Diabetes in pregnancy creating dangerous cycle
Tuesday 12 January 2010, 1:18PM
By AUT University
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“Mothers who go into pregnancy overweight and go on to develop gestational diabetes are putting their children at risk of significant health issues,” says AUT Professor of Nutrition Elaine Rush
Infants born to mothers with gestational diabetes are at an increased risk of obesity and type2 diabetes in adulthood and adolescence.
“This could impact on the rates of these diseases, particularly in Indian, Pacific Island, and Maori populations, who tend to have higher rates of gestational diabetes,” says Professor Rush.
“In effect a cyclical relationship could develop, where obese and diabetic mothers give birth to infants who become obese and develop diabetes before childbearing years, only to pass it on to their offspring.”
In a sample of average-for-gestational-age newborns, those exposed to gestational diabetes in utero have greater fat mass, body fat percentage and skin fold thickness when compared with those born to glucose tolerant mothers.
Data from National Women’s Hospital, Auckland, during 2008, show that gestational diabetes was diagnosed in over 16 per cent of Indian, almost 10 per cent of Asian, and over six per cent of Pacific Island and Maori women (groups known to have high rates of type2 diabetes), compared with three per cent of NZ European women.
“At National Women’s Hospital the number of women diagnosed with gestational diabetes has doubled in the past 10 years,” says Dr Janet Rowan, physician at the National Women’s Pregnancy Diabetes Clinic.
“With almost one in five Indian women presenting with gestational diabetes in Auckland alone, we are sure to feel the effects of this for generations to come.”
Dr Rowan is keen to help women with gestational diabetes control their blood sugar levels with lifestyle measures plus additional insulin or metformin treatment . Her aim is to reduce the amount of sugar that crosses to the fetus (to improve pregnancy outcomes) and hopefully reduce the likelihood of children developing obesity and diabetes as they grow up.
“The association of gestational diabetes with pregnancy complications and later risks of type2 diabetes in the mother is well-recognised,” says Dr Rowan “however, the potential long-term implications for the offspring deserves better recognition.”
To address the long-term implications Rush and Rowan have teamed up to follow children whose mothers have been treated for gestational diabetes and see how treatment and subsequent postnatal exposures such as diet and physical activity can alter the risk of obesity in the offspring of mothers with diabetes. They are also interested in whether ethnicity plays a part in the equation.
“Early findings are pointing to some stark differences by ethnicity,” says Professor Rush.
“Indian children might be the smallest babies, but they have the highest fat mass percentage. Whereas Pacific Island children are the largest - yet this is due in part to their great muscle mass.
“Our findings join a growing body of evidence that the environment an individual is exposed to early in life can alter their long-term health and risk of disease.”
Both Rush and Rowan believe that society needs to consider how we should address this issue to improve the health and of the next generation.
“Childhood obesity has reached epidemic proportions,” says Rush “and can be tracked back to birthweight”.
The 2006/2007 New Zealand Health Survey found that one in five children are now overweight and one in 12 obese.
“Of equal concern is that these children are going on to have children, without realising the implications for their young.”
Notes to editors:
Dr Janet Rowan - Metformin versus insulin for the treatment of gestational diabetes.
http://content.nejm.org/cgi/content/full/358/19/2003 New England Journal of Medicine
Professor Elaine Rush: Birth weight and growth trajectory to six years in Pacific children.