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Epidemiology

Maternal glycemic index and glycemic load in pregnancy and offspring metabolic health in childhood and adolescence—a cohort study of 68,471 mother–offspring dyads from the Danish National Birth Cohort

Abstract

Background

High glycemic index (GI) and glycemic load (GL) as indicators of carbohydrate quality and quantity have been found to increase risk of metabolic outcomes in adults. Whether carbohydrate quality may influence metabolic programming already in early life is unknown. We examined the association of maternal GI and GL with offspring body mass index (BMI) in the first 7 years of life among 68,471 mother–offspring dyads from the Danish National Birth Cohort (DNBC). In a sub-cohort of offspring with clinical data (n = 1234) that included 608 dyads exposed to gestational diabetes mellitus (GDM), we also examined the relation to metabolic health at 9–16 years.

Methods

Maternal GI and GL were quantified using a mid-pregnancy food frequency questionnaire. We used birth weight and length to calculate offspring’s ponderal index. Age- and sex-specific BMI z scores at 5 mo, 12 mo, and 7 y were standardized against WHO reference data. In the clinical cohort, we quantified body composition, HOMA-IR, and HOMA-B. We used multivariable mixed linear and Poisson regression to model the associations.

Results

Median (IQR) of GI and GL were 83 (63–111) and 241 (180–333) g/day, respectively. We found that GI (Q4 vs. Q1:1.09, 95%CI: 1.03, 1.15) and GL (Q4 vs. Q1:1.10, 95%CI: 1.05, 1.16) modestly increased the relative risk of large-for gestational age (LGA). In the clinical sub-cohort, we observed a potential increase in offspring HOMA-IR, adiposity, and metabolic syndrome z score with higher maternal GI and GI. These associations were stronger among the GDM-exposed offspring, but the CI included the null value.

Conclusion

We found associations of GI and GL in pregnancy with offspring LGA. Potential long-term benefits to offspring exposed to GDM need to be confirmed in larger, well-powered studies.

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Acknowledgements

Funding

Funding for this study was provided by a fellowship grant from the Danish Diabetes Academy supported by the Novo Nordisk Foundation (EM); grants from the Danish Council for Strategic Research (09–067124 (Center for Fetal Programming) and 09–075611); the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (contract #HHSN275201000020C); the Innovation Fund Denmark (11–115923) and Rigshospitalet, Copenhagen University Hospital.

Author contributions

The authors’ contributions were as follows—EM, AAV, CZ, and SFO: study concept and design; SH, LGG, MS, AAB, LH, FBK, CMM, and ACBT: took part in the planning and conductance of the clinical follow-up study; EM: conducted the statistical analyses and drafted the manuscript; SH, LGG, AAB, LH, FBK, CCM, and CG: contributed to the statistical analyses and methods description; EM, SH, LGG, MS, BHB, TIH, AAV, and CZ: contributed critical advice and revisions of the manuscript; and EM and SFO: responsibility for the entire contents of the manuscript. All authors had full access to study data. All authors read and approved the final manuscript.

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Correspondence to Ekaterina Maslova.

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Maslova, E., Hansen, S., Grunnet, L.G. et al. Maternal glycemic index and glycemic load in pregnancy and offspring metabolic health in childhood and adolescence—a cohort study of 68,471 mother–offspring dyads from the Danish National Birth Cohort. Eur J Clin Nutr 73, 1049–1062 (2019). https://doi.org/10.1038/s41430-018-0316-6

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