Intrauterine Exposure to Diabetes Is a Determinant of Hemoglobin A1c and Systolic Blood Pressure in Pima Indian Children

Abstract

Context/Objective: Given the increasing rates of both childhood obesity and type 2 diabetes (T2DM), we investigated whether maternal diabetes status during pregnancy is a determinant of risk factors associated with T2DM or cardiovascular disease in offspring during childhood. Design/Participants: Forty-two Pima Indians, aged 7–11 yr, were identified retrospectively from maternal oral glucose tolerance tests as offspring of a diabetic pregnancy (22 ODM, eight males, 14 females) or offspring born before the mother developed diabetes (20 PRE, 12 males, eight females). Setting/Main Outcome Measures: Weight, height, body mass index, percent body fat, blood pressure, and fasting concentrations of glucose, insulin, hemoglobin A1c (HbA1c), total cholesterol, triglycerides, and high-density lipoprotein-cholesterol were measured while staying in an in-patient clinical research unit and compared in cross-sectional analyses. Results: After adjustment for age and gender, ODM had significantly higher concentrations of HbA1c (ODM = 5.7 ± 0.4, PRE = 5.0 ± 0.4%, P = 0.002), higher systolic (SBP) blood pressure (ODM = 118 ± 13, PRE = 107 ± 10 mm Hg; P = 0.02), and lower concentrations of high-density lipoprotein (ODM = 41 ± 9, PRE = 48 ± 6 mg/dl, P = 0.03) than PRE. Maternal diabetes status during pregnancy persisted as a significant determinant of SBP (beta = 7.50, P = 0.03) and HbA1c (beta = 0.43, P = 0.002), independent of age, gender, and percent body fat. Conclusion: Intrauterine exposure to diabetes is a significant determinant of higher SBP and HbA1c during childhood, independent of adiposity and a genetic predisposition to T2DM. These data suggest that in utero exposure to diabetes confers an additional independent risk for the development of T2DM and/or cardiovascular disease later in life.