Early Growth in Offspring of Diabetic Mothers

Abstract

OBJECTIVE -By age 5 years, offspring of diabetic mothers (ODMs) are heavier and have altered glucose metabolism compared with offspring of mothers without diabetes (non-DMs). This study evaluates the growth pattern of ODMs before the age of 5 years.RESEARCH DESIGN AND METHODS -Anthropometric measures (z scores) from birth, 1.5 years, and 7.7 years in Pima Indian children were compared by maternal diabetes status.RESULTS -After adjustment for earlier gestational age at delivery (37.8 vs. 39.3 weeks, P Ͻ 0.01), ODMs were heavier at birth (z score birth weight 0.49 vs. Ϫ0.04, P Ͻ 0.01) than non-DMs. At age 1.5 years, ODMs were shorter than the non-DMs (z score ϭ Ϫ0.24 vs. 0.12, P Ͻ 0.01) but their weight and relative weight (RW; weight adjusted for age, sex, and length or height) were similar. From birth to 1.5 years, ODMs showed significant "catch down" of weight compared with non-DMs (change in weight z score from birth to 1.5 years of ODMs and non-DMs was Ϫ0.56 and 0.12, respectively, P Ͻ 0.01). By age 7.7 years, ODMs were heavier (weight z score 0.89 vs. Ϫ0.07, P Ͻ 0.01) but had similar height as non-DMs. Differences in glucose and insulin concentrations at age 7.7 years were dependent on RW.CONCLUSIONS -ODMs had a dramatically different growth pattern from that of nonDMs. Gestational age-adjusted birth weight was higher. During the first 1.5 postnatal years, the change in weight z score and attained height were reduced. Subsequently, height caught up to that of non-DMs, while weight gain greatly exceeded that of non-DMs. Diabetes Care 28:585-589, 2005T here is an alarming increase in obesity and type 2 diabetes in children in the United States, particularly among high-risk populations such as Pima Indians (1). Because both of these disorders carry great morbidity and are so difficult to treat, understanding their pathogenesis in order to formulate treatment and prevention strategies is important.A number of anthropometric and personal characteristics have been identified as risk factors for obesity and diabetes. These attributes are at times difficult to reconcile. In the Pima Indian population, maternal diabetes during pregnancy, usually associated with higher offspring birth weight, carries an increased risk of diabetes and obesity in their children (2,3). Lower birth weight, however, is also associated with increased risk of later type 2 diabetes in both the Pima (4) and other populations (5). Individuals who develop type 2 diabetes in adult life in Caucasian (6) and Asian (7) populations have been found to have low BMI in the first 2 years of life but accelerated weight gain thereafter. By contrast, "catch-up" growth (upward crossing of centiles) in this same postnatal period (birth to age 2 years) has been associated with increased adiposity in childhood (8), which is in turn associated with early-onset diabetes (1). Breastfeeding, which does not alter the weight gain pattern of infants in the first 6 months of life (9), is associated with reduced risk of obesity and type 2 diabetes in some populations (1...

Early manifestation of cardiovascular disease risk factors in offspring of mothers with previous history of gestational diabetes mellitus

“…A steep weight gain was observed subsequently until school-age [33,34]. In contrast, BMI is high in the first year of offspring, decreasing between 2-5 years, and then an upward tendency from school age to puberty in the normal paediatric population [35].…”

Early-Life Predictors of Higher Body Mass Index in Healthy Children

“…Adjustment for infant weight gain strengthened the effect of higher birthweight on higher childhood BMI, suggesting that, although high birthweight infants gain less weight in the 1st year of life, they still remain at higher risk for higher childhood BMI. Similarly, a study in the Pima Indians found that children exposed to diabetes in utero had higher birthweights, slower weight gain ('catch-down growth') in infancy, and subsequent greater childhood obesity [42] .…”

Breastfeeding After Gestational Diabetes Pregnancy

“…Early introduction of cow's milk or other foods are hypothesized to trigger autoimmune responses leading to type 1 diabetes, especially among children with high-risk HLA genotypes, but findings are inconclusive (43). Growth patterns among children of women with diabetes, including those with GDM, in general are slower after birth through the first 2 years of life, with rapid weight gain thereafter (44,45).…”