Neonatal Adiposity is Largely Driven by Maternal Hyperglycemiain utero: Analysis of Routine Clinical Data from a Diabetes Clinic in India

Abstract

Background: Segregation of the effect of maternal size and glycemia on fetal growth is difficult to understand in overweight-obese women with diabetes. Aim: To examine the effect of maternal size and degree of hyperglycemia on neonatal obesity-adiposity in the relatively thin Indian population. Study design: Analysis of real-life data collected in one diabetes clinic. Methods: We examined the association of maternal size (BMI) and degree of hyperglycemia (type of diabetes, type 1 being the thinnest and most hyperglycemic, type 2 and Gestational diabetes being overweight and obese but less hyperglycemic) with neonatal obesity-adiposity measurements (weight, ponderal index, abdominal circumference, and skinfold thickness) using multiple linear regression. Results: We included data on 772 pregnancies with diabetes (61 with type 1, 79 with type 2, and 632 with gestational) and 349 with normal glucose tolerance (NGT). Mothers with type 1 diabetes had the lowest BMI and highest HbA1c, however, their neonates were the most obese, centrally obese, and adipose. Compared to neonates of NGT mothers, those of mothers with type 1 diabetes were 370 g heavier, those of mothers with type 2 diabetes 265 g, and those of mothers with GDM by 200 g. Prediction models adjusted for gestational age at birth, neonatal sex, maternal age, parity, and year of birth confirmed that neonates of mothers with type 1 diabetes were the most obese-adipose, followed serially by those of mothers with type 2 diabetes, GDM, and NGT. Other obesity adiposity measurements showed a similar gradient. Compared to maternal type of diabetes, pre-pregnancy BMI and gestational weight gain (GWG) made a much smaller contribution to neonatal obesity-adiposity. Conclusion: Our findings provide a clear answer that maternal hyperglycemia rather than size is the primary driver of neonatal obesity-adiposity. Adequate control of maternal hyperglycemia will help control neonatal obesity-adiposity.