The study of women, infant feeding and type 2 diabetes after GDM pregnancy and growth of their offspring (SWIFT Offspring study): prospective design, methodology and baseline characteristics

Abstract

BackgroundBreastfeeding is associated with reduced risk of becoming overweight or obese later in life. Breastfed babies grow more slowly during infancy than formula-fed babies. Among offspring exposed in utero to maternal glucose intolerance, prospective data on growth during infancy have been unavailable. Thus, scientific evidence is insufficient to conclude that breastfeeding reduces the risk of obesity among the offspring of diabetic mothers (ODM).To address this gap, we devised the Study of Women, Infant Feeding and Type 2 Diabetes after GDM Pregnancy and Growth of their Offspring, also known as the SWIFT Offspring Study. This prospective, longitudinal study recruited mother-infant pairs from the SWIFT Study, a prospective study of women with recent gestational diabetes mellitus (GDM). The goal of the SWIFT Offspring Study is to determine whether breastfeeding intensity and duration, compared with formula feeding, are related to slower growth of GDM offspring during the first year life. This article details the study design, participant eligibility, data collection, and methodologies. We also describe the baseline characteristics of the GDM mother-infant pairs.MethodsThe study enrolled 466 mother-infant pairs among GDM deliveries in northern California from 2009–2011. Participants attended three in-person study exams at 6–9 weeks, 6 months and 12 months after delivery for infant anthropometry (head circumference, body weight, length, abdominal circumference and skinfold thicknesses), as well as maternal anthropometry (body weight, waist circumference and percent body fat). Mothers also completed questionnaires on health and lifestyle behaviors, including infant diet, sleep and temperament. Breastfeeding intensity and duration were assessed via several sources (diaries, telephone interviews, monthly mailings and in-person exams) from birth through the first year of life. Pregnancy course, clinical perinatal and newborn outcomes were obtained from health plan electronic medical records. Infant saliva samples were collected and stored for genetics studies.DiscussionThis large, racially and ethnically diverse cohort of GDM offspring will enable evaluation of the relationship of infant feeding to growth during infancy independent of perinatal characteristics, sociodemographics and other risk factors. The longitudinal design provides the first quantitative measures of breastfeeding intensity and duration among GDM offspring during early life.

Systemic and oral conditions of pregnant women with excessive weight assisted in a private health system

“…Women with PEW have a larger amount of fat mass but achieve lower weight gain in pregnancy than pregnant women with PNW 36 . In our study, there was no intergroup difference in the overall absolute weight gain during pregnancy (PEW = 8.77 AE 7.38; PNW = 8.31 AE 3.81); however, women with PEW more often presented a higher level of weight gain during the third trimester than that recommended by the Institute of Medicine (P = 0.010; Table 2).…”

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

“…All infants were healthy, live singleton births ≥35 weeks of gestation without serious medical conditions (e.g. failure to thrive, physical impairment affecting feeding ability, chronic infectious disease, severe jaundice or metabolic disorders) (18). Mothers provided written consent for three study visits at 6–9 weeks (baseline), 6 months and 12 months to measure their infant’s weight, length, three skin-fold thicknesses and head circumference, and completed surveys on infant behaviours and health.…”

“…These cut-offs are based on average milk intake of 24 oz among infants aged 6–9 weeks, such that >17 oz of formula represents >65%, and ≤6 oz of formula is ≤25% of the daily energy intake (20,21). As previously described (18), we classified exclusive or mostly BF as ‘intensive BF’ and exclusive or mostly FF as ‘intensive FF’ with <10% mixed feeders.…”

“…To evaluate the relation of infant feeding methods and infant growth among offspring of mothers with GDM, we conducted the Study of Women, Infant Feeding and Type 2 Diabetes Mellitus after GDM pregnancy and the Growth of their Offspring (The SWIFT Offspring Study) (18). We prospectively quantified BF intensity and duration, and serially measured infant weight and length through 1 year of age.…”

Intrahepatic Cholestasis of Pregnancy is Associated with Gestational Diabetes Mellitus

“…GDM increases risks of perinatal complications and constitutes a risk for fetal macrosomia, shoulder dystocia and neonatal hypoglycemia (13). It is also demonstrated that women with a history of GDM have a high risk of developing dyslipidemia, obesity and insulin resistance as part of metabolic syndrome later in life (14,15). Due to the high risk for both the mother and fetus, its diagnosis and treatment during pregnancy should be managed accurately.…”