Dana Dabelea, MD, PhD, Principal Investigator.
EPOCH is a longitudinal study of adolescents and their long-term health outcomes related to whether they were exposed to mother’s diabetes during pregnancy. While it is known that a mother with diabetes during pregnancy increases the risk of childhood obesity and diabetes, many other things are not known, including whether infant or childhood feeding changes these outcomes.
Researchers Involved: Dana Dabelea, Katherine Sauder, Allison Shapiro, Christy Hockett, Anna Bellatorre, Wei Perng
Offspring diet quality modifies the effect of gestational diabetes exposure on adiposity outcomes: The EPOCH study
Sauder KA, Bekelman TA, Harrall K, Glueck DH, Dabelea D. Poster presentation at American Diabetes Association 79th Scientific Sessions, San Francisco, CA, June 2019.
Intrauterine exposure to gestational diabetes (GDM) is associated with increased adiposity; however, not all exposed offspring exhibit excess adiposity, indicating that additional factors are involved. We examined whether higher diet quality in childhood and adolescence modifies the association between GDM exposure and adiposity outcomes. In 499 offspring (n=88 GDM-exposed), we assessed dietary intake (via food frequency questionnaire) and adiposity (BMI, waist-to-height ratio, visceral and subcutaneous adipose tissue [VAT, SAT], and subscapular-to-triceps skinfold ratio) at 6-12 and 12-19 years of age. Diet quality was estimated with the Healthy Eating Index (HEI). Linear mixed models were used to examine the association between GDM exposure and adiposity among those with higher (HEI>60) versus lower (HEI<60) diet quality, adjusting for sex, race/ethnicity, age, and pubertal status. Among those with lower diet quality, exposure to GDM was associated with increased adiposity for all outcomes (all p<0.05; Table). Among those with higher diet quality, there was no association between GDM exposure and adiposity outcomes (all p>0.05). Our results suggest that higher diet quality in childhood and adolescence may be a potential postnatal strategy for reducing adiposity among offspring exposed to GDM.
Table: Measures of adiposity (mean, SE) among youth with high and low diet quality, stratified by GDM exposure.
||HEI < 60
||HEI > 60
||HEI x GDM
|Waist to height ratio
Sauder KA, Hockett CW, Ringham BM, Glueck DH, Dabelea D. Fetalovernutrition and offspring insulin resistance and beta-cell function: theExploring Perinatal Outcomes among Children (EPOCH) study. Diabet Med. 2017;34(10):1392-1399.
Abstract: To examine the associations of intrauterine
exposure to maternal diabetes and obesity with offspring insulin resistance,
beta-cell function and oral disposition index in a longitudinal observational
study of ethnically diverse offspring. METHODS: A total of 445 offspring who
were exposed (n=81) or not exposed (n=364) to maternal diabetes in utero
completed two fasting blood measurements at mean (sd) ages of 10.5 (1.5) and
16.5 (1.2) years, respectively, and an oral glucose tolerance test at the
second visit. We used linear mixed models and general linear univariate models
to evaluate the associations of maternal diabetes and pre-pregnancy BMI with
offspring outcomes. RESULTS: Maternal diabetes in utero predicted increased
insulin resistance [18% higher updated homeostatic model assessment of insulin
resistance (HOMA2-IR), P=0.01; 19% lower Matsuda index, P=0.01 and 9% greater
updated homeostatic model assessment of beta-cell function (HOMA2-beta),
P=0.04]. Each 5-kg/m(2) increase in pre-pregnancy BMI predicted increased insulin
resistance (11% greater HOMA2-IR, P<0.001; 10% lower Matsuda index,
P<0.001; 6% greater HOMA2-beta, P<0.001). Similar results were obtained
in a combined model with both exposures. After adjustment for offspring BMI,
only maternal diabetes was associated with higher HOMA2-IR (beta=1.12, P=0.03)
and lower Matsuda index (beta=0.83, P=0.01). Neither exposure was associated
with early insulin response or oral disposition index. CONCLUSIONS:
Intrauterine exposure to diabetes or obesity is associated with greater
offspring insulin resistance than non-exposure, supporting the hypothesis that
fetal overnutrition results in metabolic abnormalities during childhood and
Epigenetic Markers of In Utero Exposure to Diabetes
An EPOCH Ancillary Study
Dana Dabelea, MD, PhD, is the Principal Investigator.
Epigenetics is a method for turning on and off genes without changing the genes themselves (like a program on a computer that does not change the computer itself). One of the possible ways that a mother’s diabetes during pregnancy might affect their offspring is through this mechanism.
Researchers involved: Dana Dabelea, Katerina Kechris, Ivana Yang, Weiming Zhang