Gestational diabetes and childhood lung function at age 8 to 9 years in a diverse US cohort.

BACKGROUND

Gestational diabetes mellitus (GDM) is associated with systemic processes that may disrupt fetal development and contribute to suboptimal lung function in offspring. Distinct from respiratory conditions such as asthma, lung function is a broad indicator of respiratory health and is predictive of long-term health outcomes. GDM has previously been associated with childhood asthma, but studies on childhood lung function are sparse.

OBJECTIVE

To evaluate the association between GDM and respiratory outcomes in children, including lung function, wheeze, and asthma.

METHODS

We studied mother-child dyads enrolled in a prospective pregnancy cohort (births 2007-2011) and followed to child age 8 to 9 years. We assessed GDM by chart review and measured child lung function using spirometry, characterizing the following outcomes: forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, and forced expiratory flow between 25% and 75% of vital capacity (FEF25-75) (n = 722). We used multiple linear regression to evaluate associations between GDM and lung function z-scores. Then, we assessed child current asthma and wheeze by questionnaire (n = 892) and evaluated their association with GDM using multivariable logistic regression.

RESULTS

GDM was identified in 6% of pregnancies. In children, median (IQR) FEV1, FVC, FEV1/FVC, and FEF25-75 z-scores were -0.47 (-1.14, 0.22), -0.41 (-1.11, 0.31), -0.08 (-0.83, 0.61), and -0.34 (-1.02, 0.38), respectively. With adjustment, GDM-exposed children had lower FEV1 (β = -0.28 [95% CI: -0.55, -0.00]) and FEF25-75 (β = -0.43 [95% CI: -0.76, -0.10]) and increased odds of current asthma (odds ratio = 3.12 [95% CI: 1.55, 6.28]) compared with unexposed children. We observed no differences in other lung function measures.

CONCLUSION

GDM may be a risk factor for decreased lung function and childhood asthma.