Table 1 Clinical consequences of gestational diabetes in offspring

164 Chinese children at a median age of 8 years (range: 7–10 years)

Maternal GDM increases the offspring’s cardiometabolic risk

[53]

Eighty-nine children (mean age 9.1 years, 93% Caucasian)

School-age children of mothers with GDM are at risk of IGT and being overweight

[63]

Studied 1,238 mother–child

Children exposed to GDM have higher adiposity, which may mediate higher systolic blood pressure in these children

[12]

Sixty-eight children

Among these children, 45 (66%), 17 (25%), 5 (7%), and 1 (1.5%) had zero, one, two, or three metabolic markers of IR, respectively

[65]

Case mothers who had GDM/GIGT in pregnancy (cases; n = 90) and normoglycaemic control women (n = 99) and their daughters underwent lifestyle assessment and metabolic tests 15-years post-partum

Case daughters have increased risk of central adiposity and insulin resistance, whereas maternal obesity strongly predicted daughters’ BMI percentile and per cent of body fat

[67]

One hundred and twenty-nine adolescents who were assessed for their cardiometabolic risks at 8 years of age were reassessed at 15 years of age

Adolescent offspring of mothers with GDM had similar blood pressure, plasma lipid profile, and a rate of abnormal glucose tolerance as control subjects. In-utero hyperinsulinemia was associated with a 17-fold increase in metabolic syndrome and a tenfold increase in overweight at adolescence, independent of birth weight, Tanner stage, maternal GDM status, and mother’s BMI

[62]

A total of 970 mothers who had joined the Hyperglycemia and Adverse Pregnancy Outcome study were reevaluated, together with their child born during the study period, 7 years after delivery

Maternal hyperglycemia in pregnancy is independently associated with offspring’s’ risk of abnormal glucose tolerance, obesity, and higher BP at 7 years of age. Its effect on childhood adiposity was apparent only in girls, not boys

[42]

BMI measurements were collected at age 2, 8, and 11 years from 232 offspring of mothers with GDM (OGDM) and compared with those from 757 offspring of mothers with type 1 diabetes (OT1D) and 431 offspring of nondiabetic mothers (ONDM)

Overweight and insulin resistance in children is increased in OGDM compared with OT1D or ONDM. The finding that overweight risk is associated mainly with maternal obesity suggests that familial predisposition contributes to childhood growth in these offspring

[66]

Studied height and BMI standard deviation score (SDS) of the OGDM group, up to the age of 14 years, with subgroup analysis comparing Large for Gestational Age (LGA) with non-LGA at birth as a reflection of the intrauterine environment

Until early adolescence, OGDM had a BMI that is 0.5 SDS higher than that of the Dutch background population. LGA OGDM appear to be at particularly higher risk of being overweight during adolescence compared with non-LGA OGDM, putting them also at a higher lifetime risk of being overweight and developing obesity. Offspring of mothers with type 2 diabetes (ODM2) showed the highest BMI SDS values and had an average BMI SDS of + 1.6 until the age of 14, when it became + 2 SD

[82]

Prevalence of overweight and abdominal obesity at age 16 years and odds ratios (ORs) for prenatal exposures to maternal prepregnancy overweight and GDM. Study prospective longitudinal Northern Finland Birth Cohort of 1986 (N = 4,168)

Maternal pre-pregnancy overweight is an independent risk factor for offspring overweight and abdominal obesity at age 16 years. The risks are highest in offspring with concomitant prenatal exposure to maternal pre-pregnancy overweight and GDM

[80]

Studied 255 obese adolescents with normal glucose tolerance. All of them were investigated for in utero exposure to GDM

Obese youth exposed in-utero to GDM show early inability of the beta cell to compensate adequately in response to decreasing levels of insulin sensitivity

[70]

HAPO Follow-up Study (FUS) included 4,160 children ages 10–14 years

Offspring exposed to untreated GDM in-utero are insulin resistant with limited β-cell compensation compared with offspring of mothers without GDM. GDM is significantly and independently associated with childhood IGT

[71]

(HAPO) Study evaluated the long-term outcomes (4697 mothers and 4832 children

Among children of mothers with GDM vs those without it, the difference in childhood overweight or obesity defined by body mass index cutoffs was not statistically significant; however, additional measures of childhood adiposity may be relevant in interpreting the study findings

[61]

Data from 7355 mother–child dyads of the German Perinatal Prevention of Obesity cohort

The postulated increased risk of overweight and abdominal adiposity in offspring of mothers with gestational diabetes cannot be explained by maternal BMI alone and may be stronger for childhood obesity than for overweight

[200]

At a mean age of 24.1 ± 1.3 years, were classified offspring as offspring of mothers with GDM regardless of the prepregnancy BMI (OGDM; n = 193); normoglycemic mothers with prepregnancy overweight/obesity (ONO; n = 157); and normoglycemic mothers with prepregnancy BMI < 25 kg/m² (controls; n = 556)

Adult offspring of mothers with GDM have increased markers of insulin resistance and a more atherogenic lipid profile

[69]

Prospective cohort study included 10,412 mother–child pairs tested for GDM with IADPSG criteria

The associations between GDM diagnosed using IADPSG criteria and BMI Z-score and the risk for overweight/obesity in offspring were largely explained by maternal pre-pregnancy BMI at the age of 1–4 years

[75]

Study in 1967 mother–child pairs

Offspring of mothers with both GDM and HDP had a higher BMI than children born from a normotensive and normoglycemic pregnancy

Maternal GDM alone or joint GDM and HDP were associated with increased ratios of offsprings being overweight

[68]

A total of 298 offspring (202 offspring of GDM mothers and 96 offspring of mothers with impaired glucose tolerance [IGT]) participated in the study

In offspring of GDM mothers, CVD risk factors were positively correlated with age, except for lipid profiles

[201]

It was examined associations of maternal GDM (n = 92 cases out of 597) with mean serum lipid levels in the offspring

GDM exposure was associated with higher total- and low-density lipoproteins (LDL)- cholesterol in girls. In boys, maternal GDM corresponded with higher SBP (systolic blood pressure). Maternal GDM is related to offspring lipid profile and SBP in a sex-specific manner

[202]

Follow-up study of 1066 primarily Caucasian women aged 18–27 yr in the Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark

The risk of overweight was doubled in offspring of women with diet-treated GDM or type 1 diabetes, whereas the risk of metabolic syndrome was 4- and 2.5-fold increased, respectively. Offspring risk of metabolic syndrome increased significantly with increasing maternal fasting blood glucose as well as 2-h blood glucose (during oral glucose tolerance test)

[72]

Follow-up study of 567 offspring, aged 18–27 years

Fasting plasma levels of glucagon-like peptide-1 (GLP-1) were lower in the two diabetes-exposed groups compared to offspring from the background population. Increasing maternal blood glucose during oral glucose tolerance test (OGTT) in pregnancy was associated with reduced postprandial suppression of glucagon in the offspring. Lower levels of GLP-1 and higher levels of glucagon during the OGTT were present in offspring characterized by overweight or prediabetes/type 2 diabetes at follow-up, irrespective of exposure status

[203]