The effect of maternal diabetes on pre- and postnatal growth

Abstract

Background and objective: The abnormal intrauterine environment in case of maternal diabetes results in impaired perinatal outcome. In this thesis we investigated factors that were related to altered fetal growth and growth during childhood. Methods: A cohort of women with pregnancies complicated by type 1 (DM1), type 2 (DM2) and gestational diabetes mellitus (GDM) who received prenatal care in the University Medical Center Utrecht and delivered there between 1990 and 2010 were included. Antenatal ultrasound data was retrieved from patient records; postnatal and height and weight for offspring of these mothers were retrieved from infant welfare centers after informed consent was received. Additionally, parents were invited to complete a questionnaire regarding lifestyle and eating habits of their children. Results: Screening for GDM around 24-28 weeks of gestation results in a better perinatal outcome than waiting for symptoms and should therefore be the method of choice. Disproportionate fetal growth (abdominal circumference larger than the fetal head (HC/AC ratio)) is found al all fetuses of mothers with all 3 types of diabetes; even in the ones with a normal birthweight, which illustrates the effect of the abnormal intrauterine environment on fetal growth. Disproportionate growth (HC/AC ratio) is correlated to the body mass index (BMI) in 4-5 year-old toddlers of women with DM1 only. In offspring from DM2 or GDM, birthweight is correlated to the BMI at these ages, but not disproportionate intra-uterine growth. Mothers with DM2 had the highest BMI, so did their toddlers. Apparently in DM2 maternal obesity is an important driving factor for childhood obesity, whereas specific effects of the altered intrauterine glucose homeostasis are only present in offspring from mothers with DM1 (ODM1). Growth trajectories of the infants until 14 years showed that being large-for-gestational age at birth or having an obese mother (mainly DM2) are related to childhood overgrowth. Offspring of mothers with DM2 (ODM2) had a BMI at 14 years that was almost 2 SD above that of the Dutch background population. Finally, lifestyle differences were found between offspring of the different types of maternal diabetes: ODM2 show a less healthy diet and lifestyle compared to ODM1 and OGDM. This may play an additional role in their higher incidence of obesity. Conclusion: Infants of women with diabetes have an altered intrauterine development, are frequently large-for-gestational age at birth and are more likely to become overweight/obese during childhood. The most important risk factors for childhood obesity were, maternal overweight, being born large-for-gestational age and inadequate diet/lifestyle during childhood. These findings enable targeted preventive strategies.