Mom's Gestational Diabetes Ups Type 1 Diabetes Risk in Kids

Marlene Busko

April 16, 2019

Children and youth whose mothers had gestational diabetes were almost twice as likely as their peers to develop diabetes by age 22, according to results of a large observational cohort study in Quebec.

And we can infer that incident diabetes at this age was largely type 1, senior author Kaberi Dasgupta, MD, McGill University, Montreal, Quebec, Canada, told Medscape Medical News.

A previous Swedish study showed that children and youth whose mothers had either gestational diabetes or type 2 diabetes had a heightened risk of diabetes onset by age 22.

Now the current study is the first to show that gestational diabetes alone is associated with type 1 diabetes in children and youth, Dasgupta said, and this risk was higher in adolescents (a 2.5-fold increased risk) than in younger children (a 40% increased risk).

The study by Andrea L. Blotsky, MD, McGill University, and colleagues was published April 15 in the Canadian Medical Association Journal.

Type 1 diabetes and diabetes in general are rare in children and the symptoms may be missed, Dasgupta noted.

Children or teens, she said, "may be a bit thirsty...a bit tired...peeing a bit more, but they're not really perceiving it as abnormal. And suddenly it gets really bad and they wind up hospitalized because they have a crisis like diabetic ketoacidosis."

She continued, "We know that [a family history of] either type 1 or type 2 diabetes is a risk factor for diabetes in kids...but now we can add gestational diabetes to that group of things to take in your history."

If a child develops symptoms of diabetes and his or her mom had gestational diabetes, "expand your possibilities in terms of testing, because it's nothing to test for [diabetes], but it's a big deal to miss it."

Does Gestational Diabetes Impact Pediatric Diabetes?

Previously, the researchers showed in a large retrospective cohort that gestational diabetes and gestational hypertension predicted subsequent risk of incident diabetes, hypertension, and cardiovascular disease or mortality in mothers.

The current study aimed to examine the link between gestational diabetes and pediatric diabetes in the same cohort.

Using a public health insurance database in the province of Quebec, researchers identified 36,590 mothers aged 20 to 44 who gave birth to a single child between 1990 and 2002 and who developed gestational diabetes.

They then matched them with similar women who did not have gestational diabetes and looked for diabetes in the children between 1990 and 2012.

A higher proportion of mothers with gestational diabetes were of non-European origin (23% vs 18%), did not graduate from high school (26% vs 19%), were from the lowest socioeconomic quintile, had a previous live birth (50% vs 28%), or had an autoimmune disease (30% vs 27%).

Among children born to mothers with gestational diabetes, 139 developed diabetes before age 12, and 95 developed diabetes between ages 12 to 22.

Of those born to mothers without gestational diabetes, 92 developed diabetes before age 12, and 33 developed diabetes between ages 12 to 22.

That is, the incidence of pediatric diabetes was 4.52/10,000 patient-years among offspring of mothers with gestational diabetes versus 2.4/10,000 patient-years among offspring of mothers who did not have gestational diabetes.

Maternal gestational diabetes conferred a 1.8-fold higher risk of type 1 diabetes in the children, after adjusting for sex, gestational age group, birth weight group, ethnicity, material deprivation, previous pregnancy, and maternal autoimmune disease (adjusted hazard ratio [aHR], 1.77; 95% CI, 1.41 - 2.22).   

Further analysis revealed the risk was higher in teens and young adults (aHR, 2.53; 95% CI, 1.67 - 3.85) than children (aHR, 1.43; 95% CI 1.09 - 1.89).

Intuitively, Dasgupta said, we would think that if the children of women with gestational diabetes develop diabetes, it would be type 2 diabetes that develops later in life driven by excess weight and insulin resistance.

And studies have shown that gestational diabetes in mothers increases the risk of type 2 diabetes in offspring, especially in indigenous populations.

The current study now links gestational diabetes with type 1 diabetes in offspring. However, the mechanism remains to be elucidated.

"We know that to develop type 1 diabetes you do need to have an immunological predisposition — some auto-antibodies to your islet cells — and there will usually be some other trigger," such as a viral infection or even insulin resistance, Dasgupta said.

Most women with gestational diabetes have the health behaviors or genes to place them at risk of insulin resistance, she noted, and probably their children live in the environments where that could happen, too.  

"The accelerator and overload hypotheses," the researchers write, "propose that insulin resistance increases destruction (apoptosis) of the insulin-producing β-cells in the pancreas, heightening the autoimmune reaction to β-cells in immunologically at-risk individuals and resulting in progression to type 1 diabetes."

They acknowledge that study limitations include the inability to distinguish between type 1 and type 2 diabetes, and lack of information about things such as health behaviors (smoking, physical activity, diet) and maternal body mass index.

Nevertheless, the researchers conclude this study may stimulate "clinicians, parents, and even children and youth to consider the possibility of diabetes if offspring of a mother with gestational diabetes mellitus develop signs and symptoms such as polyuria, polydipsia, weight loss, or fatigue."

The study was supported by a grant from Diabetes Canada. Dasgupta and a coauthor were supported by awards from the Fonds de recherche du Québec — Santé (FRQS).

CMAJ. 2019;191:E410-E417. Full Text

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