Objectives To assess the precision magnetic resonance imaging (MRI) in the neonate and determine if there is an early maternal influence on the pattern of neonatal fat deposition in the offspring of mothers with gestational diabetes (GDM) and obesity compared with the offspring of normal weight women. Study design 25 neonates, born to normal weight mothers (n=13) and to obese mothers with GDM (n=12), underwent MRI for measurement of subcutaneous and intra-abdominal fat and magnetic resonance spectroscopy for the measurement of intrahepatocellular (IHCL) fat at 1-3 weeks of age. Results Infants born to obese/GDM mothers had a mean 68% increase in IHCL compared with infants born to normal weight mothers. For all infants, IHCL correlated with maternal pre-pregnancy BMI but not with subcutaneous adiposity. Conclusion Deposition of liver fat in the neonate correlates highly with maternal BMI. This finding may have implications for understanding the developmental origins of childhood NAFLD.

Objective To examine associations between pregnancy physical activity and neonatal fat mass and fat-free mass, birth weight and small for gestational age (SGA). Methods We analyzed 826 mother-neonate pairs (term births) participating in the longitudinal Healthy Start study. The Pregnancy Physical Activity Questionnaire was used to assess total energy expenditure and meeting American College of Obstetricians and Gynecologists (the College) guidelines for physical activity during early pregnancy, mid-pregnancy and late pregnancy. Models were adjusted for maternal and neonatal characteristics. Results Neonates had mean fat mass of 292.9 grams, fat-free mass of 2,849.8 g, and birth weight of 3,290.7 g. We observed 107 (12.9%) SGA and 30 (3.6%) large-for-gestational age (LGA) births. A significant inverse linear trend between total energy expenditure during late pregnancy and neonatal fat mass (Ptrend = 0.04) was detected. Neonates of mothers in the highest compared to lowest quartile of total energy expenditure during late pregnancy had 41.1 g less fat mass (249.4 vs. 290.5 g; P = 0.03). No significant trend was found with total energy expenditure and neonatal fat-free mass or birth weight. Early-pregnancy and mid-pregnancy total energy expenditure were not associated with neonatal outcomes. No significant trend was observed between late-pregnancy total energy expenditure and SGA (Ptrend = 0.07), but neonates of mothers in the highest compared to the lowest quartile had a 3.0 (95% CI 1.4–6.7) higher likelihood of SGA. Meeting the College’s physical activity guidelines during pregnancy was not associated with differences in neonatal outcomes. Conclusions Increasing levels of late-pregnancy total energy expenditure are associated with decreased neonatal adiposity without significantly reduced neonatal fat-free mass.

OBJECTIVEDiet therapy in gestational diabetes mellitus (GDM) has focused on carbohydrate restriction but is poorly substantiated. In this pilot randomized clinical trial, we challenged the conventional low-carbohydrate/higher-fat (LC/CONV) diet, hypothesizing that a higher–complex carbohydrate/lower-fat (CHOICE) diet would improve maternal insulin resistance (IR), adipose tissue (AT) lipolysis, and infant adiposity.RESEARCH DESIGN AND METHODSAt 31 weeks, 12 diet-controlled overweight/obese women with GDM were randomized to an isocaloric LC/CONV (40% carbohydrate/45% fat/15% protein; n = 6) or CHOICE (60%/25%/15%; n = 6) diet. All meals were provided. AT was biopsied at 37 weeks.RESULTSAfter ∼7 weeks, fasting glucose (P = 0.03) and free fatty acids (P = 0.06) decreased on CHOICE, whereas fasting glucose increased on LC/CONV (P = 0.03). Insulin suppression of AT lipolysis was improved on CHOICE versus LC/CONV (56 vs. 31%, P = 0.005), consistent with improved IR. AT expression of multiple proinflammatory genes was lower on CHOICE (P < 0.01). Infant adiposity trended lower with CHOICE (10.1 ± 1.4 vs. 12.6 ± 2%, respectively).CONCLUSIONSA CHOICE diet may improve maternal IR and infant adiposity, challenging recommendations for a LC/CONV diet.

II-2.

Importance: The novel coronavirus 2019 (SARS-CoV-2) has been well described in adults. Further, the impact on older children and during the perinatal time is becoming better studied. As community spread increases, it is important to recognize that neonates are vulnerable to community spread as well. The impact that community-acquired SARS-CoV-2 has in the neonatal time period is unclear, as this population has unique immunity considerations. Objective: To report on a case series of SARS-CoV-2 in neonates through community acquisition in the USA. Design: This is an early retrospective study of patients admitted to the Neonatal Intensive Care Unit (NICU) identified as having SAR-CoV-2 through positive real-time polymerase chain reaction assay of nasopharyngeal swabs. Findings: Three patients who required admission to the NICU between the ages of 17 and 33 days old were identified. All 3 had ill contacts in the home or had been to the pediatrician and presented with mild to moderate symptoms including fever, rhinorrhea, and hypox-ia, requiring supplemental oxygen during their hospital stay. One patient was admitted with neutropenia, and the other 2 patients became neutropenic during hospitalization. None of the patients had meningitis or multiorgan failure. Conclusions and Relevance: Infants with community-acquired SARS-CoV-2 may require hospitalization due to rule-out sepsis guidelines if found to have fever and/or hypoxia. Caregivers of neonates should exercise recommended guidelines before contact with neonates to limit community spread of SARS-CoV-2 to this potentially vulnerable population, including isolation, particularly as asymptomatic cases become prevalent.

Objective To examine the dose-dependent and time-specific relationships of prenatal smoking with neonatal body mass, fat mass (FM), fat-free mass (FFM) and fat to fat-free mass ratio (F:FFM), as measured by air displacement plethysmography (PEA POD). Study design We analyzed 916 mother-neonate pairs participating in the longitudinal pre-birth cohort study, Healthy Start. Maternal prenatal smoking information was collected in early-, mid- and late-pregnancy by self-report. Neonatal body composition was measured by PEA POD following delivery. Multiple general linear regression models were adjusted for maternal and neonatal characteristics. Results For each additional pack smoked during pregnancy, neonatal body mass was significantly reduced (adjusted mean difference: −2.8 grams; 95% confidence interval [CI]: −3.9 to −1.8; P<0.001), FM (−0.7 g [−1.1 to −0.3]; P<0.001) and FFM (−2.1 g [−2.9 to −1.3]; P<0.001). Neonates exposed to prenatal smoking throughout pregnancy had significantly less body mass (P<0.001), FM (P<0.001) and FFM (P <0.001) compared with those unexposed. However, neonates of mothers who only smoked before late-pregnancy had no significant differences in body mass (P = 0.47), FM (P = 0.43) or FFM (P = 0.59) compared with unexposed offspring. Conclusions Exposure to prenatal smoking leads to systematic growth restriction. Smoking cessation before late-pregnancy may reduce the body composition consequences of exposure to prenatal smoking. Follow-up of this cohort is needed to determine the influence of catch-up growth on early-life body composition and the risk of childhood obesity.

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Bioactive components in HM may contribute to regulation of partitioning of body composition, and these contributions may differ between mothers of normal-weight vs. with OW/Ob.