Glycemic Control Trajectories among Individuals with Gestational Diabetes Are Associated with Risk of Childhood Obesity in the Offspring

Gestational diabetes (GDM) increases offspring risk of childhood obesity, but the role of glycemic control (GC) is unclear. We examined the association of GC trajectories, which profile longitudinal GC patterns from GDM diagnosis to delivery, with childhood obesity risk. Among 26774 individuals (78% from minority groups) enrolled in Kaiser Permanente Northern California (KPNC)'s GDM care program (2007-2017), we derived four GC trajectories: stably optimal, rapidly improving to optimal, slowly improving to near optimal and slowly improving to suboptimal. Offspring weight and height were collected at well-child visits until 2022. We calculated adjusted relative risk (aRR) and 95% CI of childhood obesity (i.e., sex-specific BMI-for-age ≥95th percentile using CDC growth charts) in association with GC trajectories using modified Poisson regression models adjusted for sociodemographic factors, parity, pre-pregnancy BMI, smoking and alcohol use, birthweight, preterm birth and breastfeeding. Obesity prevalence was 21.9% at 2-5 years, 28.6% at 6-11 years and 30.2% at 12-16 years. Compared to offspring of individuals in stably optimal trajectory who achieved GC shortly after GDM diagnosis, their counterparts in rapidly improving to optimal, slowly improving to near optimal and slowly improving to suboptimal trajectories had an increasing gradient of obesity risk at 2-5 years (aRR [95% CI]: 1.04 [0.98, 1.10], 1.06 [0.99, 1.14] and 1.16 [1.07, 1.25], respectively) and 6-11 years (1.08 [1.02, 1.15], 1.07 [0.99, 1.15] and 1.15 [1.07, 1.24], respectively); both P-for-trend<0.001. A similar yet weaker pattern was observed at 12-16 years (0.98 [0.88, 1.10], 1.03 [0.90, 1.18] and 1.13 [0.97, 1.30], respectively; P-for-trend=0.11). These associations were stronger in girls than boys (all P-for-interaction<0.05). Early GC achievement after GDM diagnosis and throughout pregnancy may be associated with lower offspring obesity risk in childhood. Disclosure R.F.Chehab: None. A.Ferrara: None. M.Greenberg: None. C.Lee: None. A.Ngo: None. Y.Zhu: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092924); The Permanente Medical Group