Central Adiposity, Rather Than in Utero Exposure to Maternal Obesity or Gestational Diabetes, Predicts Metabolic Syndrome Risk in Children Aged 4-10 Years.

BACKGROUND

Children born to mothers with obesity or gestational diabetes mellitus (GDM) face elevated risks of central adiposity and adverse cardiometabolic outcomes, including metabolic syndrome (MetS) and systemic inflammation. However, it remains unclear whether these risks are primarily driven by current adiposity or by in utero exposure. This study investigated associations between waist circumference (WC), waist-to-height ratio (WHtR), and continuous MetS (cMetS) scores in children, and evaluated whether in utero exposure to maternal obesity or GDM moderated these relationships. Associations between cMetS and cardiometabolic biomarkers were also examined.

METHODS

Children were grouped by maternal early-pregnancy weight status and GDM diagnosis: (1) normal weight without GDM, (2) overweight/obesity without GDM, and (3) overweight/obesity with GDM. WC was classified as < 85th or ≥ 85th percentile; WHtR as < 0.5 or ≥ 0.5. cMetS scores were computed with and without the WC component. Group differences and associations were assessed using ANCOVA and correlation analyses.

RESULTS

WC and WHtR were strong predictors of cMetS, independent of in utero exposure group. Children with WC ≥ 85th percentile or WHtR ≥ 0.5 had significantly higher cMetS scores (p < 0.0001), even when WC was excluded from the cMetS calculation. cMetS was inversely correlated with adiponectin and positively correlated with leptin, the leptin-to-adiponectin ratio, HOMA-IR, CRP, and IL-6 (all p < 0.01).

CONCLUSIONS

Central adiposity-indexed by WC or WHtR-rather than in utero exposure, is the primary driver of cardiometabolic risk. Associations between cMetS and cardiometabolic biomarkers underscore insulin resistance and adipose tissue dysfunction as key mechanisms underlying MetS in children.