Beyond gestational diabetes : maternal and offspring health and lifestyle 3 years postnatally in a secondary analysis of the UPBEAT trial cohort

Background - Gestational diabetes (GDM) is associated with increased future obesity risk in affected mothers and children. Objective - We assessed if dietary behaviours learnt during a GDM pregnancy positively impact maternal and child health 3 years postpartum. Method - In a secondary analysis, we included women with obesity recruited to the UPBEAT randomised controlled trial with 3-year follow-up postnatally (n = 441). Maternal and offspring anthropometry and dietary data were recorded antenatally and at follow-up. Data were assessed using linear/logistic regression, adjusting for confounders. Results - Women with GDM (22%) had higher BMI (median 35.6 vs. 34.2 kg/m2; p = 0.049) and energy intake (1738.2 vs. 1551.6 kcal/day; p = 0.005) at ~16 weeks' gestation compared to unaffected women, but lower gestational weight gain (4.5 kg vs. 6.6 kg; p < 0.001). However, at 3 years postpartum BMI was similar between groups (35.8 vs. 35.2 kg/m2; p > 0.5). GDM-exposed infants had a higher birthweight (55.4 vs. 45.9th centile; p = 0.008) than unexposed infants and at 3 years of age were more likely to be overweight/obese (International Obesity Task Force, IOTF, standards; OR 2.32; 95% CI 1.38, 3.91) but with similar skinfold thicknesses and dietary patterns. Conclusion - Women with GDM demonstrated reduced gestational weight gain, and despite a higher BMI than women without GDM in early pregnancy, this difference was not evident at 3 years postpartum. However, while maternal and offspring dietary behaviours were comparable between groups, exposed offspring were at increased risk of overweight/obesity at 3 years of age.