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Intensive gestational glycemic management and childhood obesity: a systematic review and meta-analysis

International Journal of Obesity volume 41, pages 999–1004 (2017)Cite this article

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Abstract

Background and objectives:

Hyperglycemia in pregnancy is associated with increased risk of offspring childhood obesity. Treatment reduces macrosomia; however, it is unclear if this effect translates into a reduced risk of childhood obesity. We performed a systematic review and meta-analysis of randomized controlled trials to evaluate the efficacy and safety of intensive glycemic management in pregnancy in preventing childhood obesity.

Methods:

We searched MEDLINE, EMBASE, CENTRAL and ClinicalTrials.gov up to February 2016 and conference abstracts from 2010 to 2015. Two reviewers independently identified randomized controlled trials evaluating intensive glycemic management interventions for hyperglycemia in pregnancy and included four of the 383 citations initially identified. Two reviewers independently extracted study data and evaluated internal validity of the studies using the Cochrane Collaboration’s Risk of Bias tool. Data were pooled using random-effects models. Statistical heterogeneity was quantified using the I2 test. The primary outcome was age- and sex-adjusted childhood obesity. Secondary outcomes included childhood weight and waist circumference and maternal hypoglycemia during the trial (safety outcome).

Results:

The four eligible trials (n=767 children) similarly used lifestyle and insulin to manage gestational hyperglycemia, but only two measured offspring obesity and waist circumference and could be pooled for these outcomes. We found no association between intensive gestational glucose management and childhood obesity at 7–10 years of age (relative risk 0.89, 95% confidence interval (CI) 0.65 to 1.22; two trials; n=568 children). Waist circumference also did not differ between treatment and control arms (mean difference, −2.68 cm; 95% CI, −8.17 to 2.81 cm; two trials; n=568 children).

Conclusions:

Intensive gestational glycemic management is not associated with reduced childhood obesity in offspring, but randomized data is scarce. Long-term follow-up of trials should be prioritized and comprehensive measures of childhood metabolic risk should be considered as outcomes in future trials.

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Acknowledgements

We are thankful for the help of two medical librarians, Angela Osterreicher, BSc MLS of the Health Sciences Libraries of the University of Manitoba, and Becky Skidmore, BA(H) MLS of the Ottawa Integrative Cancer Centre of the Ottawa Hospital Research Institute, who developed the search strategy in consultation with the authors without any compensation. LG, AAS, RZ, TAD and JMM designed the research. LG and AD conducted the search. LG, AAS and RR analyzed the data. LG drafted the manuscript. LG, BW, AAS, TAD and JMM made revisions to the manuscript for important intellectual content. All authors read and approved the final manuscript. LG was supported by a Fonds de Recherche en Santé—Québec Doctoral training award and by the University of Manitoba Graduate Enhancement of Tri-Council Stipends program during this work. RZ is the recipient of a New Investigator Award from the Canadian Institutes of Health Research (CIHR). JMM holds the CIHR Applied Public Health Chair in Resilience and Childhood Obesity. These organizations had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; nor in the preparation, review or approval of this manuscript. Prospero Registration Number: CRD42016038624.

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Authors and Affiliations

  1. Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada

    L Guillemette & A Durksen

  2. and Department of Community Health Sciences, George & Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada

    R Rabbani, R Zarychanski & A M Abou-Setta

  3. Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

    R Zarychanski

  4. Health, Leisure & Human Performance Research Institute, University of Manitoba, and Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada

    T A Duhamel

  5. and Department of Pediatrics and Child Health, Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada

    J M McGavock & B Wicklow

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  1. L Guillemette
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Correspondence to L Guillemette.

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Guillemette, L., Durksen, A., Rabbani, R. et al. Intensive gestational glycemic management and childhood obesity: a systematic review and meta-analysis. Int J Obes 41, 999–1004 (2017). https://doi.org/10.1038/ijo.2017.65

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