In utero exposure to gestational diabetes mellitus and long term endocrine morbidity of the offspring

Background: Gestational diabetes mellitus (GDM) is a worldwide public health problem. Few studies investigated the association of intra uterine exposure to GDM and long-term endocrine morbidity of offspring. Objective: To assess whether in utero exposure to GDM increases the risk for long-term endocrine morbidity of the offspring. Methods: A retrospective cohort study was conducted including all singleton born to women who delivered between 1988 and 2014. All births occurred in a tertiary medical center. Data were collected from the computerized perinatal database of the obstetrics and gynecology department and the computerized hospitalization database. The exposure variables were: diet-controlled GDM (GDMA1) and treated GDM (GDMA2). Multivariate generalized estimating equation (GEE) logistic regression model analysis was used to control for confounders and for maternal clusters. Results: During the study period 231,271 deliveries met the inclusion criteria, of which 12,642 deliveries (5.4%) were diagnosed with GDM. During the follow-up period, children exposed in utero to GDM had a higher rate of long- term hospitalizations with diagnoses of endocrine morbidity (such as diabetes mellitus and obesity) compared to those unexposed. Using a GEE model, controlling for confounders such as maternal age, follow up-time, obesity and birthweight, in-utero exposure to GDMA1 (adjusted OR = 2.1; 95% CI 1.7–2.7; P < 0.001) and especially to GDMA2 (adjusted OR = 3.1; 95% CI 2.2–4.4, P < 0.001) were found as risk factors for long-term endocrine disease during childhood. Conclusion: Exposure to GDM is a risk factor for long-term endocrine morbidity in the offspring.