Pregestational diabetes and the offspring: comparing the effects according to the type of maternal diabetes and with paternal type 1 diabetes

Abstract

Background and aims: Pregestational diabetes (DM) is associated with an increased risk of obesity and diabetes in the offspring. The aim of this project is to compare the differences between children of mothers with DM1 and DM2, children of fathers with DM1 and healthy mothers.

Materials and methods: In this longitudinal, prospective study, women with diabetes who delivered in 2012-2016 and accepted were contacted for follow-up. As controls, healthy mothers with a partner with DM1 and healthy mothers with a partner without diabetes were studied. In the offspring, breastfeeding, eating habits (KidMed questionnaire), physical activity (Enkid test), anthropometric measurements, body composition (impedance, Akern Nutrilab), blood pressure and HbA1c (Alere Afinion AS100) were recorded. Blood samples were collected to analyse insulin resistance and immunity markers (Luminex-200 Bio-Plex Assays 171A7001M and 171AL003M; Bio-Rad Laboratories). A descriptive statistical analysis was performed [SPSS 15 (IBM-Spain)]. Differences between groups were compared (chi square, Studentʼs t or Mann-Whitneyʼs U test) and univariate correlations were assessed. A two-tailed p <0.05 was considered significant.

Results: 85 women with their children were evaluated by telephone. The Enkid questionnaire gave 6 (1-9) points (most children should improve their physical activity) and the Kidmed questionnaire 8 (3-12) points (most children follow a Mediterranean diet), with no differences between groups. Breastfeeding was more frequent in children of fathers with DM1 (13/15) than of mothers with DM1 (16/29) p<0.05. From June 2019 to January 2020, 52 mothers and their children (46.2% girls) were examined [20 with DM1, 17 DM2, 11 from fathers with DM1 and 4 from healthy parents], at age 72 ± 10 months. They had a BMI percentile of 75 (3-97), waist of 56 (41-86) cm, hip of 65 ± 7 cm, systolic blood pressure of 101 ± 13 mmHg diastolic blood pressure of 58 ± 12 mmHg and HbA1c of 5.2 ± 0.3%. There were no differences between groups for any of these variables, though the proportion of children with blood pressure >the 90th percentile was higher in offspring of mothers with DM (9/25 vs 0/15, p= 0,042). Although mothers with DM1 delivered more large for gestational age children than those with DM2, their weight percentile at 6 years did not differ. Gestational weight gain (in DM2) and preconceptional HbA1c (in DM1) correlated with present offspring weight (R=0.611, p=0.012 and R=0.559, p=0.038, respectively). Analysis of impedance data and markers of insulin resistance and immunity are pending.

Conclusion: In this small, prospective, cohort study, no differences were found in lifestyle questionnaires, basic anthropometry or blood pressure in offspring of women with DM1 as compared with maternal DM2 or paternal DM1, except for a higher frequency of breastfeeding in children of fathers with DM1. Analysis of impedance and markers of insulin resistance and immunity might identify more subtle differences between groups. Gestational weight gain and preconceptional HbA1c were associated with offspring weight at 6 years of age.