Consequences of maternal overweight and obesity in pregnancy on offspring diabetes risk: a record linkage study in Aberdeen, Scotland

摘要

Background: Maternal obesity in pregnancy is associated with cardiovascular disease and mortality in the offspring. With the rising prevalence of obesity in pregnancy it is vital to understand the underlying mechanisms in order to design appropriate interventions to prevent adverse offspring outcomes. We aimed to determine whether maternal obesity is also associated with increased risk of offspring type 2 and type 1 diabetes as a candidate mechanistic pathway. Methods: Birth records of 118,201 children from 1950-2011 from the Aberdeen Maternity and Neonatal Databank were linked to Scottish Care Information-Diabetes, the national register for diagnosed diabetes in Scotland, to identify incident and prevalent type 1 and type 2 diabetes up to 01/01/2012. Maternal body mass index (BMI) was calculated from height and weight measured at the first antenatal visit. The effect of maternal obesity on offspring outcomes was tested using time-to-event analysis using Cox-proportional hazard regression to compare outcomes in offspring of mothers in underweight, overweight or obese categories of BMI, compared to offspring of women with normal BMI. Results: Offspring of obese (BMI > 30 kg/m~2 ) and overweight (BMI > 25-29-9 kg/m~2) mothers had increased risk of type 2 diabetes compared to normal BMI mothers after adjustment for gestation when weight was measured, maternal history of diabetes before pregnancy, age at delivery, parity, socio-economic status, and offspring sex (Hazard ratio (95% confidence interval) 3.48 (2.39, 5.06) and 1.39 (1.06, 1.83), respectively. There were no significant associations of maternal BMI with offspring Type 1 diabetes. Conclusions: Maternal obesity is associated with increased risk of type 2 diabetes in the offspring. Evidence-based strategies to reduce obesity among women of reproductive age are urgently required.