Abstract
Background and objectives:
Hyperglycemia in pregnancy is associated with increased risk of offspring childhood obesity. Treatment reduces macrosomia; however, it is unclear if this effect translates into a reduced risk of childhood obesity. We performed a systematic review and meta-analysis of randomized controlled trials to evaluate the efficacy and safety of intensive glycemic management in pregnancy in preventing childhood obesity.
Methods:
We searched MEDLINE, EMBASE, CENTRAL and ClinicalTrials.gov up to February 2016 and conference abstracts from 2010 to 2015. Two reviewers independently identified randomized controlled trials evaluating intensive glycemic management interventions for hyperglycemia in pregnancy and included four of the 383 citations initially identified. Two reviewers independently extracted study data and evaluated internal validity of the studies using the Cochrane Collaboration’s Risk of Bias tool. Data were pooled using random-effects models. Statistical heterogeneity was quantified using the I2 test. The primary outcome was age- and sex-adjusted childhood obesity. Secondary outcomes included childhood weight and waist circumference and maternal hypoglycemia during the trial (safety outcome).
Results:
The four eligible trials (n=767 children) similarly used lifestyle and insulin to manage gestational hyperglycemia, but only two measured offspring obesity and waist circumference and could be pooled for these outcomes. We found no association between intensive gestational glucose management and childhood obesity at 7–10 years of age (relative risk 0.89, 95% confidence interval (CI) 0.65 to 1.22; two trials; n=568 children). Waist circumference also did not differ between treatment and control arms (mean difference, −2.68 cm; 95% CI, −8.17 to 2.81 cm; two trials; n=568 children).
Conclusions:
Intensive gestational glycemic management is not associated with reduced childhood obesity in offspring, but randomized data is scarce. Long-term follow-up of trials should be prioritized and comprehensive measures of childhood metabolic risk should be considered as outcomes in future trials.
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References
de Onis M, Onyango A, Borghi E, Siyam A . Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007; 85: 660–667.
WHO Population-Based Approaches to Childhood Obesity Prevention. Geneva: Switzerland, 2012.
Singh AS, Mulder C, Twisk JW, van Mechelen W, Chinapaw MJ . Tracking of childhood overweight into adulthood: a systematic review of the literature. Obesity Rev 2008; 9: 474–488.
Wittmeier KD, Wicklow BA, MacIntosh AC, Sellers EA, Ryner LN, Serrai H et al. Hepatic steatosis and low cardiorespiratory fitness in youth with type 2 diabetes. Obesity 2012; 20: 1034–1040.
Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 766–781.
Roberts KC, Shields M, de Groh M, Aziz A, Gilbert J-A . Overweight and obesity in children and adolescents: results from the 2009 to 2011 Canadian Health Measures Survey. Health Rep 2012; 23: 37.
Ogden CL, Kit BK, Carroll MD, Flegal KM . Prevalence of childhood and adult obesity in the United States, 2011-2012. (Report). JAMA 2014; 311: 806.
Poolsup N, Suksomboon N, Amin M . Effect of treatment of gestational diabetes mellitus: a systematic review and meta-analysis. PloS ONE 2014; 9: e92485.
Hoffman L, Nolan C, Wilson JD, Oats JJN, Simmons D . Gestational diabetes mellitus - management guidelines. (statement of the Australasian Diabetes in Pregnancy Society). Med. J. Aust. 1998; 169: 93.
Blank A, Grave GD, Metzger BE . Effects of gestational diabetes on perinatal morbidity reassessed. Report of the International Workshop on Adverse Perinatal Outcomes of Gestational Diabetes Mellitus, December 3-4, 1992. Diabetes Care 1995; 18: 127–129.
Scott D, Loveman E, McIntyre L, Waugh N . Screening for gestational diabetes: a systematic review and economic evaluation. Health Technol Assess 2002; 6: 172.
Young TK, Martens PJ, Taback SP, Sellers EA, Dean HJ, Cheang M et al. Type 2 diabetes mellitus in children: prenatal and early infancy risk factors among native canadians. Arch Pediatr Adolesc Med 2002; 156: 651–655.
McCrindle BW . Cardiovascular consequences of childhood obesity. Can J Cardiol 2015; 31: 124–130.
Metzger B, Gabbe SG, Persson B, Buchanan TA, Catalano P, Damm P et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33: 676–682.
Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Aktary WM et al. Screening and diagnosing gestational diabetes mellitus. Evid Rep Technol Assess 2012; 210: 1–327.
Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009; 361: 1339–1348.
HAPO Study Cooperative Research Group. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Int J Gynaecol Obstet 2002; 78: 69–77.
International Association of Diabetes & Pregnancy Study Groups (IADPSG) Consensus Panel Writing Group and the Hyperglycemia & Adverse Pregnancy Outcome (HAPO) Study Steering Committee, Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PM et al. The diagnosis of gestational diabetes mellitus: new paradigms or status quo. J Matern Fetal Neonatal Med 2012; 25: 2564–2569.
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2014; 37 (Suppl 1): S81–S90.
Alberti KG, Zimmet PZ . Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabetic Med 1998; 15: 539–553.
Carpenter MW, Coustan DR . Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982; 144: 768–773.
Landon MB, Rice MM, Varner MW, Casey BM, Reddy UM, Wapner RJ et al. Mild gestational diabetes mellitus and long-term child health. Diabetes Care 2015; 38: 445–452.
Gillman MW, Oakey H, Baghurst PA, Volkmer RE, Robinson JS, Crowther CA . Effect of treatment of gestational diabetes mellitus on obesity in the next generation. Diabetes Care 2010; 33: 964–968.
Green S, Cochrane C . Cochrane Handbook for Systematic Reviews of Interventions. John Wiley & Sons Ltd.: West Sussex, England, 2008. Available at http://handbook.cochrane.org/.
Moher D, Liberati A, Tetzlaff J, Altman DG,, PRISMA group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Open Med 2009; 3: e123–e130.
Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005; 352: 2477–2486.
Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928.
Garner P, Okun N, Keely E, Wells G, Perkins S, Sylvain J et al. A randomized controlled trial of strict glycemic control and tertiary level obstetric care versus routine obstetric care in the management of gestational diabetes: a pilot study. Am J Obstet Gynecol 1997; 177: 190–195.
Fadl HE, Gardefors S, Hjertberg R, Nord E, Persson B, Schwarcz E et al. Randomized controlled study in pregnancy on treatment of marked hyperglycemia that is short of overt diabetes. Acta Obstet Gynecol Scand 2015; 94: 1181–1187.
Keely EJ, Malcolm JC, Hadjiyannakis S, Gaboury I, Lough G, Lawson ML . Prevalence of metabolic markers of insulin resistance in offspring of gestational diabetes pregnancies. Pediatr Diabetes 2008; 9: 53–59.
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH . Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240–1243.
Cole TJ, Lobstein T . Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatric Obes 2012; 7: 284–294.
Barlow S . Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: Summary report. Pediatrics 2007; 120: S164–S192.
Mayo K, Melamed N, Vandenberghe H, Berger H . The impact of adoption of the international association of diabetes in pregnancy study group criteria for the screening and diagnosis of gestational diabetes. Am J Obstet Gynecol 2015; 212: 224.e1–e9.
Falavigna M, Schmidt MI, Trujillo J, Alves LF, Wendland ER, Torloni MR et al. Effectiveness of gestational diabetes treatment: a systematic review with quality of evidence assessment. Diabetes Res Clin Pract 2012; 98: 396–405.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339: b2700.
Acknowledgements
We are thankful for the help of two medical librarians, Angela Osterreicher, BSc MLS of the Health Sciences Libraries of the University of Manitoba, and Becky Skidmore, BA(H) MLS of the Ottawa Integrative Cancer Centre of the Ottawa Hospital Research Institute, who developed the search strategy in consultation with the authors without any compensation. LG, AAS, RZ, TAD and JMM designed the research. LG and AD conducted the search. LG, AAS and RR analyzed the data. LG drafted the manuscript. LG, BW, AAS, TAD and JMM made revisions to the manuscript for important intellectual content. All authors read and approved the final manuscript. LG was supported by a Fonds de Recherche en Santé—Québec Doctoral training award and by the University of Manitoba Graduate Enhancement of Tri-Council Stipends program during this work. RZ is the recipient of a New Investigator Award from the Canadian Institutes of Health Research (CIHR). JMM holds the CIHR Applied Public Health Chair in Resilience and Childhood Obesity. These organizations had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; nor in the preparation, review or approval of this manuscript. Prospero Registration Number: CRD42016038624.
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Guillemette, L., Durksen, A., Rabbani, R. et al. Intensive gestational glycemic management and childhood obesity: a systematic review and meta-analysis. Int J Obes 41, 999–1004 (2017). https://doi.org/10.1038/ijo.2017.65
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DOI: https://doi.org/10.1038/ijo.2017.65