Gestational diabetes mellitus, pre-pregnancy body mass index, and gestational weight gain as risk factors for increased fat mass in Brazilian newborns

Abstract

Background Gestational diabetes mellitus (GDM) is a common complication of pregnancy. It may predispose offspring to increased fat mass (FM) and the development of obesity, however few data from Latin America exist. Objective To investigate the influence of GDM on newborn FM in mother-newborn pairs recruited from a public maternity care center in São Paulo, Brazil. Methods Data were collected cross-sectionally in 2013–2014 from 72 mothers diagnosed with GDM, and 211 mothers with normal glucose tolerance (NGT). Newborn FM was evaluated by air-displacement plethysmography (PEA POD), and relevant demographic and obstetric data were collected from hospital records. Associations between maternal GDM status and newborn FM were investigated by multiple linear regression analysis, with adjustment for maternal age, pre-pregnancy BMI, gestational weight gain, type of delivery, sex of the child, and gestational age. Results FM was greater in GDM versus NGT newborns in a bivariable model (Median (IQR), GDM: 0.35 (0.3) kg vs. NGT: 0.27 (0.2) kg, p = 0.02), however GDM status was not a significant predictor of FM with adjustment for other variables. Rather, pre-pregnancy BMI (coefficient (β) 1.46; 95% confidence interval (CI) 0.66, 2.27), gestational weight gain (β 1.32; 95% CI 0.49, 2.15), and male sex (β -17.8; 95% CI -27.2, -8.29) predicted newborn FM. Analyzing GDM and NGT groups separately, pre-pregnancy BMI (β 6.75; 95% CI 2.36, 11.1) and gestational weight gain (β 5.64; 95% CI 1.16, 10.1) predicted FM in the GDM group, while male sex alone predicted FM in the NGT group (β -12.3; 95% CI -18.3, -6.34). Conclusions Combined model results suggest that in our cohort, pre-pregnancy BMI and gestational weight gain are more important risk factors for increased neonatal FM than GDM. However, group-specific model results suggest that GDM status may contribute to variation in the relationship between maternal/offspring factors and FM. Our use of a binary GDM variable in the combined model may have precluded clearer results on this point. Prospective cohort studies including data on maternal pre-pregnancy BMI, GWG, and glycemic profile are needed to better understand associations among these variables and their relative influence on offspring FM.

Determinants of Infant Adiposity across the First 6 Months of Life: Evidence from the Baby-bod study

“…Our findings of the impact of ppBMI were consistent with those who reported a positive association between ppBMI and %FM at birth [ 7 , 35 ] and others who did not find significant associations at 3 months [ 36 ], 5 months [ 6 ] and 6 months [ 36 ]. However, the positive association between ppBMI and FM/FFM p at birth, showed by Abreu et al [ 26 ], was not evident in our study. Conversely, some researchers have shown that ppBMI is not associated with FM or %FM, even in newborns [ 37 ].…”

“…In addition, recent research has demonstrated that FMI is a more reliable index than %FM when assessing neonatal adiposity [ 48 ]. In contrast, some studies [ 26 , 47 ] have suggested that an appropriate index should adjust the originator of the risk (FM) for a variable that is bearing the risk (FFM), thus recommending the index of FM/FFM p ; however, to the best to our knowledge, only one study [ 26 ] used FM/FFM p to identify maternal predictors of infant adiposity at birth. Our data demonstrate that FM/FFM p is highly sensitive to rapid changes in adiposity during this critical period of growth, with drastic increases from birth (~36) to 6 months (~1500).…”

“…Next, log FM was regressed on log FFM to find distinct regression coefficients for each time-point. These coefficients were used for p to calculate FM/FFM p , and the derived values were multiplied by 1000 to enhance the readability [ 26 ].…”

“…Nonetheless, the absolute values of FM have been used as a measure of adiposity in infants [ 24 ]. Additionally, different indices derived from FM, including %FM (FM adjusted for total body weight) [ 7 ], FMI (FM adjusted for height/length) [ 25 ], and FM/FFM p (FM adjusted for FFM) [ 26 ], have been used, but their interrelationships and, whether their determinants are identical, have not been investigated thoroughly.…”

Contribution of gestational diabetes mellitus heterogeneity and prepregnancy body mass index to large‐for‐gestational‐age infants—A retrospective case‐control study

“…We also confirmed that maternal prepregnancy overweight and obesity were associated with an increased risk of LGA, independent of GDM subtypes. Studies in different races have reported that newborn body weight was positively correlated with maternal adiposity, 10,25 which is reflected as higher maternal pre‐BMI and GWG. Our study found that excessive GWG was not associated with increased risk of LGA, which may be due to the doctors' recommendation of weight gain control for women with GDM.…”