Third-Trimester Hyperglycemia Linked to Obesity Risk in Offspring: Study
A 40-year study published in Pregnancy has revealed that elevated glucose levels in the third trimester of insulin-dependent diabetic pregnancies are associated with a higher risk of obesity in adult offspring. Among 161 adults studied, those born to mothers with poor glucose control had increased BMI and fat mass, underscoring the critical importance of managing maternal glucose in late pregnancy to support long-term health of the child.
Limited data are available to describe the long-term implications of pre-pregnancy diabetes on offspring body composition in adulthood. The objective of this study was to examine the association between maternal glucose control and variation throughout pregnancy and long-term obesity in offspring. A second objective was to identify the critical windows of gestational exposure most related to the development of long-term obesity. This cohort study included offspring of women with insulin-dependent diabetes (IDDM) who participated in the Diabetes in Pregnancy Program Project Grant (PPG) between 1978 and 1995 to evaluate the long-term implications of in utero glucose exposure. Offspring completed a comprehensive study visit which included measures of height and weight, and measures from dual-energy X-ray absorptiometry. The exposure was maternal glucose control as measured by glycohemoglobin A1 concentration (where HbA1 was represented as standard deviation units from the mean for the laboratory HBA1SD), and blood glucose level and variation across pregnancy, and by trimester, characterized using functional principal components (fPC). Outcomes were adult offspring BMI (kg/m2), as well as visceral and whole-body fat. Results: A total of 161 offspring completed a study visit. Mean offspring age at follow-up was 32.3 years (± 4.6), 50.3% were female and 17.4% identified as Black. After adjustment for covariates (maternal age, education, family history of diabetes, diabetes severity, and BMI at last menstrual period), third-trimester maternal HbA1SD was significantly associated with offspring adiposity measures including BMI, BMI ≥ 30 kg/m2, and visceral and whole-body fat mass and percentage. The third-trimester fPC representing variability of glucose demonstrated a consistent positive association with obesity outcomes but did not reach statistical significance in adjusted models. The findings corroborate that the third trimester is a critical window of exposure associated with offspring adiposity. Specifically, higher levels of third-trimester maternal glycohemoglobin A1 is a risk factor for obesity in the adult offspring of IDDM mothers. Additionally, results suggest that glucose variability may increase the risk for obesity in the adult offspring.
Reference:
Bowers, K., Bhoopathy, K., Szczesniak, R., Ehrlich, S., Dolan, L.M., Kalkwarf, H., Summer, S., Smith, E., Altaye, M., Ollberding, N.J., Catalano, P., Miodovnik, M. and Khoury, J.C. (2025), Timing and Variability of Maternal Hyperglycemia in Insulin-Dependent Diabetes, Long-Term Effects on Offspring Obesity—The TEAM Study. Pregnancy, 1: e70048. https://doi.org/10.1002/pmf2.70048
Keywords:
Third-Trimester, Hyperglycemia, Linked, Obesity, Risk, Offspring, Study, Bowers, K., Bhoopathy, K., Szczesniak, R., Ehrlich, S., Dolan, L.M., Kalkwarf, H., Summer, S., Smith, E., Altaye, M., Ollberding, N.J., Catalano, P., Miodovnik, M. and Khoury, J.C, Pregnancy
