Abstract
INTRODUCTION: Gestational diabetes mellitus (GDM) is associated with various health risks in offspring. We investigated the effect of GDM exposure on offspring morbidity in a population-based cohort, assessed by the utilization of specialized health care services up to 12 years of age. MATERIAL AND METHODS: This register-based study, part of the Finnish Gestational Diabetes (FinnGeDi) study, included all singleton children born in Finland in 2009, captured from the Medical Birth Registry. Mothers of children in the study cohort underwent comprehensive screening for GDM. The study cohort included 6235 (11.1%) GDM-exposed children and 49 484 unexposed children. Utilization of specialized health care services was measured as the number of outpatient visits and inpatient treatment episodes (including duration in days). Data were obtained from the Finnish Care Register for Health Care up to 12 years of age and were analyzed separately for early childhood (0-2 years), preschool age (3-6 years), and school age (7-12 years) also. Maternal, birth, and child-related factors were considered, including maternal age, pre-pregnancy body mass index (BMI), parity, maternal hypertensive disorders, socioeconomic status (SES), smoking status, mode of delivery, preterm birth, small for gestational age, and child sex in the adjustment model. RESULTS: Children exposed to maternal GDM had a higher incidence of outpatient visits than unexposed children (adjusted incidence rate ratio [IRR] 1.10, 95% confidence interval [CI] 1.07-1.13). Among children with multiple outpatient care visits (the highest quartile), GDM-exposed children were overrepresented in early childhood (adjusted odds ratio [aOR] 1.08, 95% CI: 1.00-1.15), preschool age (aOR 1.12, 95% CI: 1.05-1.19), and school age (aOR 1.11, 95% CI: 1.04-1.19). Children exposed to GDM were also more likely to require inpatient treatment than unexposed children (adjusted IRR 1.14, 95% CI: 1.10-1.19). The difference was not explained by shorter episodes (adjusted IRR 1.20, 95% CI: 1.16-1.24 for inpatient treatment days). CONCLUSIONS: Children exposed to maternal GDM required more specialized health care services than unexposed children, with increased utilization of specialized health care observed across all age categories up to 12 years of age.