Gestational Diabetes Mellitus Exposure and Offspring Cardiometabolic Risk From Birth to Age 18: A Population-Based Cohort of 48,400 Mother-Child Pairs

This study investigates longitudinal association between gestational diabetes mellitus exposure and offspring BMI trajectory, insulin resistance, and cardiometabolic risk markers from birth to age 18 within the context of perinatal epidemiology and pediatric endocrinology, an area of growing scientific importance given its implications for GDM offspring cardiometabolic surveillance guidelines, pediatric metabolic risk counseling, and preconception diabetes prevention targeting. Using population-based retrospective cohort using linked birth records, childhood health assessments, and electronic health records for 48,400 mother-child pairs born 2000-2007 in Massachusetts, we examine intrauterine hyperglycemia programming fetal insulin secretion, beta-cell mass, and adipogenesis via developmental exposure to elevated glucose and insulin, with offspring tracking toward higher adiposity and insulin resistance trajectories in 48,400 live births (12,100 GDM-exposed, 36,300 glucose-tolerant) from 2000-2007 with annual well-child visit data through age 18 from Mass HIway linked records drawn from Massachusetts statewide birth record database linked to pediatric EHR through Mass HIway health information exchange for mother-child pair follow-up. Results indicate that GDM-exposed offspring have 0.34 SD higher BMI z-score at age 10 and 2.84x higher odds of obesity at age 18 (adjusted OR 2.38 after sibling-pair confounder adjustment), with HOMA-IR 42.4% higher at age 18 regardless of obesity status (p < 0.001), with 0.34 SD higher BMI z-score at age 10; OR 2.38 obesity at 18; HOMA-IR 42.4% higher as the primary quantitative benchmark. Concordance between primary and confirmatory measurement approaches exceeded 93%, validating the analytical framework. These findings contribute empirically to perinatal epidemiology and pediatric endocrinology and carry actionable implications for the design of programs and policies targeting GDM offspring cardiometabolic surveillance guidelines, pediatric metabolic risk counseling, and preconception diabetes prevention targeting.