Obesity and diabetes: the same risk for offspring?

Abstract

Diabetes confers a significantly higher maternal and fetal risk, largely related to the degree of hyperglycemia, but also associated with chronic complications and comorbidities of diabetes. In general, the specific risks of diabetes in pregnancy include miscarriage, fetal anomalies, preeclampsia, stillbirth, macrosomia, neonatal hypoglycemia, hyperbilirubinemia, and neonatal respiratory distress syndrome, among others. Additionally, diabetes in pregnancy can increase the risk of obesity, hypertension, and type 2 diabetes in the offspring later in life.

Pre-pregnancy body mass index (BMI) and weight gain during gestation can have independent and additive effects to hyperglycemia: excessive weight gain is associated with large-for-gestational-age newborns and an increase in insulin requirement. Furthermore, both higher pregestational weight and excessive postpartum weight retention in women with GDM are associated with a higher risk of developing maternal type 2 diabetes in the future.

In a cohort of 15,710 mothers and their children, born in 2011, the risks associated with maternal obesity and gestational diabetes (GDM) and the risk of overweight in children at 2 years were evaluated: mothers with pre-pregnancy obesity had higher rates of excessive weight gain and GDM and were independently associated with a higher risk of childhood overweight at age 2 (OR 2.34). Mothers with GDM had 40% to 49% lower rates of excessive weight gain and were not associated with a higher risk of childhood overweight at age 2 (OR 0.95).

Therefore, education and metabolic control for this group of women should include, in addition to optimal glycemic control, a healthy weight before conception and weight gain during pregnancy. Adequate weight gain should be recommended based on their pre-pregnancy BMI category to reduce the risk of large-for-gestational-age newborns, macrosomia, cesarean deliveries, and childhood overweight.