Research Article: Prenatal exposure to gestational diabetes mellitus increases developmental defects in the enamel of offspring

Date Published: February 27, 2019

Publisher: Public Library of Science

Author(s): Tawana Pascon, Angélica M. P. Barbosa, Rita C. L. Cordeiro, Diego G. Bussaneli, Caroline B. Prudencio, Sthefanie K. Nunes, Fabiane A. Pinheiro, Grasiela Bossolan, Leandro G. Oliveira, Iracema M. P. Calderon, Gabriela Marini, Marilza V. C. Rudge, Víctor Sánchez-Margalet.


Gestational diabetes mellitus (GDM) is associated with short- and long-term maternal and perinatal repercussions. Our objective was to evaluate the long-term consequences of intrauterine exposure to hyperglycemia on Developmental Defects of Enamel (DDE) in offspring.

Overall, 50 children of women with GDM and 250 children of normoglycemic women participated, the latter serving as controls. Children were examined at the age between 3 and 12 years. In addition to physical examination, two independent observers examined and rated photographs to identify specific types of DDE in a blinded fashion. Among offspring of mothers with GDM, rates of DDE (all types combined) and hypoplasia (specific type) were significantly higher (p<0.001, p = 0.04), in comparison to offspring of normoglycemic mothers. Considering only the affected teeth (1060 in GDM category; 5499 in controls), rates of DDE (all types combined) were significantly higher for total teeth (p <0.001) and deciduous teeth (p<0.001), but not permanent teeth. In specific types of DDE involving deciduous teeth, rates of demarcate opacity were significantly higher (p<0.001; canine and 2nd mandibular molars) and hypoplasia (p <0.001; 2nd maxillary molars and 2nd mandibular molars). In permanent teeth, the rate of diffuse opacity in association with GDM was significantly higher (p<0.001; maxillary central incisors and 1st maxillary molars). GDM was associated with the adverse effects of DDE on offspring. This study lays the foundation for future studies to determine the impact of GDM on long-term risk of DDE.

Partial Text

Gestational diabetes mellitus (GDM) [1, 2] is associated with an increased risk of complications for both mother and baby during pregnancy as well as the postpartum period [3–6]. GDM is also associated with short- and long-term repercussions [7–11]. The effects of the diabetic intrauterine environment during gestation cannot be ignored and extend beyond those apparent at birth [12]. Currently, infant survival is the norm, but the long-term effects on the offspring of GDM mothers who are born today may differ from those reported many years ago.[13–16].

Table 1 compares demographic and anthropometric data among offspring of mothers with and without gestational diabetes mellitus, along with numbers of deciduous and permanent teeth evaluated. Among women with GDM, white ethnicity and overweight/obesity both occurred more frequently when compared to normoglycemic women.

Our findings showed higher rates of DDE and hypoplasia in the offspring of mothers with gestational diabetes. The logistic model adjusted for the gender, ethnicity and BMI of the newborns shows a higher risk of DDE and demarcated opacity in the offspring exposed to GDM.

In conclusion, in the present study, GDM was independently associated with the adverse effects of DDE on offspring, and the most common type of DDE that was associated with GDM was demarcated opacity. The prevalence of DDE was significantly higher in the offspring of GDM mothers, and the type of DDE with the highest rate of occurrence was hypoplasia. It was also concluded that there was a higher proportion of teeth with DDE in the offspring of GDM mothers; moreover, in the GDM group, the deciduous dentition had a significantly higher proportion of demarcated opacity and hypoplasia, and the permanent dentition had a significantly higher proportion of diffuse opacity. This study lays the foundation for future studies to determine the impact of GDM on long-term risk of DDE.




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