Association of Infant Temperament With Subsequent Obesity in Young Children of Mothers With Gestational Diabetes Mellitus

Abstract

Infant temperament is associated with excess weight gain or childhood obesity risk in samples of healthy individuals, although the evidence has been inconsistent. To our knowledge, no prior research has examined this topic among children exposed to gestational diabetes mellitus (GDM) in utero. OBJECTIVE To prospectively evaluate infant temperament in association with overweight and obesity status at ages 2 to 5 years among children born to mothers who experienced GDM. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study took place at Kaiser Permanente Northern California medical centers. We studied singleton infants delivered at 35 weeks' gestational age or later to mothers who had been diagnosed with GDM. Data were collected from 2009 to 2016, and data analysis occurred from June 2017 to October 2018. EXPOSURES The primary exposures in the child's first year were soothability, distress to limitations, and activity aspects of temperament, as assessed by a validated questionnaire. Modifiable covariates in the child's first year included breastfeeding intensity and duration monthly ratio scores, along with the timing of the introduction of sugary beverages and complementary foods. MAIN OUTCOMES AND MEASURES The primary outcome was child overweight and obesity status, assessed at ages 2 to 5 years. Multinomial logistic regression models estimated adjusted odds ratios and 95% CIs for infants whose temperaments were measured at 6 to 9 weeks of age and categorized as elevated (Ն75th percentile) or not elevated in the 3 domains. We controlled for nonmodifiable and modifiable covariates across models. RESULTS A total of 382 mother-infant pairs participted, including 130 infants (34.0%) who were non-Hispanic white, 126 infants (33.0%) who were Hispanic, 96 infants (25.1%) who were Asian, 26 infants (6.8%) who were non-Hispanic black, and 4 infants (1.1%) who were of other races/ethnicities. In descriptive analyses, elevated infant soothability and activity temperaments were associated with the early introduction of 100% fruit juice and/or sugar-sweetened beverages (at ages <6 months) and shorter breastfeeding duration (from 0 to <3 months), while elevated distress to limitations was associated with early introduction of complementary foods (at ages <4 months). Elevated soothability consistently was associated with a higher odds of later childhood obesity, with adjusted odds ratios across models ranging from 2.22 (95% CI, 1.04-4.73) to 2.54 (95% CI, 1.28-5.03). Greater breastfeeding intensity and duration (12-month combined) score was associated with lower odds of obesity, independent of infant temperament and other covariates. CONCLUSIONS AND RELEVANCE Among this high-risk population of infants, elevated soothability was associated with early childhood obesity risk, perhaps in part because caregivers use sugary drinks to assuage infants. Soothability temperament may be a novel screening target for early obesity prevention interventions involving responsive feeding and emotion regulation.

Strategies to promote responsive bottle‐feeding in WIC predict less frequent use of food to soothe and healthier weight status for infants with negative temperaments

“…This was evident for participants in control clinics, wherein a significant association between greater infant negative affectivity and more frequent use of food to soothe was noted. These findings are consistent with previous research illustrating greater infant negative affectivity predicts more frequent use of food to soothe, 5,6,48 greater feeding frequency, 49,50 and earlier introduction to complementary foods and beverages, most often via addition of cereal to the bottle, 51,52 likely because feeding effectively reduces fussing and crying 19 …”

Effect and Significance of High-Quality Nursing on Blood Glucose, Pregnancy Outcome, and Neonatal Complications of Patients with Gestational Diabetes Mellitus

“…For example, Tang [ 10 ] showed that detailed consultation and guidance by professional medical personnel are useful for improving the condition of GDM patients. It can be seen that nursing methods have a key positive effect on GDM patients and infants [ 11 ]. The “high-quality nursing service demonstration project” is an important guiding measure for the reform of nursing work in our country at present [ 12 ] and is also an important measure for establishing a patient-centered nursing service concept in China [ 13 ].…”

Gestational Diabetes Mellitus Among Asians – A Systematic Review From a Population Health Perspective

“…Among Asian immigrants, two studies in the UK ( 94 , 95 ) and one study in the US ( 96 ) with sample sizes ranging from 382 to 6 060 reported a consistent association between GDM and childhood obesity across all races and ethnic groups. The magnitude in such association between NHW women and Asian female immigrants was similar.…”