Development of Early Adiposity in Infants of Mothers With Gestational Diabetes Mellitus

Abstract

OBJECTIVEInfants born to mothers with gestational diabetes mellitus (GDM) are at greater risk of later adverse metabolic health. We examined plausible candidate mediators, adipose tissue (AT) quantity and distribution and intrahepatocellular lipid (IHCL) content, comparing infants of mothers with GDM and without GDM (control group) over the first 3 postnatal months. RESEARCH DESIGN AND METHODSWe conducted a prospective longitudinal study using MRI and spectroscopy to quantify whole-body and regional AT volumes, and IHCL content, within 2 weeks and 8-12 weeks after birth. We adjusted for infant size and sex and maternal prepregnancy BMI. Values are reported as the mean difference (95% CI). RESULTSWe recruited 86 infants (GDM group 42 infants; control group 44 infants). Mothers with GDM had good pregnancy glycemic control. Infants were predominantly breast-fed up to the time of the second assessment (GDM group 71%; control group 74%). Total AT volumes were similar in the GDM group compared with the control group at a median age of 11 days (228 cm 3 [95% CI 2121, 65], P = 0.55), but were greater in the GDM group at a median age of 10 weeks (247 cm 3 [56, 439], P = 0.01). After adjustment for size, the GDM group had significantly greater total AT volume at 10 weeks than control group infants (16.0% [6.0, 27.1], P = 0.002). AT distribution and IHCL content were not significantly different at either time point. CONCLUSIONSAdiposity in GDM infants is amplified in early infancy, despite good maternal glycemic control and predominant breast-feeding, suggesting a potential causal pathway to later adverse metabolic health. Reduction in postnatal adiposity may be a therapeutic target to reduce later health risks.Diabetes in pregnancy is increasing and currently affects up to 5% of women in the U.K.(1) and up to 9.2% in the U.S. (2). Approximately 87.5% of cases are gestational diabetes mellitus (GDM), 7.5% are type 1 diabetes, and 5% are type 2 diabetes (1). The offspring of mothers with diabetes have greater risks of adverse metabolic sequelae in childhood and later life that appear to be additional to genetic predisposition (3-5).The underlying mechanisms are unclear, but increased infant adiposity is a plausible mediator because adiposity in childhood and adult life are associated with type 2 diabetes and cardiovascular disease (6). The Hyperglycemia and Adverse

Effects of maternal obesity on placental function and fetal development

“…Obese mothers with GDM are three times more likely to have LGA or macrosomic babies who have increased adiposity and are more likely to be delivered by caesarian section (Harper, 2015; Logan et al 2016). Moreover, GDM diagnosis is associated with increased future risk of obesity, cardiovascular disease and metabolic disease in both mother and child (Zhao et al 2016; Stang and Huffman, 2016).…”

Association of breastfeeding and early exposure to sugar‐sweetened beverages with obesity prevalence in offspring born to mothers with and without gestational diabetes mellitus

“…In a prospective longitudinal study, Logan et al used magnetic resonance imaging (MRI) and spectroscopy to determine adipose tissue (AT) quantity and distribution and intrahepatocellular lipid (IHCL) content of 86 infants over the first 12 postnatal weeks and found that GDM offspring who were EBF had significantly greater total AT volume at 10 weeks than infants of non‐GDM women. However, they found no significant differences between AT distribution and IHCL content of GDM and non‐GDM groups at 11‐day or 10‐week postpartum . Human milk oligosaccharides (HMOs) are one of the key components in human milk that may protect against chronic diseases.…”

Maternal gestational diabetes and infant feeding, nutrition and growth: a systematic review and meta-analysis

“…All the included studies were observational, with the majority being cohort studies; thirteen were prospective (19,37,(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54) , eleven were retrospective (20,(38)(39)(40)(41)(42)(43)(55)(56)(57)(58)(59) and one was a retrospective casecontrol study (60) (Table 1). All but three studies (38,44,45) were published after 2010.…”