Effect of maternal lifestyle intervention on metabolic health and adiposity of offspring: Findings from the Finnish Gestational Diabetes Prevention Study (RADIEL).

AIM: To assess in women at high risk of gestational diabetes mellitus (GDM) the effect of a lifestyle intervention on the metabolic health of their offspring around 5 years after delivery. METHODS: For the original Finnish gestational diabetes prevention study (RADIEL), 720 women with a prepregnancy body mass index (BMI)≥30kg/m2 and/or previous GDM were enrolled before or during early pregnancy and allocated to either an interventional (n=126) or conventional (n=133) care group. The present 5-year follow-up substudy assessed the metabolic health outcomes of their offspring. Age- and gender-standardized residuals of metabolic health components (waist circumference, mean arterial pressure, high-density lipoprotein and triglyceride levels, and fasting insulin/glucose ratio) were also combined to determine the accumulation of metabolic effects. Body composition was assessed by electrical bioimpedance. RESULTS: Offspring of women in the intervention group had a less optimal metabolic profile after the 5-year follow-up compared with offspring in the usual care group (P=0.014). This difference in metabolic health was primarily related to lipid metabolism, and was more prominent among boys (P=0.001) than girls (P=0.74). Neither GDM, gestational weight gain, prepregnancy BMI, offspring age nor timing of randomization (before or during pregnancy) could explain the detected difference, which was also more pronounced among the offspring of GDM pregnancies (P=0.010). Offspring body composition was similar in both groups (P>0.05). CONCLUSION: The lifestyle intervention aimed at GDM prevention was associated with unfavourable metabolic outcomes among offspring at around 5 years of age.

Transgenerational effects of maternal obesity and gestational diabetes on offspring body composition and left ventricle mass: the Finnish Gestational Diabetes Prevention Study (RADIEL) 6-year follow-up.

AIM: To investigate the influence of maternal adiposity and gestational diabetes on offspring body composition and left ventricle mass in early childhood. METHODS: The observational follow-up study included 201 mother-child pairs, a sub-cohort from the Finnish Gestational Diabetes Prevention Study, who were recruited 6.1 ± 0.5 (mean ± SD) years postpartum, aiming for an equal number of mothers with and without gestational diabetes. RESULTS: Maternal pre-pregnancy BMI (mean ± SD; 30.5 ± 5.6 kg/m2 ) was associated with child body fat percentage [0.26 (95% CI; 0.08, 0.44)% increase in child body fat per 1 kg/m2 increase in pre-pregnancy BMI of mothers with obesity] and was reflected in child BMI Z-score (mean ± SD; 0.45 ± 0.93). Left ventricle mass, left ventricle mass index and left ventricle mass Z-score were not associated with gestational diabetes, pre-pregnancy BMI or child body fat percentage. After adjusting for child sex, body fat percentage, systolic blood pressure, pre-pregnancy BMI and maternal lean body mass, left ventricle mass increased by 3.08 (95% CI; 2.25, 3.91) g for each 1 kg in child lean body mass. CONCLUSIONS: Left ventricle mass at 6 years of age is determined predominantly by lean body mass. Maternal pre-gestational adiposity is reflected in child, but no direct association between left ventricle mass and child adiposity or evidence of left ventricle mass foetal programming related to gestational diabetes and maternal adiposity was observed in early childhood.

Neonatal outcomes among offspring of obese women diagnosed with gestational diabetes mellitus in early versus late pregnancy.

BACKGROUND: Maternal metabolic derangements associated with early pregnancy gestational diabetes may affect the fetus differently compared with gestational diabetes diagnosed later in pregnancy. The aim of this observational study was to assess neonatal outcomes according to timing of gestational diabetes diagnosis in obese women. METHODS: Women ≥18 years of age with a pre-pregnancy body mass index ≥30 kg/m2 were grouped according to the results of a 75 g 2-h oral glucose tolerance test performed at 13.1 weeks of gestation and repeated at 23.4 weeks if normal at first testing. The main outcomes were birthweight and large for gestational age. RESULTS: Out of 361 women, 164 (45.4%) were diagnosed with gestational diabetes, 133 (81.1%) of them in early pregnancy. The mean offspring birthweight was 3673 g (standard deviation (SD) 589 g) in the early and 3710 g (SD 552 g) in the late gestational diabetes group. In a multivariate logit model, the odds ratio for large for gestational age was 2.01 (95% CI: 0.39-10.39) in early compared with late gestational diabetes. CONCLUSIONS: We observed no statistically significant differences in neonatal outcomes according to timing of gestational diabetes diagnosis. In addition to lack of power, early treatment of hyperglycemia may partly explain the results.

Association between diet quality measured by the Healthy Food Intake Index and later risk of gestational diabetes-a secondary analysis of the RADIEL trial.

This corrects the article DOI: 10.1038/ejcn.2016.275.

Association between diet quality measured by the Healthy Food Intake Index and later risk of gestational diabetes-a secondary analysis of the RADIEL trial.

The aim of this study was to find the association between adherence to the Nordic Nutrition Recommendations (NNR) and glucose metabolism. Participants were 137 pregnant obese women or women with a history of gestational diabetes (GDM) from the Finnish Gestational Diabetes Prevention Study. Adherence to the NNR was assessed by the Healthy Food Intake Index (HFII) calculated from the first trimesters' food frequency questionnaires. Higher HFII scores reflected higher adherence to the NNR (score range 0-17). Regression models with linear contrasts served for the main analysis. The mean HFII score was 10.0 (s.d. 2.8). The odds for GDM decreased toward the higher HFII categories (P=0.067). Fasting glucose (FG) and 2hG concentrations showed inverse linearity across the HFII categories (P(FG)=0.030 and P(2hG)=0.028, adjusted for body mass index, age and GDM/pregnancy history). Low adherence to the NNR is associated with higher antenatal FG and 2hG concentrations and possibly GDM.