N A L A R T I C L E Effects of Maternal Gestational Diabetes and Adiposity on Neonatal Adiposity and Blood Pressure BETTY R. VOHR, MD STEPHEN T. MCGARVEY, PHD CYNTHIA GARCIA COLL, PHD OBJECTIVE — To determine the effects of maternal factors, including prepregnancy maternal adiposity, weight gain during pregnancy, degree of abnormality of the glucose tolerance test, glycemia during pregnancy, and treatment with insulin versus diet therapy, on neonatal body weight, adiposity, and blood pressure in infants of mothers with gesta- tional diabetes (IGDM) and control patients. RESEARCH DESIGN AND METHODS— A total of 119 term IGDM, including 57 large-for-gestational-age (LGA) and 62 appropriate-for-gestational-age (AGA) infants, and 143 term control infants, including 74 LGA and 69 AGA infants, were prospectively enrolled. Maternal measurements of prepregnancy weight, height, and weight gain were abstracted from medical records. A diagnosis of gestational diabetes was made on the basis of an initial 1-h 50-g glucose screen value ^130 mg/dl followed by two abnormal values in a 100-g oral glucose tolerance test. Infant anthropometric measurements were obtained, and blood pressure was measured on day 2 of life. Correlation analyses and multiple regression analyses were performed to assess the relationships among maternal factors and neonatal adiposity and blood pressure. RESULTS — Multiple regression analyses to determine the effects of significant maternal factors on infant body mass index (BMI) revealed that prepregnancy weight and weight gain were significant predictors for both IGDM and control infants. An increased glucose screen predicted BMI for control subjects, whereas the mean 2nd and 3rd trimester glucose values were the significant predictors for IGDM. Also, increased newborn triceps skinfold thick- ness measurements correlated with increased systolic blood pressure for IGDM (r = 0.29, P < 0.03). CONCLUSIONS— Increased maternal prepregnancy weight, weight gain in preg- nancy, and glycemia in pregnancy all place IGDM at increased risk of macrosomia and adiposity. Increased adiposity in the IGDM appears to be related to increased infant blood pressure. Longitudinal evaluation is needed to determine whether neonatal adiposity in IGDM is predictive of increased adiposity and blood pressure during childhood. From the Department of Pediatrics (B.H.V., C.G.C.), Women and Infants' Hospital, and Department of Medicine (S.T.M.), Miriam Hospital, Providence, Rhode Island. Address correspondence and reprint requests to Betty R. Vohr, MD, Director, Neonatal Follow-up Clinic, Department of Pediatrics, Women and Infants' Hospital of Rhode Island, 101 Dudley St., Providence, RI 02905. Received for publication 13 July 1994 and accepted in revised form 21 December 1994. AGA, appropriate for gestational age; LGA, large for gestational age; BMI, body mass index; GDM, gestational diabetes mellitus; IGDM, infants of mothers with gestational diabetes; SES, socioeconomic status. P eterson (1) proposed in 1952 that maternal hyperglycemia may produce fetal hyperglycemia and hyperinsulin- ism, resulting in increased birth size and macrosomia (birth weight >90th pereen- tile). Since that time, multiple studies have evaluated the relationships among maternal diabetes, infant size, and subsequent adi- posity (2-5). Infants of mothers with gesta- tional diabetes (IGDM) have been shown to be at risk for macrosomia (5). Because ges- tational diabetes mellitus (GDM) occurs in 2-3% of all pregnancies, pediatric sequelae associated with macrosomia and adiposity are clearly an important health care con- cern. Adiposity in children has been strongly correlated with higher childhood systolic and diastolic blood pressure values (6-9). This is significant because children with elevated blood pressure appear more likely to become adults with hypertension, which may be a serious life-threatening morbidity with increasing age. The purpose of the present study was to evaluate the effects of maternal fac- tors, including prepregnancy maternal adiposity, weight gain during pregnancy, degree of abnormality of the oral glucose tolerance test, glycemia during preg- nancy, and treatment with insulin versus diet therapy, on neonatal body weight, adiposity, and blood pressure in IGDM and control infants. We hypothesized that increased maternal adiposity, in- creased weight gain in pregnancy, and in- creased abnormality of the glucose screen and glycemia during a GDM pregnancy would contribute to increased total and central adiposity in IGDM. Furthermore, we hypothesized that increased adiposity in IGDM would be correlated with in- creased infant blood pressure. RESEARCH DESIGN AND METHODS— GDM and control mother-infant dyads were prospectively enrolled in this study between 1 October 1991 and 29 June 1993. All mothers were screened for GDM in a universal screen program instituted at Women and In- fants' Hospital in 1982. Women are screened at 24-28 weeks of gestation, and a diagnosis of GDM is made on the basis of an initial 1-h 50-g glucose screen value DIABETES CARE, VOLUME 18, NUMBER 4, APRIL 1995 467