Intrauterine exposure to a hyperglycemic environment can cause long term changes in body composition resulting in increased adiposity and cardio metabolic risk in the offspring. The aim of this study was to determine the association between hyperglycaemia in pregnancy (HIP) and risk of adiposity in the offspring at 10-11 years of age. Methods A retrospective cohort study was conducted in the Colombo district, Sri Lanka. 7205 children who were born in 2005 were identified through schools and

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... ic Health Midwives in the community. Mothers of these children still possessing antenatal records were interviewed and relevant data were extracted from medical records to identify eligible participants. Exposure status (hyperglycaemia in pregnancy) was ascertained based on client held antenatal records. 159 children of mothers with HIP (exposed) and 253 children of mothers with no HIP (non-exposed) were recruited. Height, weight, waist circumference and triceps skin fold thickness (TSFT) of participants were measured to ascertain outcome status. Results The mean ages (SD) of exposed and non-exposed groups were 10.9 (0.3) and 10.8 (0.3) years respectively. The median BMI (17.6 vs 16.1, p<0.001), waist circumference (63cm vs 59.3 cm, p<0.001) and triceps skinfold thickness (13.7mm vs 11.2mm, p< 0.001) were significantly higher in the exposed group than in the non-exposed group. Children who were exposed to intrauterine hyperglycaemia were more likely to be overweight (aOR=2.5, 95% CI 1.3-4.7), have abdominal obesity (aOR=2.9, 95% CI 1.2-6.8) and high TSFT > 70th centile (aOR=2.1, 95% CI 1.2-3.9) at 10-11 years of age than children who were not exposed after adjusting for maternal BMI, birth weight and birth order. Conclusions Intrauterine exposure to HIP is associated with significantly higher risk of adiposity in the offspring at 10 years of age.