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Increase in Gestational Diabetes May Increase Early Diabetes Among Children

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Blood Glucose MeasureAs more women develop gestational diabetes during pregnancy, the number of children who develop diabetes or prediabetes may also increase, suggests a new study published in the journal Diabetologia, the journal of the European Association for the Study of Diabetes.

Gestational diabetes mellitus (GDM) is high blood sugar (diabetes) that occurs during pregnancy. Untreated or poorly controlled gestational diabetes can lead to macrosomia (high birth weight), increases the risk very low blood glucose levels and breathing problems at birth, and increases the risk of obesity and type 2 diabetes later in life. According to the American Diabetes Association, gestation diabetes affects 18 percent of pregnancies. Rates of gestational diabetes have been increasing over the past couple of decades.

For the present study, researchers led by Dr. Sonia Caprio, Yale University School of Medicine, investigated the effects of glucose exposure on the newborn in the womb, at birth and later in life, specifically examining the risk in obese youths of developing impaired glucose tolerance (IGT), or prediabetes, after exposure to GDM in the womb.

Explain the researchers:

“We hypothesised that prenatal exposure to GDM in obese children with normal glucose tolerance (NGT) would be associated with development of altered glucose metabolism over time, driven by an impairment of beta cell secretion relative to the insulin sensitivity.”

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The researchers studied 255 obese adolescents with a normal glucose tolerance. Of the total participants, 210 (82%) were not exposed to gestational diabetes in utero while 45 (18%) were exposed to GDM. Only 18 (9%) participants in the unexposed group developed impaired glucose tolerance or type 2 diabetes. Within the exposed group, 14 (31%) developed either IGT or type 2 diabetes. Both results are statistically significant.

Comment the researchers, “Exposure to GDM was the most significant predictor of developing IGT or type 2 diabetes, with an increased risk of almost six times for those children exposed to GDM in the womb.”

Furthermore, the exposed participants exhibited a reduction in beta cell function, the cells that produce insulin, compared to the unexposed participants.

Explain the researchers:

“Our study demonstrates that obese normal glucose-tolerant children of GDM mothers have pre-existing defects in beta cell function. This is in turn a strong risk factor for these children to develop prediabetes or diabetes. The ever growing number of women with gestational diabetes (18%) suggests that the future will be filled with children with early diabetes at a rate that far exceeds the current prevalence.”

Conclude the researchers:

“Offspring of GDM mothers ought to be screened for IGT and/or impaired fasting glucose (another form of prediabetes), and preventive and therapeutic strategies should be considered before the development of full clinical manifestation of diabetes. While we cannot use this analysis for development of definitive screening guidelines, we strongly suggest that, among obese children and adolescents exposed to GDM, specifically if additional risk factors are present – such as severe obesity or being of ethnicity minorities at higher risk – oral glucose tolerance tests should be performed at baseline (specifically in mid-pubertal adolescents) and potentially repeated based on clinical judgement. Furthermore, the need for studies aimed at unravelling the role of genetic or epigenetic factors and environmental postnatal factors that might be causing functional defects in the beta cell has never been more urgent.”

Women can reduce the risk of gestational diabetes by maintaining a health weigh before and during pregnancy.

References

The increasing number of women with gestational diabetes could lead to many more children with early diabetes: http://www.medicalnewstoday.com/releases/281518.php
A low disposition index in adolescent offspring of mothers with gestational diabetes: a risk marker for the development of impaired glucose tolerance in youth: http://www.diabetologia-journal.org/files/Holder.pdf

Image Credits

Blood Glucose Measure: http://www.freeimages.com/photo/485478

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Written by Heather Johnson

Heather is a writer, librarian, linguist, wife, and mother who loves her husband, children, dogs, and cat. She has a bachelor's degree in English with a minor in creative writing and master's degrees in library and information science and English studies with a concentration in linguistics.

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