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NEW ORLEANS -- Children whose mothers had gestational diabetes reached puberty at an earlier age and grew faster than children of nondiabetic mothers, a small cohort study presented here found.
Compared with unexposed children, children of mothers with gestational diabetes had a 45% higher risk of early puberty (HR 1.45, P<0.02), reported Christine W. Hockett, MS, of University of Colorado at Denver, and colleagues. This association was independent of the mother's pre-pregnancy body mass index and education or child's race/ethnicity and sex.
Effects of diabetic exposure also varied by sex, with girls exposed to diabetes growing faster than boys who were exposed. Exposed females had a 10% greater growth velocity than unexposed females, while the growth acceleration for males was only 3.5%. The resultant lower risk of early puberty for boys compared with girls was statistically significant (HR 0.17, P<0.01).
Boyd Metzger, MD, an ADA spokesperson for gestational diabetes and professor emeritus at Northwestern University, told MedPage Today that pediatricians have certainly been aware that the age of puberty, especially in girls, has lowered in the past 20 years.
"What is different in this cohort ... is this was applied to children with mothers who had gestational diabetes," said Metzger, who was not involved with the research. "What has not been reported on and was mentioned during the paper discussion is whether that feature in children in mothers with gestational diabetes is primarily accounted for by their more rapid weight gain."
Hockett's team did not control for obesity in children, and the question was indeed raised during a discussion of this presentation about whether the weight of the child may have accounted for the association between exposure to gestational diabetes and early puberty.
"We didn't control for obesity because it was on the causal pathway, and that would definitely attenuate the effects," said Hockett, adding that the next step in their research is to discover whether there is an additive effect when examining gestational diabetes and obesity together.
Exposed youth overall in the study reached puberty 3 months earlier than unexposed youth. Race/ethnicity also played a role in an exposed child's risk for earlier puberty, with Hispanic youth at a 41% increased risk of early puberty compared with non-Hispanic white youth (HR 1.41, P<0.01). Not surprisingly, exposed children also had a significantly greater birth weight compared to unexposed children.
The EPOCH study (Exploring Perinatal Outcomes among Children) originally looked at a cohort of children from Colorado, where recruitment was based on exposure status (diabetes during pregnancy). Researchers here used data from 63 exposed children and 232 unexposed children where longitudinal heights were collected from age 2 years through current age (mean age 16.5 years). To approximate puberty for both sexes, they used age at peak height velocity (when the child is growing in height at their fastest rate) and peak height velocity (peak speed of growth for a child).
Hockett said that the next step in the research is to investigate the consequences on disease risk for these findings -- specifically whether earlier pubertal timing and faster speed of growth mediates the relationship between exposure to diabetes and adiposity and cardiometabolic risk factors.
"If true, this supports need for life-stage targeted interventions aimed at reducing diabetes during pregnancy," she said.
Prior randomized treatment trials conducted on interventions for women with gestational diabetes during pregnancy have shown some improvement in perinatal outcomes, but follow-up with children at 5 and 7 years of age showed minimal differences between groups. However, considering the onset of puberty is several years later, Metzger said that additional follow-up may be needed.
He added that there is an interest in earlier diagnosis of gestational diabetes, as long-term offspring outcomes may be determined much earlier than a third trimester diagnosis during pregnancy.
"What we don't know is whether better or earlier treatment of gestational diabetes or more optimal control of diabetes in people with preexisting diabetes will lessen long-term consequences," said Metzger. "That is an area of research that I think is really critical to do because we know that such exposure has effects at the earliest stage of pregnancy, but we don't know when those effects are going to show up."
Hockett and colleagues disclosed no relevant financial relationships.
- Reviewed by F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner