Effects of Lifestyle Intervention of Maternal Gestational Diabetes Mellitus on Offspring Growth Pattern Before Two Years of Age

Abstract

Ourgroupconductedapopulation-based randomized controlled trial (RCT) in Tianjin, China, which tested the effectiveness of intensive care (IC) versus usual care (UC) on adverse pregnancy outcomes among womenwith gestational diabetes mellitus (GDM), and found that with IC of GDM during pregnancy a 98-g birth weight reduction and a 34% risk reduction in macrosomia were achieved (1). We further followed offspring born to womenenrolled in theRCT from1month to2yearsafterdelivery to testwhether IC ofGDMduringpregnancymodifiedearlylife growth of offspring born to Chinese women with GDM. The study settings, population, and design have been previously described (1). Briefly, a total of 19,847 pregnant women were screened for GDM with a glucose challenge test between the 24th and 28th weeks of pregnancy, and 2,921 women with a glucose challenge test level $7.8 mmol/L underwent the standardoral glucose tolerance test.Of them, 1,440 women with GDM were identified based on the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria (2) and 706 eligible women were randomized to either IC or UC group and completed the trial. The UC included one group diabetes education session at diagnosis of GDM, while the IC included additional two individualized diabetes education sessions at the 30th and34th gestationalweeks and three group diabetes education sessions at the 27th, 29th, and 33rd gestational weeks. The detailed intervention measures have been previously published (1). Postpartum, 706 childrenborn to the706 women (IC 344 vs. UC 362) were invited to participate in the follow-up study, and 671children (IC324vs.UC347) turnedup at least once for the follow-up study (an overall follow-up rate of 95%) from 1– 24 months of age. Ethics of this study were approved by the Clinical Ethics Committee of Tianjin Women and Children’s Health Center, and informed written consent was obtained from all of the women (ClinicalTrials.gov, clinical trial reg. no. NCT01565564). Statistical analysiswasperformedwith SAS release 9.4 (SAS Institute, Cary, NC). BMI-for-age and -sex and its Z scores were calculated from 1 to 24 months of age and divided by age-groups: 1–3, 4–6, 7–9, 10–12, 13–18, and 19–24months of age. Overweight was defined as BMI-forageand -sex$85thpercentiles according to the World Health Organization ageand sex-specific growth references (3). Overweight at one time point within 1 year of age was defined as BMI-for-age and -sex $85th percentiles at any one time point of 1–3, 4–6, 7–9, and 10– 12monthsofage,whileoverweightatone timepoint at 1–2 years of agewas defined asBMI-for-ageand-sex$85thpercentiles at 13–18 and 19–24 months of age. There were no differences in clinical characteristics of women at enrollment between the IC group (N5 324) and the UC group (N5 347) (P. 0.10). Although children born to the women in the IC group were more likely to be male than children born to the women in the UC group, BMI-for-age and -sex and Z score for BMI-for-age and -sex at 1–3, 4–6, 7–9, 10–12, and 19–24 months of age were similar between children born to the women in the IC group and children born to the women in the UC group (P . 0.10) (Table 1). BMI-for-age and -sex and Z score for BMI-for-age and -sex at 13–18 months were borderline lower