2162-P: Reaching Glycemic Targets in Gestational Diabetes (GDM) Attenuates Early Menarche Risk in Offspring

Introduction and Objective: In utero exposure to GDM is associated with earlier menarche, a risk factor for diabetes and cardiovascular disease. However, the role of glycemic targets (GT) during pregnancy is unknown. We evaluated whether reaching GT during GDM-complicated pregnancies reduces offspring risk of early menarche to levels comparable to those unexposed to GDM in utero. Methods: This study included mothers who delivered at Kaiser Permanente Northern California (2006-2012) and their offspring with teen well visit questionnaire data on age at menarche. Among GDM pregnancies, GT was assessed using self-monitored blood glucose data. Reaching GT was defined as ≥80% of values <95mg/dL for fasting and <140mg/dL for 1-hour postprandial glucose. Linear and log Poisson regressions adjusted for maternal race and age at delivery compared age at menarche (years) and risk of menarche <12 years in offspring of individuals without GDM (n=3,248), with GDM and reached GT (n= 128), and GDM and unreached GT (n=116). Results: Mothers were 28% Asian, 7% Black, 27% Hispanic, and 32% White. Mean age at menarche in offspring was 11.6±1.2 for those without GDM, 11.6±1.3 for GDM and reached GT, and 11.3±1.4 for GDM and unreached GT. There was no significant difference in menarche age between offspring of mothers with GDM and reached GT and those of mothers without GDM (β= −0.03; 95% CI: −0.26, 0.21), nor in risk of menarche <12 years (RR = 1.10; 95% CI: 0.92, 1.31). In contrast, offspring of mothers with GDM and unreached GT experienced menarche approximately 3 months earlier (β =−0.27; 95% CI: −0.52, −0.02) and had significantly higher risk of menarche <12 years (RR=1.22; 95% CI: 1.03,1.45) compared with offspring of mothers without GDM. In a subset of 634 mothers with pre-pregnancy BMI (ppBMI) available, models additionally adjusted for ppBMI gave similar results. Conclusion: These findings suggest that reaching GT during GDM pregnancies may mitigate the risk of early menarche in exposed offspring and highlight an opportunity for risk stratification and intervention.