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In utero exposure to gestational diabetes and adiposity: does breastfeeding make a difference?
L L Hui1,2, A M Li1, E A S Nelson1
1Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
Insights
Gestational diabetes (GDM) in pregnancy is linked to higher childhood and adolescent adiposity in offspring. However, early breastfeeding does not worsen this risk and should still be encouraged for maternal and infant health.
Area of Science:
- Reproductive health
- Pediatric endocrinology
- Metabolic disease research
Background:
- Gestational diabetes mellitus (GDM) in pregnancy may influence offspring's long-term metabolic programming.
- Maternal GDM is a potential risk factor for increased adiposity in children.
- The role of early infant feeding, particularly breastfeeding, in modifying GDM's metabolic effects on offspring requires investigation.
Purpose of the Study:
- To investigate the association between in utero exposure to GDM and offspring adiposity from infancy through adolescence.
- To determine if early infant feeding modifies the relationship between in utero GDM exposure and offspring adiposity.
Main Methods:
- Utilized the prospective Chinese birth cohort "Children of 1997" (n=7342).
- Employed generalized estimating equations with multiple imputation to assess body mass index (BMI) z-scores at different life stages.
- Adjusted for multiple covariates and analyzed the interaction between GDM exposure and infant feeding modes (formula, mixed, breastfed) in the first three months.
Main Results:
- In utero GDM exposure was associated with lower infant BMI z-scores but significantly higher BMI z-scores in childhood and adolescence.
- Early breastfeeding (first three months) did not alter the association between in utero GDM exposure and subsequent offspring BMI.
- No statistically significant interaction was found between GDM status and infant feeding mode on BMI z-scores.
Conclusions:
- Exposure to GDM in utero is linked to increased adiposity in offspring during childhood and adolescence.
- Breastfeeding in early infancy among mothers with GDM is not associated with increased offspring adiposity.
- Encouraging breastfeeding remains advisable for mothers with GDM, as it does not appear to exacerbate long-term adiposity risks.
Background/Objectives:
Short-term breastfeeding from mothers with gestational diabetes (GDM) may programme metabolism and increase offspring diabetes risk. We examined the association of in utero GDM exposure with adiposity from infancy to adolescence, and whether any association was modified by breastfeeding during early infancy.
Methods:
In the prospective Chinese birth cohort "Children of 1997" (n = 7342, 88% follow-up rate), generalised estimate equations with multiple imputation were used to assess associations of in utero GDM exposure with age- and sex-specific body mass index (BMI) z-score during infancy (3 and 9 months), childhood (2- < 8 years) and adolescence (8-16 years), adjusted for sex, parity, maternal age, birth place, preeclampisa, smoking, and family socio-economic position. We also tested whether the associations differed by mode of infant feeding (always formula-fed, mixed, always breastfed) during the first three months of life.
Results:
In utero GDM exposure (7.5%) was associated with a lower BMI z-score during infancy (-0.13, 95% confidence interval (CI) -0.22, -0.05) but higher BMI z-scores during childhood (0.14, 95% CI 0.03, 0.25) and adolescence (0.25 95% CI 0.11, 0.38). Breastfeeding for the first three months did not modify the association of in utero GDM status with subsequent BMI (all p values for interaction >0.4).
Conclusions:
In utero GDM exposure was associated with greater adiposity during childhood and adolescence. Breastfeeding in early infancy from mothers with GDM was not associated with greater adiposity in children and thus should still be encouraged.
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