Associations of infant milk feed type on early postnatal growth of offspring exposed and unexposed to gestational diabetes in utero

Abstract

Purpose Infants on prolonged breastfeeding are known to grow slower during the first year of life. It is still unclear if such effects are similar in offspring exposed to gestational diabetes (GDM) in utero. We examined the associations of infant milk feeding on postnatal growth from birth till 36 months of age in offspring exposed and unexposed to GDM.MethodsPregnant mothers undertook 75 g 2-h oral glucose tolerance tests at 26–28 weeks of gestation for GDM diagnosis. Up to 9 measurements of offspring weight and length were collected from birth till 36 months, and interviewer-administered questionnaires were used to ascertain the duration of breastfeeding.ResultsThere was a statistically significant interaction between GDM status and breastmilk intake by any (p interaction = 0.038) or exclusive/predominant breastfeeding (p interaction = 0.035) for the outcome of conditional weight gain. In offspring of non-GDM mothers (n = 835), greater breastmilk intake (BF ≥ 4 milk months) was associated with lower conditional gains in weight [B (95 % CI) −0.48 (−0.58, −0.28); p < 0.001] within the first year of life, as well as decreasing weight SDS velocity [−0.01 (−0.02, −0.005); p < 0.001] and BMI SDS velocity [−0.008 (0.01, −0.002); p = 0.008] across age in the first 36 months. In offspring of GDM mothers (n = 181), however, greater breastmilk intake was associated with increased conditional gains in weight [0.72 (0.23, 1.20); p = 0.029] and BMI SDS [0.49 (0.04, 0.95); p = 0.04] in the first 6 months and did not demonstrate the decreasing weight and BMI SDS velocity observed in offspring of non-GDM mothers.ConclusionsThe reduced weight gain in the first year of life conferred by greater breastmilk intake in non-GDM children was not observed in GDM children.Clinical trial registrationThis study is registered under the Clinical Trials identifier NCT01174875; http://www.clinicaltrials.gov/ct2/show/NCT01174875?term=GUSTO&rank=2.Electronic supplementary materialThe online version of this article (doi:10.1007/s00394-015-1057-0) contains supplementary material, which is available to authorized users.

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 contrast to the current findings and findings of the above studies, a prospective cohort of 1152 Asian women with GDM (n = 181) in Singapore reported that offspring of mothers without GDM who were breastfed for at least 4 months had slower growth rate from birth to 36 months of age than those who were not breastfed or were BF for less than 4 months; however, they did not find similar results in offspring of mothers with GDM . In the GDM offspring, greater breast milk intake was associated with accelerated weight gain and BMI in the first 6 months of age.…”

Breastfeeding and growth during infancy among offspring of mothers with gestational diabetes mellitus: a prospective cohort study

“…Only one prospective study previously measured growth during the first year of life among infants of GDM mothers. This study of 181 Singaporean infants found that breast milk intake for ≥4 months was associated with accelerated weight gain from birth to 6 months and higher attained BMI compared to no BF (16). Unmeasured confounding or reverse causation could explain these findings because early preterm births were not excluded, and the analysis did not account for effects of adverse newborn health outcomes or maternal GDM severity.…”

“…These studies showed mixed findings that do not support the previously reported protective associations between BF duration and subsequent development of overweight or obesity among children exposed to maternal diabetes in utero. A prospective study of 181 GDM infants found that BF ≥4 months accelerated weight gain from birth to 6 months compared with no BF (16), and a retrospective study of 94 youth exposed to maternal diabetes found a borderline lower body mass index (BMI) gain from birth to 9 months associated with 'adequate breast-milk months' (17). However, these studies did not account for reverse causation related to inclusion of early preterm infants (i.e.…”

Early postpartum oral metoclopramide augments lactogenesis II in insulin-dependent mothers with gestational diabetes: a randomized placebo-controlled trial

“…Social support may only have limited success in mitigating these effects (33), and are less likely to succeed in communities with low breastfeeding prevalence like Singapore (34,35). Increasing awareness of the bene ts of breastfeeding for mother and infant, especially of the reduced long-term risk of metabolic conditions in breast-fed infants creates a stronger incentive to improve lactation through a multidisciplinary approach (35,36). Offspring of diabetic mothers are at an increased risk of developing impaired glucose tolerance themselves; there is evidence that the rst week of life appears to be the critical window period for nutritional programming in offspring of diabetic mothers (3).…”