{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:52:09Z","timestamp":1787025129587,"version":"build-2736575974"},"reference-count":40,"publisher":"American Diabetes Association","issue":"5","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"DOI":"10.13039\/100000071","name":"National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["K99HD115836"],"award-info":[{"award-number":["K99HD115836"]}],"id":[{"id":"10.13039\/100000071","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Kaiser Permanente Northern California\u2019s Central Research Committee Community Health grant","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["1R01HL157666"],"award-info":[{"award-number":["1R01HL157666"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["K01DK120807"],"award-info":[{"award-number":["K01DK120807"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["P30-DK092924"],"award-info":[{"award-number":["P30-DK092924"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["P30DK092924"],"award-info":[{"award-number":["P30DK092924"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Children exposed to gestational diabetes mellitus (GDM) face an increased risk of obesity. We examined whether offspring obesity risk varied by maternal glycemic management trajectories during pregnancy compared with offspring unexposed to GDM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>This population-based prospective cohort included individuals who delivered at Kaiser Permanente Northern California (2011\u20132017) and their offspring with BMI measured at ages 2\u201310 years through 2022. Glycemic management trajectories (optimal \u226580% of glucose values meeting American Diabetes Association targets) were identified from GDM diagnosis to delivery. Associations with offspring BMI and obesity risk were estimated using adjusted generalized estimating equations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Among 206,464 pregnant individuals, 14,870 (7.2%) had GDM, among whom four glycemic management trajectories were identified: stably optimal (T1), rapidly improving to optimal (T2), slowly improving to near optimal (T3), and slowly improving to suboptimal (T4). Associations showed a dose-response pattern across T1\u2013T4. By age 10, offspring in T1 had BMI (\u03b2 = 0.27 [95% CI \u22120.13, 0.66]) and obesity risk (risk ratios 1.07 [0.91, 1.26]) similar to those of offspring unexposed to GDM. In contrast, offspring in T2, T3, and T4 had progressively higher BMI (1.00 [0.55, 1.46], 1.22 [0.67, 1.76], and 2.15 [1.48, 2.49]) and obesity risk (1.37 [1.18, 1.59], 1.53 [1.29, 1.81], and 1.62 [1.33, 1.98]). Associations were attenuated but persisted after adjustment for prepregnancy BMI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Early and sustained glycemic management after GDM diagnosis was associated with lower childhood obesity risk comparable to that in offspring unexposed to GDM. These findings suggest an opportunity for prenatal risk stratification and prevention for children at higher obesity risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc25-1643","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T17:01:36Z","timestamp":1772643696000},"page":"772-782","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":2,"title":["Gestational Diabetes Mellitus, Glycemic Management Trajectories, and Offspring Growth Patterns and Obesity Risk"],"prefix":"10.2337","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3558-9006","authenticated-orcid":false,"given":"Rana F.","family":"Chehab","sequence":"first","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California 1 , Pleasanton, CA"},{"name":"Center for Upstream Prevention of Adiposity and Diabetes Mellitus (UPSTREAM), Kaiser Permanente Northern California 2 , Pleasanton, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mara B.","family":"Greenberg","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Kaiser Permanente Northern California 3 , Oakland, CA"},{"name":"Regional Perinatal Service Center, Kaiser Permanente Northern California 4 , Santa Clara, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of California 5 , San Francisco, San Francisco, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda L.","family":"Ngo","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California 1 , Pleasanton, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juanran","family":"Feng","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California 1 , Pleasanton, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7296-738X","authenticated-orcid":false,"given":"Yeyi","family":"Zhu","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California 1 , Pleasanton, CA"},{"name":"Center for Upstream Prevention of Adiposity and Diabetes Mellitus (UPSTREAM), Kaiser Permanente Northern California 2 , Pleasanton, CA"},{"name":"Department of Epidemiology and Biostatistics, University of California 5 , San Francisco, San Francisco, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7505-4826","authenticated-orcid":false,"given":"Assiamira","family":"Ferrara","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California 1 , Pleasanton, CA"},{"name":"Center for Upstream Prevention of Adiposity and Diabetes Mellitus (UPSTREAM), Kaiser Permanente Northern California 2 , Pleasanton, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"2026061812473700200_B1","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1001\/jamapediatrics.2022.2052","article-title":"Trends in obesity prevalence among children and adolescents aged 2 to 19 years in the US from 2011 to 2020","volume":"176","author":"Hu","year":"2022","journal-title":"JAMA Pediatr"},{"key":"2026061812473700200_B2","first-page":"1","article-title":"Trends and characteristics in gestational diabetes: United States, 2016-2020","volume":"71","author":"Gregory","year":"2022","journal-title":"Natl Vital Stat Rep"},{"key":"2026061812473700200_B3","doi-asserted-by":"crossref","first-page":"e0216897","DOI":"10.1371\/journal.pone.0216897","article-title":"Diagnostic thresholds for pregnancy hyperglycemia, maternal weight status and the risk of childhood obesity in a diverse Northern California cohort using health care delivery system data","volume":"14","author":"Ehrlich","year":"2019","journal-title":"PLoS One"},{"key":"2026061812473700200_B4","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1093\/ije\/dyx151","article-title":"Offspring risk of obesity in childhood, adolescence and adulthood in relation to gestational diabetes mellitus: a sex-specific association","volume":"46","author":"Li","year":"2017","journal-title":"Int J Epidemiol"},{"key":"2026061812473700200_B5","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.2337\/diab.29.12.1023","article-title":"Banting Lecture 1980. 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