Prenatal depression and gestational diabetes are associated with increased risk of childhood obesity

1. Prenatal depression and gestational diabetes were independently associated with a higher risk of childhood obesity within the first 10 years of life, with gestational diabetes showing a greater risk.

2. Children exposed to both conditions had the highest risk of childhood obesity. 

Evidence Rating Level: 2 (Good)

Study Rundown: Gestational diabetes and prenatal depression have each been independently associated with increased risk of childhood obesity. Prenatal depression has also been associated with increased risk of gestational diabetes. Although gestational diabetes and prenatal depression often co-occur, it is unclear whether there is a joint association with risk of childhood obesity. This study thus examined whether gestational diabetes and prenatal depression are independently or jointly associated with risk of childhood obesity.

Parent-child pairs with births between 2011 and 2021 were included and followed up for 10 years. The exposures were gestational diabetes diagnosis and prenatal depression diagnosis and severity, and the primary outcome was childhood obesity. In total, 203,333 birthing parent-child pairs were included in the study. Compared with having neither prenatal depression nor gestational diabetes, prenatal depression was associated with a 5% to 8% higher risk of childhood obesity across offspring’s age group, gestational diabetes was associated with a 29% to 45% higher risk, and joint exposure was associated with 33% to 54% higher risk. Overall, this study found that prenatal depression and gestational diabetes were independently associated with a higher risk of childhood obesity within the first 10 years of life, with gestational diabetes showing a greater risk. Children exposed to both conditions had the highest risk of childhood obesity.

Click to read the study in JAMA Network Open

Relevant reading: The role of inflammation in the development of GDM and the use of markers of inflammation in GDM screening

In-Depth [prospective cohort study]:

This study examined data from Kaiser Permanente Northern California, an integrated health care system. Parent-child pairs with births between 2011 to 2021 were included and followed up for 10 years. The exposures were gestational diabetes diagnosis, and prenatal depression diagnosis and severity. The primary outcome was childhood obesity, defined as Centers for Disease Control and Prevention body mass index z scores > 95th percentile stratified by child age in years. In total, 203,333 birthing parent-child pairs were included (mean [SD] age of birthing parents at the time of delivery, 30.8 [5.3] years; 104,214 male children [51.3%]). Compared with having neither prenatal depression or gestational diabetes, prenatal depression was associated with a 7% higher risk of obesity in children aged 2.0-4.9 years (risk ratios of [RR], 1.07; 95% CI, 1.04-1.10), 8% higher in children aged 5.0-7.9 years (RR, 1.08; 95% CI, 1.04-1.12]), and 5% higher risk in children aged 8.0-10.0 years (RR, 1.05; 95% CI, 1.00-1.11).  Gestational diabetes was associated with a 29% higher risk of obesity in children aged 2.0-4.9 years (RR, 1.29; 95% CI, 1.25-1.34), 45% risk in children aged 5.0-7.9 years (RR, 1.45; 95% CI, 1.40-1.51), and 39% in children aged 8.0-10.0 years (RR, 1.39; 95% CI, 1.31-1.46). Joint exposure to gestational diabetes and depression was associated with a 33% higher risk of obesity in children ages 2.0 to 4.9 (RR, 1.33 [95% CI, 1.23-1.44), 54% higher risk in children aged 5.0 to 7.9 years (RR, 1.54; 95% CI, 1.41-1.69), and 43% higher risk in children aged 8.0 to 10.0 years (RR, 1.43; 95% CI, 1.25-1.64). There was no evidence of interaction, suggesting that combined effects were additive rather than synergistic. After adjusting for prepregnancy body mass index, only the association for the 5.0 to 7.9 years age group remained significant for joint results. Overall, this study found that prenatal depression and gestational diabetes were independently associated with a higher risk of childhood obesity within the first 10 years of life, with gestational diabetes showing a greater risk. Children exposed to both conditions had the highest risk of childhood obesity, particularly at ages 5.0 to 7.9 years. These findings support the need for prenatal risk stratification and targeted interventions for children exposed to these conditions in utero. Some strengths of this study include a large, racially and ethnically diverse cohort that increases generalizability, using objective plasma glucose values to diagnose gestational diabetes, and longitudinal follow-up. Some limitations of this study include the observational nature that prevents causal inference and the potential for residual confounding, such as postnatal factors that may influence childhood obesity. Future studies should address these limitations and confirm study results.

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