Cardiovascular disease is the leading cause of death among Mexican Americans, and their children are more likely to be overweight/obese than are non-Hispanic white children. Data are lacking on the association between in utero exposure to levels of maternal glycemia below those diagnostic of disease and cardiometabolic risk in childhood. This longitudinal cohort study was undertaken to determine the cardiometabolic risk in children of mothers without recognized pregestational diabetes or gestational diabetes mellitus (GDM).
The mothers and children were participants in a study of low-income Mexican Americans. Of 601 women enrolled, 485 were followed until the delivery of a full-term, live-born singleton neonate. Measurements of pregestational and gestational plasma glucose, as well as diabetes and GDM diagnoses, were abstracted from the medical records. The plasma glucose value was measured 1 hour after a 50-g oral glucose challenge test performed at 24 to 28 weeks’ gestation. Diagnosis of GDM was based on accepted criteria. After exclusions, 331 women met the lower plasma glucose thresholds for GDM; 211 had children with nonfasting total cholesterol and triglyceride levels, blood pressure (BP), or waist circumference (WC) measurements at 7 years of age. Data were obtained on the maternal prepregnancy weight, smoking status, poverty level, and consumption of sugar-sweetened beverages. Separate multiple logistic regression models were used to estimate the risk of each cardiometabolic risk factor, defined as 75th percentile or greater, associated with a 1-mmol/L increase in pregnancy glucose, measured 1 hour after a 50-g oral glucose tolerance load. The results were compared with models that used the 50th and 90th percentiles as cut points.
In the 211 mother-child pairs, the mean glucose value at the screening test was 107.1 mg/dL, and mean prepregnancy body mass index was 26.9 kg/m2. Thirty-eight percent of the children were obese at age 7 years (body mass index z score ≥95th percentile). The children’s mean total cholesterol and triglyceride levels were 170.1 and 131.1 mg/dL, respectively. Waist circumferences for the boys and girls were 66.2 and 67.3 cm, respectively. The cohort-specific 75th percentiles for WC were 71.5 and 75.3 cm for boys and girls, respectively, exceeding the nationally representative 75th percentiles for 7-year-old Mexican Americans by 8.1 and 12.3 cm, respectively. Diastolic and systolic BP values were 52.9 and 96.1 mm Hg, respectively. The odds ratios for children belonging to the upper quartile of diastolic BP and systolic BP associated with a 1-mmol/L increase in pregnancy glucose level were 1.39 and 1.38, respectively. The odds of children in the upper quartile of WC were 1.25 times higher for those exposed to a 1-mmol/L increase in maternal glucose level. Risk estimates were not changed after adjusting for child’s sex, birth weight, and gestational age at birth; maternal prepregnancy obesity; sugar-sweetened beverage consumption before glucose testing; gestational weight gained before glucose testing; gestational age at weight measurement; smoking; and poverty.
These results suggest that lifestyle interventions to encourage healthy dietary intakes and physical activity to improve pregnancy glucose levels, as well as abdominal obesity and elevated BP in late childhood, should be evaluated as ways to prevent the development of cardiometabolic disease.
Center for Environmental Research and Children’s Health (S.F.E., K.G.H., B.E.) and Division of Epidemiology, School of Public Health, University of California–Berkeley, Berkeley (S.F.E., B.A., B.E.); Division of Research, Kaiser Permanente Northern California, Oakland (S.F.E., A.F., M.M.H.); Stanford School of Medicine, Prevention Research Center, Stanford (L.G.R.); Children’s Hospital and Research Center, Oakland, CA (J.C.K.)