Background: Gestational Diabetes Mellitus (GDM) has been linked with later metabolic
abnormalities in offspring due to subsequent overweight and obesity. In Sub-Saharan Africa,
there is a paucity of data on the outcomes of children exposed to GDM in utero.
Aims: The primary aim of this sub-study was to investigate the prevalence of overweight and
obesity in 5 and 6-year-old children from GDM complicated pregnancies and macrosomia at
birth in the same cohort. The secondary aim was to identify risk factors associated with
overweight and obesity in these 5 and 6-year-old children.
Outcome measures: The main outcome was the prevalence of overweight and obesity in
these children as measured by their age-specific body mass index (BMI) and Z-scores.
Additionally, the association between other risk factors, overweight and obesity was
investigated.
Methods: A cross-sectional sub-study design was employed nested within a larger study that
is investigating the progression to type 2 diabetes in women managed for GDM during 2010
and 2011. Mothers who participated in the larger study were informed about the sub-study and
invited to allow their children to participate in the sub-study. Written informed consent was
obtained from the mothers for the sub-study. The following data were collected: anthropometric
data at birth and pregnancy related information from the mothers’ hospital record, additional
demographic, social and medical information by questionnaire from the mother and at the
research center. In addition, the children were weighed and had their height measured using
standardized methods. Anthropometry was standardized using WHO standards. Risk factors
for overweight and obesity were tested using a BMI>1 Z-score cut-off, (as a binary variable) in
a manual multivariate logistic regression model.
Results: The sub-study recruited 176 participants; 78 boys (44.3%) and 98 girls (55.7%). The
mean (SD) Z-scores for the children’s anthropometry at ages 5 to 6 years were 0.28 (1.40) for
weight, 0.01 (1.07) for height and 0.37 (1.63) for BMI. The overall prevalence of macrosomia
at birth (birth weight>4000 gm) was 12.3 % (95% CI 8.2-9.1). The overall prevalence of
overweight in the 5 and 6-year-old children was 13.4% (95% CI 8.6-20.4), while the prevalence
of obesity was 14.2% (95% CI 9.2-21.2). The combined prevalence of overweight and obesity
was 27.6% (95% CI 20.6-35.9). The prevalence of macrosomia (P=0.53) or overweight/obesity
proportions (P=0.37) at ages 5 to 6 years did not differ by gender. In multivariate logistic
regression analysis, factors independently associated with the risk of overweight and obesity
were: mothers’ oral glucose tolerance test 2-hour blood glucose level during pregnancy
(AOR=2.06, 95% CI 1.14-3.74, P=0.02), birth weight (AOR=1.00, 95% CI 1.00-1.00, P=0.01),
child’s age in years (AOR=0.03, 95% CI 0.002-0.29, P=0.004) and number of adults in the
house (AOR=0.38, 95% CI 0.17-0.86, P=0.02).
Conclusion: This is the first study to report the prevalence of overweight and obesity in
children born from GDM complicated pregnancies, in the Western Cape, South Africa. The
combined prevalence of overweight and obesity found in 5 and 6-year-old children exposed to
GDM in the Western Cape is higher than overweight and obesity in children reported in other
South African studies. This can imply a higher tendency towards overweight and obesity in
children exposed to GDM which needs further exploration.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uct/oai:localhost:11427/29982 |
| Date | 10 May 2019 |
| Creators | Haynes, Magret C. |
| Contributors | Kyriacos, Una, Levitt, Naomi S., Chivese, Tawanda |
| Publisher | Faculty of Health Sciences, Division of Nursing and Midwifery |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Master Thesis, Masters, MSc (Nursing) |
| Format | application/pdf |
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