Long-Term Impact of Breast-Feeding on Body Weight and Glucose Tolerance in Children of Diabetic Mothers

Abstract

OBJECTIVE -Offspring of diabetic mothers (ODM) are at increased risk of developing overweight and impaired glucose tolerance (IGT). Recently, we observed that early neonatal ingestion of breast milk from diabetic mothers (DBM) may dose-dependently increase the risk of overweight in childhood. Here, we investigate whether DBM intake during the late neonatal period and early infancy also influences later adipogenic and diabetogenic risk in ODM.RESEARCH DESIGN AND METHODS -A total of 112 ODM were evaluated for influence of DBM ingestion during the late neonatal period (2nd-4th neonatal week) and early infancy on relative body weight (RBW) and glucose tolerance in early childhood. RESULTS -Exclusive breast-feeding was associated with increased childhood RBW (P ϭ 0.011). Breast-fed ODM had an increased risk of overweight (odds ratio 1.98 [95% CI 1.12-3.50]). Breast-feeding duration was also positively related to childhood RBW (P ϭ 0.004) and 120-min blood glucose during an oral glucose tolerance test (P ϭ 0.022). However, adjustment for the DBM volume ingested during the early neonatal period, i.e., 1st week of life, eliminated all these relations with late neonatal breast-feeding and its duration. Interestingly, no relationship was observed between maternal blood glucose in the middle of the third trimester and the outcome.CONCLUSIONS -Neither late neonatal DBM intake nor the duration of breast-feeding has an independent influence on childhood risk of overweight or IGT in ODM. Therefore, the 1st week of life appears to be the critical window for nutritional programming in ODM by ingestion of maternal "diabetic" breast milk. Diabetes Care 28:1457-1462, 2005B reast feeding was variously shown to protect against later overweight and diabetes (1-6). This effect is attributed to differences in the composition of formula compared with breast milk (3). Offspring of diabetic mothers (ODM) are at increased risk of developing overweight and impaired glucose tolerance (IGT) even in childhood (7-10). Underlying mechanisms are still not understood. Clinical (8 -10) and experimental (11-13) studies have shown that a diabetic intrauterine environment plays a key role in programming of increased susceptibility to overweight and diabetes.We recently observed that ingestion of breast milk from diabetic mothers (diabetic breast milk; DBM) during the 1st neonatal week may dose-dependently lead to increased rather than decreased risk of overweight in later childhood of ODM (14). This lasting deleterious effect of DBM ingestion might result from altered macronutrient and hormonal milk composition (15-18).However, as the study addressed the early neonatal nutrition, results did not show whether breast-feeding after the 1st neonatal week also has any lasting influence. The vast majority of studies on the influence of breast-feeding on later disease risk ignored whether the mother was affected by a noncommunicable, i.e., metabolic disease, during lactation and, moreover, focused only on whether breast-feeding and/or the duration of breast-f...

Breastfeeding After Gestational Diabetes Pregnancy

“…A subsequent analysis of the same cohort examined the association between later breastfeeding and total duration of breastfeeding and risk of overweight at age 2 years in the offspring. These factors were strongly associated with child overweight in minimally adjusted models but exhibited no independent relationship once early neonatal breast milk from diabetic mothers was included in the model (47). Findings for impaired glucose tolerance during early or later neonatal periods were inconsistent.…”

“…Whether breast milk from mothers with diabetes differentially influences early infant growth compared with banked donor breast milk has been evaluated in a nonrandomized longitudinal study of German children born to mothers with diabetes during pregnancy. The cohort included 83 women with type 1 diabetes and 29 women with GDM (46,47). The highest tertile of breast milk intake from mothers with diabetes during the first week of life was associated with twice the risk of overweight, defined as relative body weight above 110% at 2 years of age, compared with the lowest tertile (OR 1.91, 95% CI 1.10 -3.30) (46).…”

Maternal over-nutrition and offspring obesity predisposition: targets for preventative interventions

“…There are conflicting reports in the literature regarding this issue in the context of gestational diabetes, hence more evidence is required to allow informed conclusions to be made. [51][52][53] Therefore, future studies that aim to prevent the programmed hyperphagia in the offspring could seek to target any of the above parameters, potentially through increasing maternal physical activity or altered maternal diet. There is some evidence to suggest that this may be a feasible option.…”

Breast-Feeding and Risk for Childhood Obesity

“…However, several issues are unresolved, including the potential for residual confounding to explain the effect (10,11). Moreover, it is possible that the impact of breast-feeding on childhood obesity may be attenuated or reversed among children whose mothers have diabetes (12)(13)(14)(15) or may be enhanced if mothers are overweight or obese (16,17).…”