Persistent effects of in utero overnutrition on offspring adiposity: the Exploring Perinatal Outcomes among Children (EPOCH) study

  • Christine W. HockettEmail author
  • Kylie K. Harrall
  • Brianna F. Moore
  • Anne P. Starling
  • Anna Bellatorre
  • Katherine A. Sauder
  • Wei Perng
  • Ann Scherzinger
  • Kavita Garg
  • Brandy M. Ringham
  • Deborah H. Glueck
  • Dana Dabelea



We previously showed that intrauterine exposure to gestational diabetes mellitus (GDM) increases selected markers of adiposity in pre-pubertal adolescents. In the present study, we examined these associations in adolescence, and explored whether they are strengthened as the participants transition through puberty.


Data from 597 individuals (505 unexposed, 92 exposed) participating in the longitudinal Exploring Perinatal Outcomes among Children (EPOCH) study in Colorado were collected at two research visits when the participants were, on average, 10.4 and 16.7 years old. Adiposity measures included BMI, waist/height ratio, and visceral and subcutaneous adipose tissue (as determined by MRI). Separate general linear mixed models were used to assess the longitudinal relationships between exposure to maternal GDM and each adiposity outcome. We tested whether the effect changed over time by including an interaction term between exposure and age in our models, and whether the associations were explained by postnatal behaviours.


Compared with unexposed participants, those exposed to maternal GDM had higher BMI (β = 1.28; 95% CI 0.35, 2.21; p < 0.007), waist/height ratio (β = 0.03; 95% CI 0.01, 0.04; p = 0.0004), visceral adipose tissue (β = 4.81; 95% CI 1.08, 8.54; p = 0.01) and subcutaneous adipose tissue (β = 35.15; 95% CI 12.43, 57.87; p < 0.003). The magnitude of these differences did not change over time and the associations did not appear to be explained by postnatal behaviours.


Our data provide further evidence that intrauterine exposure to maternal GDM is associated with increased offspring adiposity, an effect that appears early in life and tracks throughout adolescence. Efforts to prevent childhood obesity following intrauterine exposure to maternal GDM should target the prenatal or early life periods.


Fetal programming GDM Maternal diabetes Obesity Puberty SAT VAT 



Exploring Perinatal Outcomes among Children


Gestational diabetes mellitus


Kaiser Permanente of Colorado


Subcutaneous adipose tissue


Tanner stage


Visceral adipose tissue


Waist/height ratio



The authors thank the EPOCH participants, their families and the study staff for their dedicated contribution to this work.

Contribution statement

DD conceptualised and designed the study. CWH and DD conceptualised the research questions, while CWH, DD, KKH, BMR, DHG designed the analyses and KH and CWH conducted the analyses. CWH wrote the first draft of the manuscript. KKH, BFM, APS, AB, KAS, WP, AS, KG, BMR, DHG and DD contributed to the interpretation of the paper and critically reviewed the manuscript for important intellectual content. All authors read and approved the final manuscript. DD is the guarantor of this work.


This work was supported by the NIH National Institute of Diabetes, Digestive, and Kidney Diseases (R01 DK068001), and DHG was supported by the NIH National Institute of General Medical Sciences (R01GM121081, R25GM111901 and R25GM111901-S1). The contents are the authors’ sole responsibility and do not necessarily represent official NIH views. The funders had no role in the design, conduct or reporting of this work.

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Supplementary material

125_2019_4981_MOESM1_ESM.pdf (59 kb)
ESM 1 (PDF 58 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Christine W. Hockett
    • 1
    Email author
  • Kylie K. Harrall
    • 1
  • Brianna F. Moore
    • 1
  • Anne P. Starling
    • 1
    • 2
  • Anna Bellatorre
    • 1
  • Katherine A. Sauder
    • 1
    • 3
  • Wei Perng
    • 1
    • 2
  • Ann Scherzinger
    • 4
  • Kavita Garg
    • 4
  • Brandy M. Ringham
    • 1
  • Deborah H. Glueck
    • 1
    • 3
  • Dana Dabelea
    • 1
    • 2
    • 3
  1. 1.Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) CenterColorado School of Public HealthAuroraUSA
  2. 2.Department of EpidemiologyColorado School of Public HealthAuroraUSA
  3. 3.Department of PediatricsUniversity of Colorado School of MedicineAuroraUSA
  4. 4.Department of RadiologyUniversity of Colorado School of MedicineAuroraUSA

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