136: Gestational diabetes mellitus: An independent risk factor for long- term pediatric endocrine morbidity of the offspring

Objective
To assess whether in utero exposure to gestational diabetes mellitus (GDM) increases the risk for long-term endocrine morbidity of the offspring.
Study Design
A retrospective population-based cohort study compared long-term (up to the age of 18 years) hospitalized pediatric endocrine morbidity between singletons prenatally exposed and unexposed to GDM. Deliveries occurred between the years 1991-2014 in a regional tertiary medical center. The exposure variables were diet-controlled GDM (GDMA1) and treated GDM (GDMA2). Mothers with pre-gestational diabetes mellitus, and infants with congenital malformations were excluded from the study. Kaplan-Meier survival curve was used to estimate cumulative incidence of endocrine morbidity. A multivariate generalized estimating equation (GEE) logistic regression model analysis was used to control for confounders and for maternal clusters.

Results
During the study period 256,270 deliveries met the inclusion criteria, of which 5.0% were diagnosed with GDM (n=12,889). During the follow-up period, children exposed in utero to GDM had a higher rate of long- term endocrine morbidity, and specifically higher rate of overweight and obesity compared to those unexposed (table). Children born to women with GDM had higher cumulative incidence of endocrine morbidity (Kaplan-Meier survival curves; figure). Using a multivariable GEE logistic regression model, controlling for maternal age, gestational age at delivery, birthweight and the time to event, in utero exposure to GDMA1 (adjusted OR =2.1; 95% CI 1.7-2.7; P<0.001) and to GDMA2 (adjusted OR =3.08; 95% CI 2.1-4.4, P<0.001) were found as independent risk factors for long-term endocrine disease during childhood.
Conclusion
Exposure to maternal GDM is an independent risk factor for long-term endocrine morbidity of the offspring.