2147-P: Associations of Gestational Diabetes Mellitus Subtypes with Offspring Adiposity Trajectories from Birth to Adolescence

Introduction and Objective: Gestational diabetes mellitus (GDM) is associated with offspring adiposity, but it remains unclear whether specific GDM subtypes better predict offspring long-term adiposity trajectories. We aimed to identify specific GDM subtypes associated with offspring adiposity trajectories from birth to adolescence. Methods: Three distinct GDM subtypes were identified in 207 out of 1,610 participants in original HAPO Hong Kong cohort by K-means clustering, using maternal age, prepregnant BMI, gestational weight change percent (GWC%), insulin sensitivity, and insulin secretion in mid-gestation. Offspring adiposity was analyzed in 568 mother-child pairs (72 were GDM) from HAPO follow-up studies, with assessments during pregnancy, at delivery, and at 7 and 10 years postpartum. Adiposity was assessed using sum of skinfold thickness (SSF). Linear mixed-effect model (LMM) evaluated associations of GDM subtypes with progression of offspring adiposity, and group-based trajectory model (GBTM) identified distinct adiposity trajectories. Results: Three clusters were identified: Cluster 1 (C1, 30.4%) as older age, high prepregnant BMI, low GWC%, and insulin resistant; Cluster 2 (C2, 26.1%) as younger age with high GWC% and insulin resistant; and Cluster 3 (C3, 43.5%) as older age with high insulin sensitivity but low insulin secretion. Offspring of mothers with GDM in C1 had higher SSF across stages (P 0.05). In LMM, C1 was associated with a greater increase in SSF over time (β = 1.33; 95% CI 0.40, 2.26; P = 0.005). GBTM identified two SSF trajectories: slowly increasing (74.1%) and rapidly increasing (25.9%). Compared to mothers without GDM, offspring of mothers with GDM in C1 were associated with a 2.94-fold increased risk (95% CI 1.14, 7.62; P = 0.024) of a rapidly increasing trajectory. Conclusion: Offspring of mothers with GDM in C1 had higher SSF and the highest risk for a rapidly increasing adiposity trajectory from birth to adolescence, highlighting the need for precision interventions to reduce offspring adiposity risk. Disclosure H. Wu: None. C.H. Tam: None. R. Ma: Research Support; Current; AstraZeneca. Speaker's Bureau; Ended; AstraZeneca. Research Support; Current; Boehringer Ingelheim International GmbH. Advisory Panel; Ended; Boehringer Ingelheim International GmbH. Research Support; Ended; Roche Diagnostics. Speaker's Bureau; Current; Roche Diagnostics. Speaker's Bureau; Ended; Eli Lilly and Company. Research Support; Ended; Novo Nordisk. Stock/Shareholder; Current; GemVCare Ltd. R. Wang: None. Funding General Research Fund (14102719) and Areas of Excellence Scheme (AoE/M-401/24R) from Research Grants Council of Hong Kong SAR, China