Diabetes
Long-Term Renal Consequences of Fetal Exposure to Maternal Diabetes – Results from the TEAM Study Shelley Ehrlich* Shelley Ehrlich Ehrlich Ehrlich Cincinnati Children’s Hospital Center
While in utero exposure to maternal diabetes mellitus is associated with increased adverse health outcomes in offspring, including obesity, insulin resistance and diabetes, human evidence regarding in utero exposure to maternal diabetes and long-term renal disease risk in offspring is limited. The goal of this study was to determine 1) if there is a transgenerational effect of in utero exposure to dysglycemia on renal health outcomes in adult offspring of women with insulin dependent diabetes mellitus (IDDM); 2) to identify the gestational periods where glycemic dysregulation is most predictive of adverse renal outcomes in adulthood. The Transgenerational Effects on Adult Morbidity (TEAM) Study followed-up offspring of mothers with pre-pregnancy IDDM, who participated in a Program Project Grant (PPG). These women were closely monitored with detailed characterization of glycemic measures across pregnancy in addition to having obstetric and delivery data. Offspring participated in a complete clinical exam, which included markers of renal function (estimated glomerular filtration rate (eGFR), and urine albumin creatinine ratio (UACR)). Linear and logistic regression were used to identify associations between trimester-specific maternal glycohemoglobinA1 standard deviation (HbA1SD) and maternal glucose profiles (functional PCA) with offspring eGFR and UACR, adjusting for covariates (maternal history of microvascular disease, hypertensive disorders of pregnancy, BMI at LMP). In 161 offspring (mean age 32.3 years) increased HbA1SD and increased fluctuations in blood glucose levels in the third trimester were associated with lower eGFR, Also, increased HbA1SD in all 3 trimesters and higher fluctuations in trimester 2 were associated with increased UACR. Our findings indicate an association between maternal glycemia, as early as the first trimester of pregnancy, and decreased renal function in adult offspring.