Pregnancy Insulin, Glucose, and BMI Contribute to Birth Outcomes in Nondiabetic Mothers

Abstract

OBJECTIVE -We investigated the effects of normal variations in maternal glycemia on birth size and other birth outcomes.RESEARCH DESIGN AND METHODS -Women in two unselected birth cohorts, one retrospective (n ϭ 3,158) and one prospective (n ϭ 668), underwent an oral glucose challenge at 28 weeks of gestation. In the retrospective study, glycemia was linked to routine birth records. In the prospective study, offspring adiposity was assessed by skinfold thickness from birth to age 24 months.RESULTS -In the retrospective study, within the nondiabetic range (2.1-7.8 mmol/l), each 1 mmol/l rise in the mother's 60-min glucose level was associated with a (mean Ϯ SEM) 2.1 Ϯ 0.8% (P ϭ 0.006) rise in absolute risk of assisted vaginal delivery, a 3.4 Ϯ 0.8% (P Ͻ 0.0001) rise in emergency cesarean delivery, a 3.1 Ϯ 0.7% (P Ͻ 0.0001) rise in elective cesarean delivery, and a 46 Ϯ 8 g (P Ͻ 0.0001) increase in offspring birth weight. In the prospective study, fetal macrosomia (birth weight Ͼ90th centile) was independently related to the mother's fasting glucose (odds ratio 2.61 per ϩ1 mmol/l [95% CI 1.15-5.93]) and prepregnancy BMI (1.10 per ϩ1 kg/m 2 [1.04 -1.18]). The mother's higher fasting glycemia (P ϭ 0.004), lower insulin sensitivity (P ϭ 0.01), and lower insulin secretion (P ϭ 0.02) were independently related to greater offspring adiposity at birth. During postnatal follow-up, the correlation between the mother's glycemia and offspring adiposity disappeared by 3 months, whereas prepregnancy BMI was associated with offspring adiposity that was only apparent at 12 and 24 months (both P Ͻ 0.05).CONCLUSIONS -Prepregnancy BMI, pregnancy glycemia, insulin sensitivity, and insulin secretion all contribute to offspring adiposity and macrosomia and may be separate targets for intervention to optimize birth outcomes and later offspring health.

Resistance exercise training during pregnancy and newborn's birth size: a randomised controlled trial

“…The results from a recent prospective study showed that newborn's birth weight was associated with mother's pre-pregnancy body weight. 40 Our findings suggest that exercise training during the second and third trimester of pregnancy might attenuate the adverse effect of high maternal body weight before pregnancy on the newborn's birth size, as well as prevent the gravida from excessive gestational weight gain. Several studies showed that maternal excessive weight gain during pregnancy as well as maternal obesity are associated with a high risk for birth defects.…”

Maternal preconceptional nutrition leads to variable fat deposition and gut dimensions of adult offspring mice (C57BL/6JBom)

“…Evidence from epidemiological studies indicates that this may indeed be the case. 46 For example, infants from mothers with normal body mass index had less total and relative fat, than infants from overweight or obese mothers. 47 Moreover, maternal pre-pregnant body mass index and the weight of their infants up to 1 year of age were positively correlated in Danish women.…”

Optimal dietary approaches for prevention of type 2 diabetes: a life-course perspective

“…Early life, i.e. from conception to late gestation and early postnatal life, is thought to be particularly critical for the development of overweight and type 2 diabetes in later life [79][80][81]. In addition, the periodicity of the adiposity rebound (~age 4-6 years, describing the nadir in the BMI growth curve before its continuous rise until adulthood) and adolescence have also been proposed as potentially critical periods for the development of later obesity [82].…”

“…The increasing prevalence of gestational diabetes parallels that of obesity and type 2 diabetes [87]. Offspring exposed to maternal impaired glucose tolerance, diabetes or obesity in utero also have a higher risk of developing overweight or diabetes in later life [80,81].…”

“…In support, the major influence of maternal glycaemia on fetal growth was on adiposity in a contemporary UK birth cohort [81]. Dietary and lifestyle approaches to reduce glycaemia in all pregnant women are now recognised to be of paramount importance for both mother and child [81,92]. Intervention studies in women without gestational diabetes suggest that a low-GI diet consumed during pregnancy will reduce the risk of a large infant [93,94].…”