Effect of maternal lifestyle intervention on metabolic health and adiposity of offspring: Findings from the Finnish Gestational Diabetes Prevention Study (RADIEL) - 14/06/19

Doi : 10.1016/j.diabet.2019.05.007

N.E. Grotenfelt ^a,^b,^⁎ , N. Wasenius ^a,^b, J.G. Eriksson ^a,^b, E. Huvinen ^c, B. Stach-Lempinen ^d, S.B. Koivusalo ^c, K. Rönö ^a,^c
^a Folkhälsan Research Center, Helsinki, Finland
^b Unit of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Finland
^c Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Finland
^d Department of Obstetrics and Gynecology, South Karelia Central Hospital, Lappeenranta, Finland

^⁎Corresponding author at: University of Helsinki, Department of General Practice and Primary Health Care, Biomedicum Helsinki, Tukholmankatu 8B, P.O. Box 20, Helsinki 00014, Finland.University of Helsinki, Department of General Practice and Primary Health Care, Biomedicum HelsinkiTukholmankatu 8B, P.O. Box 20Helsinki 00014Finland

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Abstract

Aim

To assess in women at high risk of gestational diabetes mellitus (GDM) the effect of a lifestyle intervention on the metabolic health of their offspring around 5 years after delivery.

Methods

For the original Finnish gestational diabetes prevention study (RADIEL), 720 women with a prepregnancy body mass index (BMI)≥30kg/m² and/or previous GDM were enrolled before or during early pregnancy and allocated to either an interventional (n=126) or conventional (n=133) care group. The present 5-year follow-up substudy assessed the metabolic health outcomes of their offspring. Age- and gender-standardized residuals of metabolic health components (waist circumference, mean arterial pressure, high-density lipoprotein and triglyceride levels, and fasting insulin/glucose ratio) were also combined to determine the accumulation of metabolic effects. Body composition was assessed by electrical bioimpedance.

Results

Offspring of women in the intervention group had a less optimal metabolic profile after the 5-year follow-up compared with offspring in the usual care group (P=0.014). This difference in metabolic health was primarily related to lipid metabolism, and was more prominent among boys (P=0.001) than girls (P=0.74). Neither GDM, gestational weight gain, prepregnancy BMI, offspring age nor timing of randomization (before or during pregnancy) could explain the detected difference, which was also more pronounced among the offspring of GDM pregnancies (P=0.010). Offspring body composition was similar in both groups (P>0.05).

Conclusion

The lifestyle intervention aimed at GDM prevention was associated with unfavourable metabolic outcomes among offspring at around 5 years of age.

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Keywords : Gestational diabetes mellitus, Lifestyle interventional trial, Pregnancy intervention, Offspring body composition, Offspring metabolic outcomes

Abbreviations : ADA, ALT, BMI, CI, GDM, HDL, hs-CRP, IQR, MAP, MetS, OGTT, SD, TG, WC