Children exposed to gestational diabetes mellitus (GDM) have a higher risk of obesity, but whether offspring risk differs according to maternal glycemic management during pregnancy remains unclear. An analysis published in Diabetes Care evaluated whether trajectories of glycemic management after GDM diagnosis were associated with childhood body mass index (BMI) and obesity risk compared with offspring unexposed to GDM.

The population-based prospective cohort included individuals who delivered within Kaiser Permanente Northern California between 2011 and 2017 and their offspring, with BMI measurements recorded between ages 2 and 10 through 2022. Glycemic management trajectories were defined from the time of GDM diagnosis to delivery using glucose monitoring data, with optimal control defined as at least 80% of glucose values meeting American Diabetes Association targets. Associations with offspring BMI and obesity risk were estimated using adjusted generalized estimating equations.

Among 206,464 pregnancies, 14,870 (7.2%) were complicated by GDM. Four glycemic management trajectories were identified: stably optimal (T1), rapidly improving to optimal (T2), slowly improving to near optimal (T3), and slowly improving to suboptimal (T4). Associations showed a dose-response pattern across T1 through T4. By age 10, offspring in T1 had BMI (β = 0.27 [95% CI −0.13, 0.66]) and obesity risk (risk ratio 1.07 [0.91, 1.26]) similar to those unexposed to GDM. Offspring in T2, T3, and T4 had progressively higher BMI (1.00 [0.55, 1.46], 1.22 [0.67, 1.76], and 2.15 [1.48, 2.49]) and obesity risk (1.37 [1.18, 1.59], 1.53 [1.29, 1.81], and 1.62 [1.33, 1.98]). Associations were attenuated but remained after adjustment for prepregnancy BMI.

These findings indicate that early and sustained glycemic management after GDM diagnosis corresponded to lower childhood obesity risk that was comparable to that of offspring unexposed to GDM.