Diabetes appears to diminish the in general more favorable cluster of risk factors of females compared with males, leading to greater differences
in central adiposity and risk factors related to coagulation and inflammation between diabetes and nondiabetes in women rather than in men (33).
Regarding the child, the importance of the intrauterine and early postnatal environments for metabolic programming and modifications of the epigenome is increasingly recognised, 12 — 14 particularly for metabolic diseases such as obesity and diabetes.15 Thus, GDM is related to macrosomia at birth (> 4 kg), to excess body fat and (
central) obesity and to insulin secretion
in infants and children, the obesity being
in part mediated by maternal body mass index (BMI) or birth weight.16 — 23 Intrauterine exposure to GDM also doubles the risk for subsequent type 2 diabetes
in offspring compared with offspring of mothers with a high genetic predisposition for type 2 diabetes, but with normal glucose tolerance during the index pregnancy.24 Maternal prepregnancy overweight and excessive gestational weight gain also predict high birth weight and
adiposity during infancy.12 25 This is highly relevant, as up to 60 % — 70 % of women with GDM are overweight or obese before pregnancy.26 Finally, maternal lifestyle behaviour such as a high fat diet or lack of physical activity during pregnancy can influence offspring
adiposity independent of maternal obesity.12 27