Association of Gestational Diabetes With Maternal Disorders of Glucose Metabolism and Childhood Adiposity

Probably not a substantial claim: may not pass S3 (load-bearing).

Multiple imputation under a missing at random assumption using the Mice R package was used to model outcomes for children to account for missing Tanner stage data.

“Multiple imputation under a missing at random assumption 18,19 using the Mice R package 20 was used in the analyses to model the outcomes for children to account for missing data for Tanner stage”

• cites [18] 18. Van Buuren S, Groothuis-Oudshoorn K. mice: multivariate imputation by chained equations in R. J Stat Softw. 2011;45(3):1-67. doi:10.18637/jss .v045.i03 sourceSupported
• cites [19] 19. Lawrence JM, Contreras R, Chen W, Sacks DA. Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women, 1999-2005. Diabetes Care. 2008;31(5): 899-904. doi:10.2337/dc07-2345 sourceNot checked — no full text of the source
• cites [20] 20. Sacks DA, Hadden DR, Maresh M, et al; HAPO Study Cooperative Research Group. Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel-recommended criteria: the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Diabetes Care. 2012;35(3):526-528. doi:10.2337 /dc11-1641 sourceCould not verify

  The Statistical analyses section (p. 1) describes logistic regression and direct standardization in Stata 11.2. Searches for multiple imputation, missing at random, Mice, and Tanner stage found no passage in this paper addressing the claimed handling of missing child-outcome data. (LLM, conf=0.76)

  Experimental — accuracy not yet measured

• AssumptionThe authors state this as an assumption: Missing data for Tanner stage are missing at random.

Probably not a substantial claim: may not pass S3 (load-bearing).

Approximately twice as many women are diagnosed with gestational diabetes using the IADPSG criteria compared with the Carpenter-Coustan criteria.

“Approximately twice as many women are diagnosed with gestational diabetes using the IADPSG criteria compared with the Carpenter-Coustan criteria.6”

• cites [6] 6. Regnell SE, Lernmark Å. Early prediction of autoimmune (type 1) diabetes. Diabetologia. 2017; 60(8):1370-1381. doi:10.1007/s00125-017-4308-1 sourceCould not verify

  The Stage 2 section discusses glucose testing during progression to type 1 diabetes, not gestational-diabetes diagnosis. Searches for IADPSG, Carpenter–Coustan, and gestational-diabetes criteria found no passage comparing the number of women diagnosed under those criteria; the claim cannot be verified from this copy. (LLM, conf=0.76)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim. May combine two claims.

New criteria for the diagnosis of gestational diabetes were proposed by the International Association of Diabetes and Pregnancy Study Groups and adopted by the World Health Organization and others based on the HAPO Study and other studies.

“Based on the HAPO Study and other studies, new criteria for the diagnosis of gestational diabetes were proposed by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) 2 and adopted by the World Health Organization and others.3,4”

• cites [2] 2. Metzger BE, Gabbe SG, Persson B, et al; International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676-682. doi:10.2337/dc09-1848 sourceSupported
• cites [3] 3. World Health Organization. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization Guideline. Diabetes Res Clin Pract. 2014;103(3):341- 363. doi:10.1016/j.diabres.2013.10.012 sourceNot checked — no full text of the source
• cites [4] 4. Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 180: gestational diabetes mellitus. Obstet Gynecol. 2017;130(1):e17-e37. doi:10.1097/AOG.0000000000002159 sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Estimating that 25% of children of mothers without gestational diabetes would be overweight or obese, a sample size of 5632 was required to detect an odds ratio of 1.30 with 90% power for a 2-sided type I error rate of 5%.

“Estimating that 25% of children of mothers without gestational diabetes would be overweight or obese, a sample size of 5632 was required to detect an odds ratio (OR) of 1.30 with 90% power for a 2-sided type I error rate of 5%.[10][11][12]”

• cites [10] 10. Hillier TA, Pedula KL, Schmidt MM, Mullen JA, Charles MA, Pettitt DJ. Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia. Diabetes Care. 2007;30 (9):2287-2292. doi:10.2337/dc06-2361 sourceNot checked — no full text of the source
• cites [11] 11. Lawlor DA, Fraser A, Lindsay RS, et al. Association of existing diabetes, gestational diabetes and glycosuria in pregnancy with macrosomia and offspring body mass index, waist and fat mass in later childhood: findings from a prospective pregnancy cohort. Diabetologia. 2010; 53(1):89-97. doi:10.1007/s00125-009-1560-z sourceCould not verify

  The Results (pp. 4–5) report cohort sizes and associations with offspring overweight or obesity, but do not give the claimed sample-size calculation. Searches for 5,632, 90% power, an odds ratio of 1.30, and the assumed 25% prevalence found no passage addressing those inputs. (LLM, conf=0.76)

  Experimental — accuracy not yet measured
• cites [12] 12. Hsieh FY, Bloch DA, Larsen MD. A simple method of sample size calculation for linear and logistic regression. Stat Med. 1998;17(14):1623-1634. doi:10.1002/(SICI)1097-0258(19980730)17: 14<1623::AID-SIM871>3.0.CO;2-S 14. Carr DB, Newton KM, Utzschneider KM, et al. Modestly elevated glucose levels during pregnancy are associated with a higher risk of future diabetes among women without gestational diabetes mellitus. Diabetes Care. 2008;31(5):1037-1039. doi:10.2337/dc07-1957 sourceNot checked — no full text of the source

May combine two claims.

Risk factors for progression to type 2 diabetes include maternal age, prepartum and postpartum BMI, family history of type 2 diabetes, receipt of insulin for gestational diabetes, and fasting glucose level during pregnancy.

“The risk factors for progression to type 2 diabetes include maternal age, prepartum and postpartum BMI, family history of type 2 diabetes, receipt of insulin for gestational diabetes, and fasting glucose level during pregnancy.6,[24][25][26]”

• cites [6] 6. Regnell SE, Lernmark Å. Early prediction of autoimmune (type 1) diabetes. Diabetologia. 2017; 60(8):1370-1381. doi:10.1007/s00125-017-4308-1 sourceCould not verify

  The Environmental factors and Stage 2 sections discuss progression to type 1 diabetes, not progression from gestational diabetes to type 2 diabetes. Searches for maternal age, prepartum and postpartum BMI, gestational diabetes, and fasting glucose did not find a passage addressing the claimed risk factors. (LLM, conf=0.76)

  Experimental — accuracy not yet measured
• cites [24] 24. Dabelea D, Crume T. Maternal environment and the transgenerational cycle of obesity and diabetes. Diabetes. 2011;60(7):1849-1855. doi:10.2337 /db11-0400 sourceCould not verify

  The “Glucose abnormalities and type 2 diabetes” section discusses diabetes risk in offspring exposed to maternal diabetes, not progression to type 2 diabetes in women after gestational diabetes. The “What is the role of maternal fuels?” section links fasting glucose during pregnancy to infant size, not maternal diabetes progression. Searches for postpartum BMI and maternal progression did not find the claimed list of risk factors in our copy; no page numbers were available. (LLM, conf=0.75)

  Experimental — accuracy not yet measured
• cites [25] 25. Buchanan TA, Xiang AH. Gestational diabetes mellitus. J Clin Invest. 2005;115(3):485-491. doi:10 .1172/JCI200524531 sourceNot checked — no full text of the source
• cites [26] 26. Lakshman R, Elks CE, Ong KK. Childhood obesity. Circulation. 2012;126(14):1770-1779. doi:10.1161/CIRCULATIONAHA.111.047738 sourceCould not verify

  The 'Birth weight and antenatal factors' section discusses maternal obesity and pregnancy glycaemia as associated with offspring outcomes, not a mother's progression to type 2 diabetes. A search for postpartum diabetes after gestational diabetes and the listed risk factors found no passage addressing that progression. (LLM, conf=0.76)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

In the United States, prevalence of gestational diabetes was 7.4% using the Carpenter-Coustan criteria during a period similar to the HAPO Study.

“In the United States, prevalence of gestational diabetes was 7.4% using the Carpenter-Coustan criteria during a period similar to the HAPO Study.21”

• cites [21] 21. Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009;373(9677):1773-1779. doi:10.1016/S0140-6736 (09)60731-5 sourceCould not verify

  The indexed copy returns passages from “The global burden of women's cancers,” including its References and Conclusions (pages not provided), despite the supplied source title. Searches for “gestational diabetes,” “7.4%,” “Carpenter-Coustan,” and “HAPO” found no passage addressing the claimed U.S. prevalence. The copy therefore cannot verify the claim. (LLM, conf=0.76)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The criteria for gestational diabetes were met by 14.3% (672/4697) of mothers overall and by 14.1% (683/4832) of mothers of participating children.

“The criteria for GD were met by 14.3% (672/4697) of mothers overall and by 14.1% (683/4832) of mothers of participating children.”

• Also stated in: § Participants · plain

  “Overall, 14.3% (672/4697) of participating mothers had gestational diabetes, which was lower than the 16% anticipated during study planning.”

May combine two claims.

Adjusted for maternal body mass index during pregnancy, the odds ratio was 1.58 (95% CI, 1.24 to 2.01) for children who were obese and the risk difference was 5.0% (95% CI, 2.0% to 8.0%).

“the OR was 1.58 (95% CI, 1.24 to 2.01) for children who were obese and the RD was 5.0% (95% CI, 2.0% to 8.0%)”

• Also stated in: § Secondary Outcomes · plain

  “In model 4 (fully adjusted model), the OR was 1.58 (95% CI, 1.24-2.01)and the risk difference was 5.0% (95% CI, 2.0%-8.0%)for obesity”

May combine two claims.

Among mothers with gestational diabetes, the odds ratio for a disorder of glucose metabolism was 3.44 (95% CI, 2.85 to 4.14) and the risk difference was 25.7% (95% CI, 21.7% to 29.7%) compared with mothers without gestational diabetes.

“(odds ratio [OR], 3.44 [95% CI, 2.85 to 4.14]; risk difference [RD], 25.7% [95% CI, 21.7% to 29.7%])”

• Also stated in: § Gestational Diabetes Status and Maternal Outcomes Primary Outcome · plain

  “The OR was 3.44 (95% CI, 2.85-4.14)for model 3, which adjusted for maternal variables at follow-up, and the risk difference was 25.7% (95% CI, 21.7%-29.7%).”

May combine two claims.

At the follow-up study visit, mothers with gestational diabetes had higher BMIs and more frequent family histories of diabetes in first-degree relatives.

“At the follow-up study visit, mothers with gestational diabetes had higher BMIs and more frequent family histories of diabetes in first-degree relatives.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Of 15,812 eligible mother-child pairs, 9,322 were screened; 4,834 children and 4,747 mothers completed all or part of the study visit, representing 69.1% and 67.8% of the 7,000 target, respectively.

“Of 15 812 eligible mother-child pairs (eTable 1 in the Supple- ment), 9322 were screened to confirm eligibility and willing- ness to participate. From these, 4834 children and 4747 moth- ers completed all or part of the study visit, representing 69.1% and 67.8% of the 7000 target, respectively”

May combine two claims.

Adjusted for maternal body mass index during pregnancy, the odds ratio was 1.57 (95% CI, 1.27 to 1.95) for sum of skinfolds and the risk difference was 6.5% (95% CI, 3.1% to 9.9%).

“the OR was 1.57 (95% CI, 1.27 to 1.95) for sum of skinfolds and the RD was 6.5% (95% CI, 3.1% to 9.9%)”

• Also stated in: § Secondary Outcomes · plain

  “the OR was 1.57 (95% CI, 1.27-1.95)and the risk difference was 6.5% (95% CI, 3.1%-9.9%)for the sum of skinfolds”

May combine two claims.

Adjusted for maternal body mass index during pregnancy, the odds ratio was 1.34 (95% CI, 1.08 to 1.67) for waist circumference and the risk difference was 4.1% (95% CI, 0.8% to 7.3%).

“the OR was 1.34 (95% CI, 1.08 to 1.67) for waist circumference and the RD was 4.1% (95% CI, 0.8% to 7.3%)”

• Also stated in: § Secondary Outcomes · plain

  “the OR was 1.34 (95% CI, 1.08-1.67)and the risk difference was 4.1% (95% CI, 0.8%-7.3%)for waist circumference”

May combine two claims.

The mean BMI, fasting plasma glucose level, 1-hour plasma glucose level, and 2-hour plasma glucose level during the HAPO Study oral glucose tolerance test and race/ethnicity were similar between participants and nonparticipants.

“The mean BMI, fasting plasma glucose level, 1-hour plasma glucose level, and 2-hour plasma glucose level during the HAPO Study oral glucose tolerance test and race/ethnicity were similar between groups.”

May combine two claims.

At the oral glucose tolerance test during the HAPO Study pregnancy, mothers with gestational diabetes were older, weighed more, and had higher BMIs, mean arterial pressures, and glucose concentrations compared with mothers without gestational diabetes.

“At the oral glucose tolerance test during the HAPO Study pregnancy, mothers with gestational diabetes were older, weighed more, and had higher BMIs, mean arterial pressures, and glucose concentrations compared with mothers without gestational diabetes.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Among women who participated in this follow-up study, the mean age during the HAPO Study was 30.1 years and the frequency of gestational diabetes was 14.3% compared with 29.1 years and 16.3%, respectively, among those women who did not participate.

“Among women who participated in this follow-up study, the mean age during the HAPO Study was 30.1 years and the frequency of gestational diabetes was 14.3% compared with 29.1 years and 16.3%, respectively, among those women who did not participate (unable to contact or declined) (Table 1).”

May combine two claims.

Adjusted for maternal body mass index during pregnancy, the odds ratio was 1.35 (95% CI, 1.08 to 1.68) for body fat percentage and the risk difference was 4.2% (95% CI, 0.9% to 7.4%).

“the OR was 1.35 (95% CI, 1.08 to 1.68) for body fat percentage and the RD was 4.2% (95% CI, 0.9% to 7.4%)”

• Also stated in: § Secondary Outcomes · plain

  “the OR was 1.35 (95% CI, 1.08-1.68)and the risk difference was 4.2% (95% CI, 0.9%-7.4%)for body fat percentage”

May combine two claims.

Adjusted for maternal body mass index during pregnancy, the odds ratio was 1.21 (95% CI, 1.00 to 1.46) for children who were overweight or obese and the risk difference was 3.7% (95% CI, -0.16% to 7.5%).

“Adjusted for maternal body mass index during pregnancy, the OR was 1.21 (95% CI, 1.00 to 1.46) for children who were overweight or obese and the RD was 3.7% (95% CI, -0.16% to 7.5%)”

Probably not a substantial claim: may not pass S3 (load-bearing).

The median duration of follow-up was 11.4 years (interquartile range, 10.6-12.2 years).

“The median duration of follow-up was 11.4 years (interquartile range, 10.6-12.2years).”

May combine two claims.

Gestational diabetes was positively associated with obesity, body fat percentage, waist circumference, and sum of skinfolds in model 1, with slight attenuation after adjusting for Tanner stage and maternal variables during pregnancy in models 2 and 3.

“Gestational diabetes was positively associated with these outcomes (model 1), with slight attenuation after adjusting for Tanner stage and maternal variables during pregnancy (models 2 and 3) (Table 3).”

May combine two claims.

In model 4, differences in continuous child adiposity measures were attenuated after adjusting for maternal BMI during pregnancy; all variables except BMI remained significant.

“In model 4, these differences were attenuated after adjusting for maternal BMI during pregnancy; however, all variables except BMI remained significant.”

May combine two claims.

Gestational diabetes was positively associated with childhood overweight or obesity in model 1, with slight attenuation after adjusting for Tanner stage and maternal variables during pregnancy in models 2 and 3.

“Gestational diabetes was positively associated with childhood overweight or obesity (model 1), with slight attenuation after adjusting for Tanner stage and maternal variables during pregnancy (models 2 and 3) (Table 3).”

May combine two claims.

In this study, adjusting for maternal BMI attenuated observed associations of gestational diabetes with measures of childhood adiposity, but multiple associations remained significant.

“In this study, adjusting for maternal BMI attenuated observed associations of gestational diabetes with measures of childhood adiposity, but multiple associations remained significant”

May combine two claims.

In model 4, adjusted mean differences were 0.26 (95% CI, -0.06 to 0.57) for BMI, 1.05 (95% CI, 0.24 to 1.85) for body fat percentage, 1.28 (95% CI, 0.43 to 2.14) cm for waist circumference, and 2.52 (95% CI, 0.82 to 4.22) mm for sum of skinfolds.

“The adjusted mean differences among the offspring of mothers with gestational diabetes vs the offspring of mothers without gestational diabetes were 0.26 (95% CI, -0.06 to 0.57) for BMI, 1.05 (95% CI, 0.24 to 1.85) for body fat percentage, 1.28 (95% CI, 0.43 to 2.14) cm for waist circumference, and 2.52 (95% CI, 0.82 to 4.22) mm for sum of skinfolds.”

May combine two claims.

Compared with offspring of mothers without gestational diabetes, offspring of mothers with gestational diabetes had higher BMIs, body fat percentages, waist circumferences, and sum of skinfolds.

“Compared with the offspring of mothers without gestational diabetes, the offspring of mothers with gestational diabetes had higher BMIs, body fat percentages, waist circumferences, and sum of skinfolds.”

May combine two claims.

In this follow-up study, more than twice as many mothers with IADPSG-defined gestational diabetes compared with mothers with Carpenter-Coustan-defined gestational diabetes (240 vs 106) developed a disorder of glucose metabolism, and there were similar findings for the adiposity outcomes for children.

“In this follow-up study, more than twice as many mothers with IADPSG-defined gestational diabetes compared with mothers with Carpenter-Coustan-defined gestational diabetes (ie, 240 vs 106) developed a disorder of glucose metabolism and there were similar findings for the adiposity outcomes for children.”

May combine two claims.

The risk differences for type 2 diabetes and prediabetes in model 3 were 7.3% (95% CI, 5.0%-9.6%) and 22.8% (95% CI, 18.6%-27.0%), respectively.

“The risk differences were consistent and there were higher outcome frequencies among mothers with gestational diabetes for model 3 (type 2 diabetes: 7.3% [95% CI, 5.0%-9.6%];prediabetes: 22.8% [95% CI, 18.6%-27.0%]).”

May combine two claims.

For type 2 diabetes, the odds ratio was 5.38 (95% CI, 3.68-7.86) for model 2 and 5.44 (95% CI, 3.68-8.08) for model 3.

“For type 2 diabetes, the OR was 5.38 (95% CI, 3.68-7.86)for model 2 and the OR was 5.44 (95% CI, 3.68-8.08)for model 3.”

May combine two claims.

For prediabetes, the odds ratio was 3.18 (95% CI, 2.63-3.85) for model 2 and 3.07 (95% CI, 2.53-3.73) for model 3.

“For prediabetes, the OR was 3.18 (95% CI, 2.63-3.85)for model 2 and the OR was 3.07 (95% CI, 2.53-3.73)for model 3.”

May combine two claims.

Among mothers with gestational diabetes, 10.7% (71/663) had type 2 diabetes and 41.5% (275/663) had prediabetes compared with 1.6% (63/3946) and 18.4% (728/3946), respectively, among mothers without gestational diabetes.

“Among mothers with gestational diabetes, 10.7% (71/663) had type 2 diabetes and 41.5% (275/663) had prediabetes compared with 1.6% (63/3946) and 18.4% (728/3946), respectively, among mothers without gestational diabetes.”

Classified as probably not a substantial claim.

Results for the oral glucose tolerance test were not known by caregivers or participants except under specified threshold conditions.

“Results for the oral glucose tolerance test were not known by the caregivers or the participants unless (1) the fasting plasma glucose level was greater than 105 mg/dL (>5.8 mmol/L), (2) the 2-hour plasma glucose level was greater than 200 mg/dL (>11.1 mmol/L), (3) both of these occurred, (4) either measure yielded a plasma glucose level of less than 45 mg/dL (<2.5 mmol/L), or (5) at 34 to 37 week”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Blinded duplicate glucose samples were assayed several weeks apart and coefficients of variation were calculated within pairs for a random subset of 10%; the mean coefficient of variation was 1.4% for fasting plasma glucose and 1.5% for 2-hour plasma glucose.

“Blinded duplicate samples were assayed several weeks apart and coefficients of variation were calculated within pairs for a random subset of 10%.The mean coefficient of variation was 1.4% for fasting plasma glucose and 1.5% for 2-hour plasma glucose.”

Probably not a substantial claim: may not pass S3 (load-bearing).

For child outcomes, model 4 adjusted for age, sex, field center, child pubertal status, maternal variables during pregnancy, and maternal BMI at oral glucose tolerance test during pregnancy.

“model 4: model 3 plus maternal BMI at oral glucose tolerance test during pregnancy.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

For type 2 diabetes, the conservative estimate that 2.5% of women with gestational diabetes and 1% of women without gestational diabetes would develop type 2 diabetes yielded an odds ratio of 2.54 and required a sample size of 6156 for 90% power at a 2-sided type I error rate of 5%.

“For the least frequent outcome of type 2 diabetes, 14 the conservative estimate that 2.5% of women with gestational diabetes and 1% of women without gestational diabetes would develop type 2 diabetes yielded an OR of 2.54 and required a sample size of 6156 for 90% power at a 2-sided type I error rate of 5%.”

• cites [14] 14. R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2016.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

The Hosmer-Lemeshow P values for the logistic regression models ranged from .35 to .99 for the outcomes of mothers and .13 to .99 for the outcomes of children, indicating reasonable model fit.

“The Hosmer-Lemeshow P values for the logistic regression models ranged from .35 to .99 for the outcomes of mothers and .13 to .99 for the outcomes of children, indicating reasonable model fit.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Colinearity was not a concern because the pairwise correlations ranged from 0 to 0.20 for the model covariates.

“Colinearity was not a concern because the pairwise correlations ranged from 0 to 0.20 for the model covariates.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Logistic regression model fit was measured using the C statistic and confirmed by the Hosmer-Lemeshow goodness-of-fit test.

“Logistic regression model fit was measured using the C statistic and confirmed by the Hosmer-Lemeshow goodness-of-fit test.17”

• cites [17] 17. Rubin DB. Multiple imputation for nonresponse in surveys. New York: Wiley; 1987. doi:10.1002 /9780470316696Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Residual plots confirmed linear modeling assumptions and DFbeta statistics indicated no observations of undue influence.

“Residual plots confirmed linear modeling assumptions and DFbeta statistics indicated no observations of undue influence.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Multiple models were considered for all outcomes and independent variables were identified according to the study design, known potential confounders, and the adjustments used for the analyses in the HAPO Study.

“Multiple models were considered for all outcomes and the independent variables were identified according to the study design, known potential confounders, and the adjustments used for the analyses in the HAPO Study. 1”

• cites [1] 1. Metzger BE, Lowe LP, Dyer AR, et al; HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008; 358(19):1991-2002. doi:10.1056/NEJMoa0707943 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The remaining participants were not treated because they did not meet any of the criteria and were not informed of their glucose tolerance test results.

“The remaining participants were not treated because they did not meet any of these criteria and they were not informed of their glucose tolerance test results.”

Classified as probably not a substantial claim.

To exclude type 1 diabetes, serum anti-GAD65, anti-insulin, anti-ZnT8, and anti-IA-2 antibodies were measured for all mothers with self-reported treated diabetes or with a new diagnosis of diabetes.

“To exclude type 1 diabetes, serum anti-GAD65, serum anti-insulin, serum anti-ZnT8, and serum anti-IA-2 antibodies were measured at the Barbara Davis Center for all mothers with self-reported treated diabetes or with a new diagnosis of diabetes.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Missing data ranged from 0% to 1.5% for model variables, and most variables had complete data; only Tanner stage had substantial missingness, with 15.2% of girls and 36.3% of boys lacking a trained assessment.

“For participating mothers and children whose data were analyzed, missing data ranged from 0% to 1.5% for model variables, and most variables had complete data (100%).Only Tanner stage had substantial missingness; 15.2% of girls and 36.3% of boys lacked a trained assessment.”

Probably not a substantial claim: may not pass S2 (checkable).

Additional measures of childhood adiposity may be relevant in interpreting the study findings.

“however, additional measures of childhood adiposity may be relevant in interpreting the study findings.”

• Also stated in: § Conclusions · hedged

  “however, additional measures of childhood adiposity may be relevant in interpreting the study findings.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Colinearity was evaluated using pairwise correlations.

“Colinearity was evaluated using pairwise correlations.”

Probably not a substantial claim: may not pass S3 (load-bearing).

For maternal outcomes, model 3 adjusted for field center, parity, gestational age, maternal follow-up age, height, BMI, family history of diabetes, mean arterial pressure, smoking, alcohol, and number of pregnancies subsequent to the HAPO Study birth.

“model 3: model 1 plus 2 of the maternal variables at oral glucose tolerance test during pregnancy from model 2 (parity [0, ≥1] and gestational age), plus maternal variables at follow-up (age, height, BMI, family history of diabetes in first-degree relatives, mean arterial pressure, smoking status [yes or no]), alcohol consumption [yes or no]), and the No. of pregnancies subsequent to birth during”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In a post hoc analysis, the Bonferroni correction was applied to take into account multiple comparisons for secondary outcomes; P < .025 was used for the 2 secondary outcomes in mothers and P < .0125 for the 4 secondary outcomes in children.

“In a post hoc analysis, the Bonferroni correction was applied to take into account the multiple comparisons involved in evaluating the secondary outcomes; therefore, P < .025was used for evaluating statistical significance for the 2 secondary outcomes in mothers and P < .0125was used for the 4 secondary outcomes in children.”

Classified as probably not a substantial claim.

This study was powered to detect associations of gestational diabetes with childhood measures of adiposity during 10 to 14 years of follow-up.

“This study was powered to detect associations of gestational diabetes with childhood measures of adiposity during 10 to 14 years of follow-up.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Linear regression model fit was assessed by scatter plots of residuals vs fitted values, histograms and qqplots of residuals, and DFbeta statistics.

“Linear regression model fit was assessed by scatter plots of residuals vs fitted values, histograms and qqplots of residuals, and DFbeta statistics.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Summary statistics during pregnancy were compared for eligible mothers and for mothers of eligible children who did or did not participate with weighted summaries for nonparticipants to account for varying participation rates at field centers.

“The summary statistics during pregnancy were compared for eligible mothers and for mothers of eligible children who did or did not participate with weighted summaries for nonparticipants to account for varying participation rates at field centers.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The HAPO Study included women from multiple racial/ethnic groups according to self-report using prespecified categories to describe the study population, ensure broad applicability of the results, and adjust for potential confounding by race/ethnicity.

“The HAPO Study included women from multiple racial/ethnic groups according to self-report using prespecified categories to describe the study population, ensure broad applicability of the results, and adjust for potential confounding by race/ethnicity due to differences in gestational diabetes or outcome frequencies if not sufficiently modeled by study site (field center).”

Probably not a substantial claim: may not pass S3 (load-bearing).

The study was not powered to examine sex-specific associations.

“The study was not powered to examine sex-specific associations.”

May combine two claims.

The IADPSG criteria for gestational diabetes, established based on glucose levels associated with adverse pregnancy outcomes in the HAPO Study and other studies, identify a larger group of mothers than the Carpenter-Coustan criteria.

“The IADPSG criteria for gestational diabetes, which were established based on glucose levels associated with adverse pregnancy outcomes in the HAPO Study and in other studies, identify a larger group of mothers than the Carpenter-Coustan criteria.”

May combine two claims.

In the HAPO Study, gestational diabetes prevalence was 17.8% using the IADPSG criteria and ranged from 15.5% to 25.5% in the North American HAPO Study field centers.

“In contrast, gestational diabetes prevalence in the HAPO Study was 17.8% using the IADPSG criteria and the prevalence ranged from 15.5% to 25.5% in the North American HAPO Study field centers.22”

• cites [22] 22. Catalano PM, Vargo KM, Bernstein IM, Amini SB. Incidence and risk factors associated with abnormal postpartum glucose tolerance in women with gestational diabetes. Am J Obstet Gynecol. 1991;165(4 Pt 1):914-919. doi:10.1016/0002-9378(91) 90438-W 25. Löbner K, Knopff A, Baumgarten A, et al. Predictors of postpartum diabetes in women with gestational diabetes mellitus. Diabetes. 2006;55 (3):792-797. doi:10.2337/diabetes.55.03.06 .db05-0746 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Social, behavioral, or other differences between participants and nonparticipants that may have confounded associations of gestational diabetes with outcome frequencies cannot be ruled out.

“however, social, behavioral, or other differences between participants and nonparticipants that may have confounded associations of gestational diabetes with outcome frequencies cannot be ruled out.”

May combine two claims.

The association of gestational diabetes with childhood overweight or obesity was not statistically significant; however, other childhood adiposity measures may be relevant for interpreting the study findings.

“The association of gestational diabetes with childhood overweight or obesity was not statistically significant; however, other childhood adiposity measures may be relevant for interpreting the study findings.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The characteristics of all mothers during pregnancy (regardless of participation) were similar.

“The characteristics of all mothers during pregnancy (regardless of participation) were similar”

May combine two claims.

In this blinded observational follow-up study, none of the participants were prospectively diagnosed with gestational diabetes, so treatment was not a confounding factor for maternal and child outcomes.

“in this blinded observational follow-up study, none were prospectively diagnosed with gestational diabetes.Therefore, treatment was not a confounding factor for maternal and child outcomes.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Maternal hemoglobin A1c levels at follow-up were not used.

“Sixth, maternal hemoglobin A 1c levels at follow-up were not used.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

The racial/ethnic diversity of the participants makes the findings broadly applicable.

“In addition, the racial/ethnic diversity of the participants make the findings broadly applicable.”

Probably not a substantial claim: may not pass S3 (load-bearing).

This study was not designed to compare women with vs without gestational diabetes defined by the Carpenter-Coustan criteria.

“This study was not designed to compare women with vs without gestational diabetes defined by the Carpenter-Coustan criteria.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The C statistics were lowest for model 1 for the outcomes of children (as low as 0.50); model fit improved for models 2 and 3, with the highest C statistics ranging from 0.68 to 0.74 in model 4.

“The C statistics were lowest for model 1 for the outcomes of children (as low as 0.50).The model fit improved for mod-els 2 and 3 for the outcomes of children, with the highest C statistics ranging from 0.68 to 0.74 in model 4.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Recruitment was lower than expected; the prespecified recruitment target was 7000 mother-child pairs, and recruitment totals were 67.8% for women and 69.1% for children.

“Fifth, recruitment was lower than expected.The prespecified recruitment target was 7000 mother-child pairs; recruitment totals were 67.8% for women and 69.1% for children.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The R2 values ranged from 0.05 to 0.28 for continuous outcomes for children and increased across models 1 through 4, suggesting improved fit for the adjusted models.

“The R 2 values ranged from 0.05 to 0.28 for continuous outcomes for children and increased across models 1 through 4, suggesting improved fit for the adjusted models.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

For childhood outcomes in this prospective study, pubertal status was determined and adiposity was characterized using standardized procedures via multiple methods.

“For childhood outcomes in this prospective study, pubertal status was determined and adiposity was characterized using standardized procedures via multiple methods.”

Classified as probably not a substantial claim.

This study addressed limitations of previous studies examining the association of gestational diabetes with childhood adiposity, including lack of complete data on glucose values during pregnancy, maternal BMI, and childhood measures of age-adjusted BMI.

“This study also addressed limitations of previous studies examining the association of gestational diabetes with childhood adiposity, including lack of complete data on glucose values during pregnancy, maternal BMI, and childhood measures of age-adjusted BMI.30,[36][37][38][39][40]”

• cites 30,[36][37][38][39][40]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Beyond family history, paternal data were not available.

“Fourth, beyond family history, paternal data were not available.”

May combine two claims.

The excluded subgroup likely would have included mothers with higher outcome frequencies for type 2 diabetes and prediabetes at follow-up and children at the highest risk of overweight or obesity; therefore, the reported associations may be underestimates.

“This subgroup likely would have included mothers with higher outcome frequencies for type 2 diabetes and prediabetes at the time of this follow-up study and children at the highest risk of overweight or obesity; therefore, the reported associations may be underestimates.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The C statistics for the logistic regression models ranged from 0.61 to 0.86 for the outcomes of mothers and increased across models 1 through 3, suggesting better model fit for the outcomes of mothers with covariate adjustments.

“The C statistics for the logistic regression models ranged from 0.61 to 0.86 for the outcomes of mothers and increased across models 1 through 3, suggesting better model fit for the outcomes of mothers with covariate adjustments.”