Comparison of Cardiometabolic Risk Factors in Offspring of Diabetic Mothers (ODM) and Nondiabetic Mothers (ONDM) in India

Background: Maternal diabetes is a risk factor for obesity and glucose intolerance in the child, and contributes to the escalating epidemic of diabesity. This could have both a genetic and fetal programming basis. Only sparse data is available in India. We followed children born to diabetic and nondiabetic mothers 2-26 years after delivery to assess their cardio-metabolic risk factors.

Methods: Of 861 women diagnosed and treated for diabetes in pregnancy (1986-2014), we traced 346 and studied 200 children (ODM). We also studied 177 children of nondiabetic mothers (ONDM), matched for age, gender and socioeconomic status. We measured anthropometry, body composition (DXA) and a capillary blood glucose (<10y, 119 ODM, 93 ONDM) or a 1.75g/kg OGTT with venous blood (>10y, 81 ODM, 84 ONDM). Overweight+obesity was diagnosed by IOTF (≤18y) or WHO criteria (>18y). Glucose tolerance was classified by the ADA 2014 criteria. We compared cardio-metabolic risk factors in ODM and ONDM by calculating age and gender specific SD scores (reference ONDM).

Results: Three (4%) ODM were known diabetic (diagnosed at 16, 14 and 23y, 2 receiving OHA and 1 insulin), one was diagnosed on testing. ODM had higher BMI, skinfolds, body fat percent, and circulating glucose, insulin, total and LDL cholesterol, and triglyceride concentrations. ODM had higher HOMA-IR and pulse rate but lower disposition index (HOMA-β/HOMA-IR) and diastolic blood pressure. Prediabetes (IFG+IGT) (37 vs. 20%, p=0.005) and overweight+obesity (24 vs. 15%, p=0.014) were more common in ODM compared to ONDM.

Conclusions: We confirm elevated risk of obesity, adiposity, diabetes and other cardio-metabolic risk factors in children of Indian diabetic mothers. Despite following the current standards of practice for GDM management, the offspring continue to have high risk of diabesity. This suggests a need for reevaluation of current standards of care which overlook the peri-conceptional window of fetal programming.