390 - Impact of Different Gestational Diabetes Detection Thresholds on Infant Growth and Body Composition: Prospective Cohort Study Nested Within a Randomised Control Trial

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 390
Publication Number: 390.145

Komal Manerkar, Liggins Institute, University of Auckland, Auckland, Auckland, New Zealand; Caroline Crowther, Liggins Institute, University of Auckland, Auckland, Auckland, New Zealand; Jane E. Harding, Liggins Institute, University of Auckland, Auckland, Auckland, New Zealand; Michael P. Meyer, Middlemore Hospital, Auckland, New Zealand, Auckland, Auckland, New Zealand; Cathryn A. Conlon, Massey University, Auckland, Auckland, New Zealand; Elaine C. RUSH, Auckland University of Technology, Auckland, Auckland, New Zealand; Jane M. Alsweiler, Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, Auckland, New Zealand; Lesley McCowan, University of Auckland, Auckland, Auckland, New Zealand; Janet Rowan, National Women's Health, Auckland, Auckland, New Zealand; Richard Edlin, University of Auckland, Auckland, Auckland, New Zealand; Francesca Amitrano, University of Auckland, Auckland, Auckland, New Zealand; Christopher JD. McKinlay, University of Auckland, Auckland, Auckland, New Zealand

Presenting Author(s)

Christopher JD McKinlay, PhD, MBChB, DipProfEthics (he/him/his)

Associate Professor Neonatology
University of Auckland
Auckland, Auckland, New Zealand

Co-Author(s)

KM

Komal Manerkar, PhD (she/her/hers)

Liggins Institute, University of Auckland
Auckland, Auckland, New Zealand

Background: Gestational Diabetes Mellitus (GDM) is a major public health problem associated with long-term health problems for the offspring. However, there are limited prospective, controlled data on whether treatment of GDM reduces the risk of later metabolic sequelae in offspring, especially obesity, and whether this is influenced by detection thresholds.

Objective: To assess the impact of detecting and treating women for GDM using higher or lower diagnostic thresholds on infant adiposity and growth.

Design/Methods: BabyGEMS was a prospective cohort study nested within the Gestational Diabetes Mellitus Study of Diagnostic Thresholds (GEMS) Trial, which recruited pregnant women across two tertiary obstetric centres in Auckland, New Zealand. Participants were randomly allocated to detection of GDM by 75g oral glucose tolerance test using the lower thresholds recommended by International Association of Diabetes in Pregnancy Study Groups (IADPSG: fasting ≥5.1 mmol/L, 2h ≥10.0mmol/Lor 2h ≥8.5mmol/L) or the higher thresholds currently used in New Zealand (fasting ≥5.5mmol/L, 2h ≥9.0mmol/L). Infants of women in both trial groups meeting the lower thresholds, and a random selection of infants of women without GDM (Controls) were included in BabyGEMS. Thus, the three infant GDM exposure groups were A) mild treated GDM by IAPSG criteria; B) mild untreated GDM by IADPSG criteria; and C) treated GDM by NZ criteria. The primary outcome was whole-body fat mass at 5-6 months, by air displacement plethysmography. GDM exposure groups A, B, and C were compared with controls using generalised linear models, with Dunnett adjustment for pairwise comparisons. Models were adjusted for potential confounding by maternal body mass index, socioeconomic status, ethnicity and sex.

Results: 760 of 804 eligible infants were enrolled, of whom 661 were assessed at 5-6 months (432 for the primary outcome). At 5-6 months there was no significant difference in fat mass between Controls and exposure groups (Controls 2.05 kg; Group A 1.96 kg, adjusted MD -0.09 95%CI-0.29,0.10; Group B 1.94 kg, adjusted MD -0.15 95%CI-0.35,0.06; Group C 1.87 kg, adjusted MD -0.17 95%CI-0.37,0.03). Controls and exposure groups were also similar at 5-6 months for lean mass, feeding, appetite and energy and macronutrient intake.

Conclusion(s): Mild GDM, detected at the lower IAPDSG thresholds, was not associated with increased infant fat mass at 5-6 months, regardless of maternal treatment. Similarly, GDM detected and treated at higher thresholds was not associated with increased fat mass at 5-6 months.