Maternal and Child Health Journal

, Volume 16, Issue 1, pp 125–132 | Cite as

Gestational Diabetes and Subsequent Growth Patterns of Offspring: The National Collaborative Perinatal Project

  • Kesha Baptiste-RobertsEmail author
  • Wanda K. Nicholson
  • Nae-Yuh Wang
  • Frederick L. Brancati


Our objective was to test the hypothesis that intrauterine exposure to gestational diabetes [GDM] predicts childhood growth independent of the effect on infant birthweight. We conducted a prospective analysis of 28,358 mother-infant pairs who enrolled in the National Collaborative Perinatal Project between 1959 and 1965. The offspring were followed until age 7. Four hundred and eighty-four mothers (1.7%) had GDM. The mean birthweight was 3.2 kg (range 1.1–5.6 kg). Maternal characteristics (age, education, race, family income, pre-pregnancy body mass index and pregnancy weight gain) and measures of childhood growth (birthweight, weight at ages 4, and 7) differed significantly by GDM status (all P < 0.05). As expected, compared to their non-diabetic counterparts, mothers with GDM gave birth to offspring that had higher weights at birth. The offspring of mothers with GDM were larger at age 7 as indicated by greater weight, BMI and BMI z-score compared to the offspring of mothers without GDM at that age (all P < 0.05). These differences at age 7 persisted even after adjustment for infant birthweight. Furthermore, the offspring of mothers with GDM had a 61% higher odds of being overweight at age 7 compared to the offspring of mothers without GDM after adjustment for maternal BMI, pregnancy weight gain, family income, race and birthweight [OR = 1.61 (95%CI:1.07, 1.28)]. Our results indicate that maternal GDM status is associated with offspring overweight status during childhood. This relationship is only partially mediated by effects on birthweight.


Gestational diabetes Childhood growth Body mass index 



The authors are supported by the National Institutes of Health. KBR received support from the National Heart, Lung and Blood Institute (T32-HL07024). WKN received support from the National Institute for Diabetes and Digestive and Kidney Diseases (K23-DK067944), NW received support by National Institutes of Health (UL1 RR025005) & (P60 DK79637), FLB is supported by the National Institute for Diabetes and Digestive and Kidney Diseases (K24-DK6222) & (P60 DK79637).


  1. 1.
    Barker, D. J., Bull, A. R., Osmond, C., & Simmonds, S. J. (1990). Fetal and placental size and risk of hypertension in adult life. BMJ, 301, 259–262.PubMedCrossRefGoogle Scholar
  2. 2.
    Phillips, D. I., Barker, D. J., Hales, C. N., Hirst, S., & Osmond, C. (1994). Thinness at birth and insulin resistance in adult life. Diabetologia, 37, 150–154.PubMedCrossRefGoogle Scholar
  3. 3.
    Barker, D. J., Martyn, C. N., Osmond, C., Hales, C. N., & Fall, C. H. (1993). Growth in utero and serum cholesterol concentrations in adult life. BMJ, 307, 1524–1527.PubMedCrossRefGoogle Scholar
  4. 4.
    Barker, D. J., Winter, P. D., Osmond, C., Margetts, B., & Simmonds, S. J. (1989). Weight in infancy and death from ischaemic heart disease. Lancet, 2, 577–580.PubMedCrossRefGoogle Scholar
  5. 5.
    Barker, D. J., Osmond, C., & Law, C. M. (1989). The intrauterine and early postnatal origins of cardiovascular disease and chronic bronchitis. Journal of Epidemiology and Community Health, 43, 237–240.PubMedCrossRefGoogle Scholar
  6. 6.
    Barker, D. J. (1995). Fetal origins of coronary heart disease. BMJ, 311, 171–174.PubMedCrossRefGoogle Scholar
  7. 7.
    Wells, J. C. (2009). Historical cohort studies and the early origins of disease hypothesis: Making sense of the evidence. Proceedings of the Nutrition Society, 68, 179–188.PubMedCrossRefGoogle Scholar
  8. 8.
    Huang, J. S., Lee, T. A., & Lu, M. C. (2007). Prenatal programming of childhood overweight and obesity. Maternal and Child Health Journal, 11, 461–473.PubMedCrossRefGoogle Scholar
  9. 9.
    Ravelli, A. C., Der Meulen, J. H., Osmond, C., Barker, D. J., & Bleker, O. P. (1999). Obesity at the age of 50 y in men and women exposed to famine prenatally. American Journal of Clinical Nutrition, 70, 811–816.PubMedGoogle Scholar
  10. 10.
    Ravelli, A. C., van der Meulen, J. H., Osmond, C., Barker, D. J., & Bleker, O. P. (2000). Infant feeding and adult glucose tolerance, lipid profile, blood pressure, and obesity. Archives of Disease in Childhood, 82, 248–252.PubMedCrossRefGoogle Scholar
  11. 11.
    Remacle, C., Bieswal, F., & Reusens, B. (2004). Programming of obesity and cardiovascular disease. International Journal of Obesity and Related Metabolic Disorders, 28(Suppl 3), S46–S53.PubMedCrossRefGoogle Scholar
  12. 12.
    Rogers, I. (2003). The influence of birthweight and intrauterine environment on adiposity and fat distribution in later life. International Journal of Obesity and Related Metabolic Disorders, 27, 755–777.PubMedCrossRefGoogle Scholar
  13. 13.
    Diagnosis and classification of diabetes mellitus. (2010) Diabetes Care 33 (Suppl 1):S62–S69.Google Scholar
  14. 14.
    Dabelea, D., Snell-Bergeon, J. K., Hartsfield, C. L., Bischoff, K. J., Hamman, R. F., & McDuffie, R. S. (2005). Increasing prevalence of gestational diabetes mellitus (GDM) over time and by birth cohort: Kaiser permanente of Colorado GDM screening program. Diabetes Care, 28, 579–584.PubMedCrossRefGoogle Scholar
  15. 15.
    Jovanovic, L., & Pettitt, D. J. (2001). Gestational diabetes mellitus. JAMA, 286, 2516–2518.PubMedCrossRefGoogle Scholar
  16. 16.
    Getahun, D., Nath, C., Ananth, C. V., Chavez, M. R., & Smulian, J. C. (2008). Gestational diabetes in the United States: Temporal trends 1989 through 2004. American Journal of Obstetrics and Gynecology, 198, 525.PubMedCrossRefGoogle Scholar
  17. 17.
    Silverman, B. L., Rizzo, T., Green, O. C., et al. (1991). Long-term prospective evaluation of offspring of diabetic mothers. Diabetes, 40(Suppl 2), 121–125.PubMedGoogle Scholar
  18. 18.
    Whitaker, R. C., Pepe, M. S., Seidel, K. D., Wright, J. A., & Knopp, R. H. (1998). Gestational diabetes and the risk of offspring obesity. Pediatrics, 101, E9.PubMedCrossRefGoogle Scholar
  19. 19.
    Metzger, B. E., Lowe, L. P., Dyer, A. R., et al. (2008). Hyperglycemia and adverse pregnancy outcomes. New England Journal of Medicine, 358, 1991–2002.PubMedCrossRefGoogle Scholar
  20. 20.
    Hillier, T. A., Pedula, K. L., Schmidt, M. M., Mullen, J. A., Charles, M. A., & Pettitt, D. J. (2007). Childhood obesity and metabolic imprinting: The ongoing effects of maternal hyperglycemia. Diabetes Care, 30, 2287–2292.PubMedCrossRefGoogle Scholar
  21. 21.
    Schaefer-Graf, U. M., Pawliczak, J., Passow, D., et al. (2005). Birth weight and parental BMI predict overweight in children from mothers with gestational diabetes. Diabetes Care, 28, 1745–1750.PubMedCrossRefGoogle Scholar
  22. 22.
    Plagemann, A., Harder, T., Melchior, K., Rake, A., Rohde, W., & Dorner, G. (1999). Elevation of hypothalamic neuropeptide Y-neurons in adult offspring of diabetic mother rats. Neuroreport, 10, 3211–3216.PubMedCrossRefGoogle Scholar
  23. 23.
    Plagemann, A., Harder, T., Janert, U., et al. (1999). Malformations of hypothalamic nuclei in hyperinsulinemic offspring of rats with gestational diabetes. Developmental Neuroscience, 21, 58–67.PubMedCrossRefGoogle Scholar
  24. 24.
    Gillman, M. W., Rifas-Shiman, S., Berkey, C. S., Field, A. E., & Colditz, G. A. (2003). Maternal gestational diabetes, birth weight, and adolescent obesity. Pediatrics, 111, e221–e226.PubMedCrossRefGoogle Scholar
  25. 25.
    Krishnaveni, G. V., Veena, S. R., Hill, J. C., Kehoe, S., Karat, S. C., & Fall, C. H. (2010). Intrauterine exposure to maternal diabetes is associated with higher adiposity and insulin resistance and clustering of cardiovascular risk markers in Indian children. Diabetes Care, 33, 402–404.PubMedCrossRefGoogle Scholar
  26. 26.
    Lawlor, D. A., Fraser, A., Lindsay, R. S., et al. (2010). Association of existing diabetes, gestational diabetes and glycosuria in pregnancy with macrosomia and offspring body mass index, waist and fat mass in later childhood: Findings from a prospective pregnancy cohort. Diabetologia, 53, 89–97.PubMedCrossRefGoogle Scholar
  27. 27.
    Vaarasmaki, M., Pouta, A., Elliot, P., et al. (2009). Adolescent manifestations of metabolic syndrome among children born to women with gestational diabetes in a general-population birth cohort. American Journal of Epidemiology, 169, 1209–1215.PubMedCrossRefGoogle Scholar
  28. 28.
    Wright, C. S., Rifas-Shiman, S. L., Rich-Edwards, J. W., Taveras, E. M., Gillman, M. W., & Oken, E. (2009). Intrauterine exposure to gestational diabetes, child adiposity, and blood pressure. American Journal of Hypertension, 22, 215–220.PubMedCrossRefGoogle Scholar
  29. 29.
    Niswander, K. R., & Gordon, M. (1972). The women and their pregnancies (NIH) (pp 73–379). Washington, DC: US Government Printing Office, US Department of Health, Education and Welfare.Google Scholar
  30. 30.
    Hamill, P. V., Drizd, T. A., Johnson, C. L., Reed, R. B., & Roche, A. F. (1977). NCHS growth curves for children birth-18 years. United States. Vital Health Stat 11 i–74.Google Scholar
  31. 31.
    Pettitt, D. J., Knowler, W. C., Bennett, P. H., Aleck, K. A., & Baird, H. R. (1987). Obesity in offspring of diabetic Pima Indian women despite normal birth weight. Diabetes Care, 10, 76–80.PubMedCrossRefGoogle Scholar
  32. 32.
    Catalano, P. M., Thomas, A., Huston-Presley, L., & Amini, S. B. (2003). Increased fetal adiposity: A very sensitive marker of abnormal in utero development. American Journal of Obstetrics and Gynecology, 189, 1698–1704.PubMedCrossRefGoogle Scholar
  33. 33.
    Dabelea, D., Hanson, R. L., Lindsay, R. S., et al. (2000). Intrauterine exposure to diabetes conveys risks for type 2 diabetes and obesity: a study of discordant sibships. Diabetes, 49, 2208–2211.PubMedCrossRefGoogle Scholar
  34. 34.
    Gillman, M. W., Oakey, H., Baghurst, P. A., Volkmer, R. E., Robinson, J. S., & Crowther, C. A. (2010). Effect of treatment of gestational diabetes on obesity in the next generation. Diabetes Care, 33, 964–968.Google Scholar
  35. 35.
    Weiss, P. A., Scholz, H. S., Haas, J., Tamussino, K. F., Seissler, J., & Borkenstein, M. H. (2000). Long-term follow-up of infants of mothers with type 1 diabetes: evidence for hereditary and nonhereditary transmission of diabetes and precursors. Diabetes Care, 23, 905–911.PubMedCrossRefGoogle Scholar
  36. 36.
    Dempsey, J. C., Sorensen, T. K., Williams, M. A., et al. (2004). Prospective study of gestational diabetes mellitus risk in relation to maternal recreational physical activity before and during pregnancy. American Journal of Epidemiology, 159, 663–670.PubMedCrossRefGoogle Scholar
  37. 37.
    Cheung, N. W., Smith, B. J., Henriksen, H., Tapsell, L. C., McLean, M., & Bauman, A. (2007). A group-based healthy lifestyle program for women with previous gestational diabetes. Diabetes Research and Clinical Practice, 77, 333–334.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Kesha Baptiste-Roberts
    • 1
    • 2
    Email author
  • Wanda K. Nicholson
    • 3
  • Nae-Yuh Wang
    • 4
    • 5
  • Frederick L. Brancati
    • 4
    • 6
  1. 1.School of NursingPenn State UniversityHersheyUSA
  2. 2.Department of Public Health SciencesPenn State University College of MedicineHersheyUSA
  3. 3.Department of Obstetrics & GynecologyUniversity of North CarolinaChapel HillUSA
  4. 4.Department of MedicineJohns Hopkins UniversityBaltimoreUSA
  5. 5.Department of BiostatisticsJohns Hopkins UniversityBaltimoreUSA
  6. 6.Department of EpidemiologyJohns Hopkins UniversityBaltimoreUSA

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