Women Who Develop Diabetes Later in Life Have Diabetes-Associated Complications during Preceding Pregnancies

Aims:?The aim of this study was to explore the outcome of previous pregnancies in women who later developed diabetes. Method: A Swedish population based cohort of 23,524 women from 1990 aged 45 - 85 yr in 2000 when they self reported health status in a questionnaire. To identify which women who delivered we matched it towards the Swedish Medical Birth Register (SMBR). We identified 14,856 women who appeared in both registers and a total of 30,559 new birth registrations. Among these women 216 had developed diabetes after their pregnancy (ies) and additional twelve women were reported to have gestational diabetes in SMBR. These 228 women and their 455 pregnancies were compared with women without diabetes. Results: Women who developed diabetes later in life were already heavier before the pregnancy (ies) (69.2 ± 13.9 vs. 63.2 ± 10.3 kg;p < 0.001) but had less weight gain during pregnancy (13.3 ± 5.4 vs. 14.1 ± 4.6 kg;p = 0.03) compared to women without diabetes. Newborns to women with diabetes diagnosed any time after pregnancy had higher birth weight (3602 vs. 3507 g;p < 0.001), were more often large for gestational age (10.5% vs. 3.1%;p < 0.001), were more often delivered by caesarean section (4.8% vs. 2.7%;p = 0.005) and had lower Apgar scores. Conclusion: Women who developed diabetes after pregnancy had hyperglycaemia-associated complications during their pregnancy (ies). We therefore postulated that women with Type 2 diabetes are mainly recruited from women with earlier GDM. A general screening for GDM should identify these women and enable life style intervention that may prevent or at least delay diabetes.

Macrosomia is associated with overweight in childhood:a follow-back of a cohort established in the early years of the obesity epidemic

Objective:Interventions currently recommended to control and prevent obesity have not been successful.Recent research has shifted toward the transgenerational cycle of obesity.We assessed the association between fetal macrosomia and early childhood body weight.Methods:We conducted a follow-back study to link birth certificate data to the Third National Health and Nutrition Examination Survey(1988–1994)of 2621 United States-born singletons aged 2–6 years.Birth weight and gestational age data were collected from birth certificates.Fetal macrosomia was defined as≥90th percentile of gestational age-race-sex-parity specific body weight distribution in 1989 vital statistics.Results:With 12.7%(standard error=0.85%)of participants born macrosomic,the prevalence of obesity and overweight(BMI percentiles≥85th in the CDC growth chart)among children was 17.8%(1.17%).When the body weight was measured against age-sex-specific height(BMI percentiles),macrosomia was significantly associated with overweight and obesity(odds ratio[OR]=1.64,95%confidence interval=1.07–2.50)adjusted for family income,maternal age and marital status,race,maternal smoking during pregnancy,and breastfeeding.The association became insignificant after adjusting for postnatal lifestyle and parental body mass index(OR=1.38[0.84-2.26]].When body weight was measured against age,children who were too heavy for their age were more likely to be born macrosomically(OR=2.64[1.66-4.22])than their peers with healthy age-specific body weight.Conclusion:Fetal macrosomia was significantly associated with a doubled risk of heavy body weight in children aged 2–6 years.