Effect Of Gestational Diabetes Mellitus On Physical And Intelligence Development Of Offspring In Infancy:a Cohort Study

Objective: The study aimed to explore effect of gestational glucose and lipid metabolism of women with GDM on physical and intelligence development of offspring in infancy.Methods: A prospective study was established at antenatal clinic of Tongling Women and Child Health Care Hospital,enrolling those singleton pregnant women who were during early pregnancy between May 2014 and May 2015.After delivery,their 632 infants were followed up to investigate the physical and intelligence development in infancy.The intelligence development was measured by using the revised version of Bayley Scales of Infant Development in China(BSID-CR).Information of infant breastfeeding and physical development were collected by self-administer questionnaire.Pearson correlation and stepwise multiple linear regression models were used to explore the associations between gestational glucose and lipid metabolism indexes and physical and intelligence development of infant.Results:(1)In all,555 eligible infants were follow-up,including 177 cases in GDM group and 378 cases in control group.(2)The differences of pre-pregnant BMI,maternal and infant age were statistically significant between the two groups(P<0.05).The incidence of macrosomia was 13.0% in GDM group,7.1% in control group,and statistically significant difference was found(P<0.05).Compared to control group,the percentage of colostrum was lower in GDM group(87% vs.94.2%,P< 0.01).(3)In GDM group,the level of FPG,TG,TC,HDL,LDL at the first trimester and OGTT blood glucose,insulin at the second trimester and FPG,TG at the third trimester and insulin of umbilical cord blood serum were all higher than control group,and the differences were statistically significant(P<0.05).The level of TC,HDL and LDL at the second trimester was lower than control group(P<0.001).(4)At birth and 42 days,the LAZ and WAZ of male were higher than control group(P<0.05).In contrast,the LAZ,WAZ and WLZ of female had no statistical difference in infancy.Compared to control group,MDI and PDI of GDM group were both lower,and the difference was statistically significant(P<0.05).(5)The results of stepwise multiple linear regression analysis showed that the level of TC(b =-1.352,P<0.001)in late pregnancy was negatively correlated with LAZ at 42 days.The level of late pregnancy DHA(b=-0.209,P=0.006)and FPG(b =-0.197,P=0.050)in early pregnancy were negatively correlated with WAZ at 42 days,GDM was positively associated with it(b = 0.268,P = 0.005).The level of mid pregnancy insulin was negatively correlated with WLZ(b =-0.186,P=0.049)at 42 days,late pregnancy insulin(b=0.222,P=0.016)and HDL of umbilical cord blood serum(b = 0.349,P<0.001)were positively correlated with it.The level of mid pregnancy insulin was positively related with LAZ(b=0.179,P=0.043)at 3 months,OGTT-2 h blood glucose(b=-0.205,P=0.024)and HDL in early pregnancy(b=-0.249,P=0.010)showed a negative correlation with it.The level of late pregnancy TG(b=0.173,P=0.043)and SFA of umbilical cord blood serum(b=0.190,P=0.017)were positively correlated with LAZ at 12 months,early pregnancy FPG was negatively correlated with WAZ at 12 months(b =-0.173,P=0.047),mid gestation Hb A1 c was negatively correlated with WLA at 12 months(b=-0.189,P=0.041).(6)The multiple linear regression analysis of intelligence development showed that the level of early pregnancy TG(b =-0.212,P=0.016),OGTT-2 h blood glucose(b=-0.161,P=0.044)and late pregnancy SFA(b=-0.218,P=0.027)were negatively correlated with MDI,late pregnancy DHA was positively associated with it(b =0.271,P=0.003).The level of early pregnancy TG(b=-0.186,P=0.045),late pregnancy FPG(b=-0.212,P=0.013)and?-ALA of umbilical cord blood serum(b =-0.237,P=0.006)were all negatively correlated with PDI.Conclusion: The glucose and lipid metabolism dysfunction are both being in GDM.The glucose level is higher in whole pregnancy than control pregnant women.The lipid level is higher at the first and third trimester,lower at the second trimester than control pregnant women.The impact of GDM on physical development of offspring may be different between genders.The development level of intelligence is lower in infants of GDM.We speculate that GDM may have an impact on intelligence development of offspring in infancy.Gestational glucose and lipid level management and giving complementary food duly are all conducive to physical and intelligence development of offspring.