Rising Pediatric Prediabetes: Intergenerational Risks and Clinical Strategies

A Finnish cohort study reports prediabetes prevalence among children with overweight or obesity climbed from 11% to 50% over two decades — an abrupt shift that signals earlier cardiometabolic risk and strengthens the case for expanded early detection and prevention.

The investigators evaluated children assessed for overweight or obesity from 2002–2020 (clinical sample n=602) alongside a control group (n=483). Over 20 years, prediabetes prevalence in the clinical sample rose from 11% to 50% despite stable obesity prevalence and BMI distributions, suggesting a rising metabolic burden independent of changes in adiposity.

Rising maternal overweight during pregnancy — from roughly 20% to 69% — was identified as a major contributor to higher offspring prediabetes risk. Increased gestational weight, intergenerational exposure, and markers linked to gestational diabetes likely alter fetal metabolic programming and shift baseline risk, underscoring family-level transmission of metabolic vulnerability.

The change was most marked in school-age children with overweight or obesity, particularly older and more pubertally advanced youth. For at‑risk children, pragmatic screening with fasting glucose and HbA1c — reserving a 2‑hour oral glucose tolerance test for select cases — balances accessibility and sensitivity; periodic checks during early school years and adolescence are reasonable.

Family-centered, non-stigmatizing lifestyle interventions that include maternal and household supports remain the first-line, evidence-aligned approach. Using person-first language and behavior-focused counseling reduces stigma and facilitates integration of family-health strategies into routine pediatric practice.

Key Takeaways:

• Prediabetes prevalence among children with overweight or obesity rose to 50% from 11%, indicating a rapid escalation of early metabolic disease.
• Children with overweight or obesity—especially school-age, pubertally advanced individuals and those exposed to higher maternal weight in pregnancy—are most affected.
• Expand periodic screening for at-risk children, prioritize maternal and family-based prevention, and reserve pharmacotherapy for pediatric patients only within established safety evidence and specialist oversight.