pregnancy obesity group was 16.4（15.5,18.0）Kg/m~2,upper arm circumference was（17.1±1.0）cm,waist circumference was 52.8（50.8,54.0）cm,left subscapular skin fold thickness was 7.9（7.0,9.0）mm,sum of thicknesses was 16.7（14.5,18.9）mm,and differences between groups were significant（all P<0.05）.Fasting blood glucose in group which were non-obesity before pregnancy was（4.8±0.4）mmol/L,insulin resistance index was 0.6（0.5,0.9）,Fasting blood glucose in pre-pregnancy obesity group was（4.8±0.3）mmol/L,insulin resistance index was 0.7（0.4,1.2）,and there were no significant differences between the groups（all P>0.05）.4.There are no differences of the effect between boys and girls who were GDM exposed in physical measurement,level of fasting blood glucose and insulin resistance（all P>0.05）5.For normal weight offspring,the upper arm circumference in GDM group was（16.6±1.1）cm,sum of skinfold thicknesses was（15.0±2.9）mm,maternal prepregnancy BMI was 23.2（21.0,26.8）Kg/m~2.The upper arm circumference in normal control group was（15.6±1.1）cm,sum of skinfold thicknesses was（13.1±2.4）mm,maternal prepregnancy BMI was 21.5（19.5,22.7）Kg/m~2,and differences between groups were significant（all P<0.05）.The BMI of the GDM group was 15.7（14.8,16.3）Kg/m~2,fasting blood glucose was（4.8±0.4）mmol/L,and insulin resistance index was 0.6（0.4,1.2）.The BMI of 36 months of normal control offspring was 15.3（14.6,15.9）Kg/m~2,fasting blood glucose was（4.8±0.3）mmol/L,and insulin resistance index was 0.6（0.5,0.7）,and there were no significant differences between groups（all P>0.05）.Conclusions1.The differences of offspring’s BMI between GDM and normal pregnancy did not appear until age of 3 years,but the differences between weight consistently persisted.2.Maternal GDM and prepregnancy obesity were independent risk factors for overweight or obesity in 3-year-old offspring,and increased abdominal fat accumulation.3.Intrauterine exposure to GDM did not increase fasting glucose and insulin resistance risk in the progeny at the age of 3 years. |
PDF Full Text Request