Keely EJ et al. (2008) Prevalence of metabolic markers of insulin resistance in offspring of gestational diabetes pregnancies. Pediatr Diabetes 9: 53–59

Maternal hyperglycemia is associated with insulin resistance in offspring in high-risk (e.g. Pima Indian) populations, but this association remains unconfirmed in low-risk populations. Keely and colleagues' previous randomized, controlled trial in 299 women (91% white) with gestational diabetes mellitus compared the effects of minimal intervention or tight glycemic control, respectively, on perinatal outcomes. These researchers have now investigated the prevalence of insulin resistance in offspring (aged 7–11 years) of those women.

In total, 68 children underwent a 2 h oral glucose tolerance test, and their 8 h fasting levels of plasma glucose, insulin, HDL cholesterol, total cholesterol and triglycerides, as well as waist circumference and BMI were measured. Insulin resistance was quantified using the homeostasis model assessment (HOMA). At least one HOMA marker of insulin resistance was present in 23 children; however, 2 h or fasting plasma glucose abnormalities were rare. Hypertriglyceridemia was the most common abnormality, present in 21% of the children. After adjustment for potential confounding variables, waist circumference and triglyceride level were significant predictors of insulin resistance. Notably, maternal and offspring triglyceride and HDL cholesterol levels, waist circumference and HOMA insulin-resistance markers were significantly correlated, but 2 h or fasting plasma glucose levels were not.

Children of mothers with gestational diabetes mellitus seem to have an increased risk of insulin resistance and the metabolic syndrome, but whether this risk is influenced by control of maternal glycemia remains unclear. Screening strategies based on blood-glucose levels alone might be inadequate to identify these children.