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Breastfeeding appears to have a protective effect against later obesity for children born to mothers with diabetes during pregnancy, based on the analysis of data from a retrospective cohort study published online Feb. 25 in Diabetes Care.
The findings could help to prevent childhood obesity in children born to mothers with diabetes during pregnancy. Research has shown that these children have a greater prevalence of obesity in childhood, Tessa L. Crume, Ph.D., of the Colorado School of Public Health at the University of Colorado in Denver and her coinvestigators noted (Diabetes Care 2011;34:641-5).
Both children exposed to diabetes in utero and those unexposed but who had adequate breastfeeding had significantly lower body mass index (BMI), waist circumference, subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT) at ages 6-13 years than did those with less breastfeeding.
"Our study provides novel evidence that the effect of exposure to diabetes in utero on childhood adiposity parameters is substantially attenuated by breastfeeding, such that the obesity outcomes in exposed youth who were adequately breastfed were similar to those of unexposed youth. Our data suggest that breastfeeding promotion may be an effective strategy for reducing the increased risk of childhood obesity in the offspring of mothers with diabetes during pregnancy," wrote Dr. Crume and her colleagues.
The researchers used data from a retrospective cohort study entitled Exploring Perinatal Outcomes Among Children (EPOCH). Participants were aged 6-13 years. In addition, they were multiethnic offspring of singleton pregnancies born at a single hospital in Denver between 1992 and 2002. The mothers were members of the Kaiser Permanente of Colorado Health Plan and were still members and living in Colorado over the study period (2006-2009).
The study included 89 youths, who were exposed to diabetes in utero. The researchers also identified a random sample of 397 children who were not exposed to diabetes in utero. Children and their biological mothers were invited for a research visit between January 2006 and October 2009.
Physician-diagnosed maternal diabetes status was ascertained from the Kaiser Permanente Colorado perinatal database – an electronic database linking neonatal and perinatal medical records. Gestational diabetes mellitus was coded as present if diagnosed through the standard Kaiser screening protocol and absent if screening was negative. All pregnant women were offered screening at 24-28 weeks.
Exposure to diabetes in utero was defined as the presence of preexistent diabetes or gestational diabetes diagnosed during the index pregnancy. Birth weight, gestational age, and maternal prepregnancy weight also were obtained from the database.
Mothers were asked about breast- and formula-feeding, timing, and the introduction of other solid foods and beverages. Mixed feeding was commonly reported, so a measure of breast milk-months was developed that incorporated duration and exclusivity. For exclusively breastfed infants, duration was equal to the age of the child (months) when breastfeeding was stopped. Breastfeeding exclusivity was quantified using weights from 0 to 1, with exclusive breastfeeding having a weight of 1 and exclusive formula-feeding having a weight of 0. For infants who were ever fed formula, mothers classified their infant feeding as formula only (0), more formula than breast milk (0.25), equal breast milk and formula (0.50), or more breast milk than formula (0.75).
The breast milk-months measure incorporated duration and exclusivity to estimate an overall breast milk dose equivalent in months. Based on a formula that included breastfeeding exclusivity and duration, breastfeeding status was categorized as low (less than 6 breast milk-months) and adequate (at least 6 breast milk-months).
The subscapular-to-triceps skinfold ratio (STR) was calculated to assess regional differences in subcutaneous fat distribution. In addition, an MRI of the abdominal region was used to quantify VAT and SAT.
The mean age was 9.6 years for exposed youth and 10.6 years for unexposed youth at the study visit – a difference that was significant. Exposed youth were significantly more likely to be non-Hispanic white or Hispanic, and a larger proportion of exposed youth self-reported a Tanner stage less than 2 (prepubertal). Mothers with diabetes during pregnancy were significantly older on average than mothers whose pregnancies were not complicated by diabetes. Exposed and unexposed offspring were not significantly different in terms of intrauterine growth, socioeconomic factors or infant feeding practices.
Among adolescents with low breastfeeding status, exposure to diabetes in utero was associated with a 1.7 kg/m2 greater BMI (significant); a 5.8 cm greater waist circumference (significant); a 6.1 cm2 higher VAT; a 44.6 cm2 greater SAT (significant); and a 0.11 higher STR (significant). The association between exposure to diabetes in utero and the adiposity parameters was substantially reduced and not significant for adolescents with adequate breastfeeding in infancy with a 0.7 kg/m2 lower BMI (significant); a 2.7 cm greater waist circumference; a 2.1 cm2 greater VAT; a 23.4 cm2 greater SAT; and a 0.05 greater STR among exposed versus unexposed children.
Importantly, all measures of adiposity were influenced, including the more sensitive VAT and SAT, the investigators noted. Although the mechanisms that trigger adipose tissue deposition in specific locations at different periods of fetal development or in childhood remain unclear, the identification of strategies to alter the long-term development of fat deposition/accumulation is necessary to minimize the significant increased morbidity risk associated with childhood obesity. "Fetal life and early infancy both represent critical periods when obesity begins and may be effectively minimized by targeted prevention strategies," they said.
Further work is needed to confirm this finding in larger populations though, and to determine if the reductions in adiposity continue into adulthood.
Dr. Crume and her associates reported that they have no relevant financial relationships.
Dr. Andreas Plageman and Dr. Thomas Harder noted that these findings may help answer key questions for the rapidly expanding fields of perinatal programming and developmental origins of health and disease.
"Differentiation and maturation, however, of affected organs and systems, such as pancreas, adipose tissue, and brain, are not finished at birth. The question therefore arises whether a prolongation of these critical exposures into the neonatal period might have similar effects," they wrote.
The question of whether continuing exposure after birth to altered fuels through breastfeeding might have consequences for child development. "This study by Crume et al. further supports the notion that a long-term breastfeeding (i.e., longer than 6 months) has a protective effect on later overweight risk in ODM [offspring of diabetic mothers]," they wrote.
The results of this study may not be generalizable to larger populations though because mothers in this cohort were screened for gestational diabetes, they noted. "Unfortunately, however, this is not the case in many other populations, although it probably has an important impact on the outcome. Therefore, to allow a comparison with data from other populations, further analyses on the potential impact of the quality of diabetes care on the outcome in breastfed infants of mothers with GDM [gestational diabetes mellitus] will be needed."
When gestational diabetes is identified, "good metabolic control during pregnancy and post partum will necessarily prevent altered milk composition and, consequently, may also prevent potential negative consequences for the developing infant. This might explain discrepancies between the results of this and other clinical studies," they observed.
However, "there is no doubt that breastfeeding should be recommended and promoted in ODM as in the general population. ... Population-wide detection and adequate treatment of GDM both pre- and postnatally should be performed to enhance not only the prenatal but also the neonatal nutritional environment of the offspring."
Dr. Plagemann is head of the division of experimental obstetrics at Charité–University Medicine Berlin. Dr. Harder also is a member of the division of experimental obstetrics at Charité–University Medicine Berlin. They commented in an editorial that accompanied the article by Crume et al. (Diabetes Care 2011;34:779-81). They reported that they had no relevant financial relationships.
Dr. Andreas Plageman and Dr. Thomas Harder noted that these findings may help answer key questions for the rapidly expanding fields of perinatal programming and developmental origins of health and disease.
"Differentiation and maturation, however, of affected organs and systems, such as pancreas, adipose tissue, and brain, are not finished at birth. The question therefore arises whether a prolongation of these critical exposures into the neonatal period might have similar effects," they wrote.
The question of whether continuing exposure after birth to altered fuels through breastfeeding might have consequences for child development. "This study by Crume et al. further supports the notion that a long-term breastfeeding (i.e., longer than 6 months) has a protective effect on later overweight risk in ODM [offspring of diabetic mothers]," they wrote.
The results of this study may not be generalizable to larger populations though because mothers in this cohort were screened for gestational diabetes, they noted. "Unfortunately, however, this is not the case in many other populations, although it probably has an important impact on the outcome. Therefore, to allow a comparison with data from other populations, further analyses on the potential impact of the quality of diabetes care on the outcome in breastfed infants of mothers with GDM [gestational diabetes mellitus] will be needed."
When gestational diabetes is identified, "good metabolic control during pregnancy and post partum will necessarily prevent altered milk composition and, consequently, may also prevent potential negative consequences for the developing infant. This might explain discrepancies between the results of this and other clinical studies," they observed.
However, "there is no doubt that breastfeeding should be recommended and promoted in ODM as in the general population. ... Population-wide detection and adequate treatment of GDM both pre- and postnatally should be performed to enhance not only the prenatal but also the neonatal nutritional environment of the offspring."
Dr. Plagemann is head of the division of experimental obstetrics at Charité–University Medicine Berlin. Dr. Harder also is a member of the division of experimental obstetrics at Charité–University Medicine Berlin. They commented in an editorial that accompanied the article by Crume et al. (Diabetes Care 2011;34:779-81). They reported that they had no relevant financial relationships.
Dr. Andreas Plageman and Dr. Thomas Harder noted that these findings may help answer key questions for the rapidly expanding fields of perinatal programming and developmental origins of health and disease.
"Differentiation and maturation, however, of affected organs and systems, such as pancreas, adipose tissue, and brain, are not finished at birth. The question therefore arises whether a prolongation of these critical exposures into the neonatal period might have similar effects," they wrote.
The question of whether continuing exposure after birth to altered fuels through breastfeeding might have consequences for child development. "This study by Crume et al. further supports the notion that a long-term breastfeeding (i.e., longer than 6 months) has a protective effect on later overweight risk in ODM [offspring of diabetic mothers]," they wrote.
The results of this study may not be generalizable to larger populations though because mothers in this cohort were screened for gestational diabetes, they noted. "Unfortunately, however, this is not the case in many other populations, although it probably has an important impact on the outcome. Therefore, to allow a comparison with data from other populations, further analyses on the potential impact of the quality of diabetes care on the outcome in breastfed infants of mothers with GDM [gestational diabetes mellitus] will be needed."
When gestational diabetes is identified, "good metabolic control during pregnancy and post partum will necessarily prevent altered milk composition and, consequently, may also prevent potential negative consequences for the developing infant. This might explain discrepancies between the results of this and other clinical studies," they observed.
However, "there is no doubt that breastfeeding should be recommended and promoted in ODM as in the general population. ... Population-wide detection and adequate treatment of GDM both pre- and postnatally should be performed to enhance not only the prenatal but also the neonatal nutritional environment of the offspring."
Dr. Plagemann is head of the division of experimental obstetrics at Charité–University Medicine Berlin. Dr. Harder also is a member of the division of experimental obstetrics at Charité–University Medicine Berlin. They commented in an editorial that accompanied the article by Crume et al. (Diabetes Care 2011;34:779-81). They reported that they had no relevant financial relationships.
Breastfeeding appears to have a protective effect against later obesity for children born to mothers with diabetes during pregnancy, based on the analysis of data from a retrospective cohort study published online Feb. 25 in Diabetes Care.
The findings could help to prevent childhood obesity in children born to mothers with diabetes during pregnancy. Research has shown that these children have a greater prevalence of obesity in childhood, Tessa L. Crume, Ph.D., of the Colorado School of Public Health at the University of Colorado in Denver and her coinvestigators noted (Diabetes Care 2011;34:641-5).
Both children exposed to diabetes in utero and those unexposed but who had adequate breastfeeding had significantly lower body mass index (BMI), waist circumference, subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT) at ages 6-13 years than did those with less breastfeeding.
"Our study provides novel evidence that the effect of exposure to diabetes in utero on childhood adiposity parameters is substantially attenuated by breastfeeding, such that the obesity outcomes in exposed youth who were adequately breastfed were similar to those of unexposed youth. Our data suggest that breastfeeding promotion may be an effective strategy for reducing the increased risk of childhood obesity in the offspring of mothers with diabetes during pregnancy," wrote Dr. Crume and her colleagues.
The researchers used data from a retrospective cohort study entitled Exploring Perinatal Outcomes Among Children (EPOCH). Participants were aged 6-13 years. In addition, they were multiethnic offspring of singleton pregnancies born at a single hospital in Denver between 1992 and 2002. The mothers were members of the Kaiser Permanente of Colorado Health Plan and were still members and living in Colorado over the study period (2006-2009).
The study included 89 youths, who were exposed to diabetes in utero. The researchers also identified a random sample of 397 children who were not exposed to diabetes in utero. Children and their biological mothers were invited for a research visit between January 2006 and October 2009.
Physician-diagnosed maternal diabetes status was ascertained from the Kaiser Permanente Colorado perinatal database – an electronic database linking neonatal and perinatal medical records. Gestational diabetes mellitus was coded as present if diagnosed through the standard Kaiser screening protocol and absent if screening was negative. All pregnant women were offered screening at 24-28 weeks.
Exposure to diabetes in utero was defined as the presence of preexistent diabetes or gestational diabetes diagnosed during the index pregnancy. Birth weight, gestational age, and maternal prepregnancy weight also were obtained from the database.
Mothers were asked about breast- and formula-feeding, timing, and the introduction of other solid foods and beverages. Mixed feeding was commonly reported, so a measure of breast milk-months was developed that incorporated duration and exclusivity. For exclusively breastfed infants, duration was equal to the age of the child (months) when breastfeeding was stopped. Breastfeeding exclusivity was quantified using weights from 0 to 1, with exclusive breastfeeding having a weight of 1 and exclusive formula-feeding having a weight of 0. For infants who were ever fed formula, mothers classified their infant feeding as formula only (0), more formula than breast milk (0.25), equal breast milk and formula (0.50), or more breast milk than formula (0.75).
The breast milk-months measure incorporated duration and exclusivity to estimate an overall breast milk dose equivalent in months. Based on a formula that included breastfeeding exclusivity and duration, breastfeeding status was categorized as low (less than 6 breast milk-months) and adequate (at least 6 breast milk-months).
The subscapular-to-triceps skinfold ratio (STR) was calculated to assess regional differences in subcutaneous fat distribution. In addition, an MRI of the abdominal region was used to quantify VAT and SAT.
The mean age was 9.6 years for exposed youth and 10.6 years for unexposed youth at the study visit – a difference that was significant. Exposed youth were significantly more likely to be non-Hispanic white or Hispanic, and a larger proportion of exposed youth self-reported a Tanner stage less than 2 (prepubertal). Mothers with diabetes during pregnancy were significantly older on average than mothers whose pregnancies were not complicated by diabetes. Exposed and unexposed offspring were not significantly different in terms of intrauterine growth, socioeconomic factors or infant feeding practices.
Among adolescents with low breastfeeding status, exposure to diabetes in utero was associated with a 1.7 kg/m2 greater BMI (significant); a 5.8 cm greater waist circumference (significant); a 6.1 cm2 higher VAT; a 44.6 cm2 greater SAT (significant); and a 0.11 higher STR (significant). The association between exposure to diabetes in utero and the adiposity parameters was substantially reduced and not significant for adolescents with adequate breastfeeding in infancy with a 0.7 kg/m2 lower BMI (significant); a 2.7 cm greater waist circumference; a 2.1 cm2 greater VAT; a 23.4 cm2 greater SAT; and a 0.05 greater STR among exposed versus unexposed children.
Importantly, all measures of adiposity were influenced, including the more sensitive VAT and SAT, the investigators noted. Although the mechanisms that trigger adipose tissue deposition in specific locations at different periods of fetal development or in childhood remain unclear, the identification of strategies to alter the long-term development of fat deposition/accumulation is necessary to minimize the significant increased morbidity risk associated with childhood obesity. "Fetal life and early infancy both represent critical periods when obesity begins and may be effectively minimized by targeted prevention strategies," they said.
Further work is needed to confirm this finding in larger populations though, and to determine if the reductions in adiposity continue into adulthood.
Dr. Crume and her associates reported that they have no relevant financial relationships.
Breastfeeding appears to have a protective effect against later obesity for children born to mothers with diabetes during pregnancy, based on the analysis of data from a retrospective cohort study published online Feb. 25 in Diabetes Care.
The findings could help to prevent childhood obesity in children born to mothers with diabetes during pregnancy. Research has shown that these children have a greater prevalence of obesity in childhood, Tessa L. Crume, Ph.D., of the Colorado School of Public Health at the University of Colorado in Denver and her coinvestigators noted (Diabetes Care 2011;34:641-5).
Both children exposed to diabetes in utero and those unexposed but who had adequate breastfeeding had significantly lower body mass index (BMI), waist circumference, subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT) at ages 6-13 years than did those with less breastfeeding.
"Our study provides novel evidence that the effect of exposure to diabetes in utero on childhood adiposity parameters is substantially attenuated by breastfeeding, such that the obesity outcomes in exposed youth who were adequately breastfed were similar to those of unexposed youth. Our data suggest that breastfeeding promotion may be an effective strategy for reducing the increased risk of childhood obesity in the offspring of mothers with diabetes during pregnancy," wrote Dr. Crume and her colleagues.
The researchers used data from a retrospective cohort study entitled Exploring Perinatal Outcomes Among Children (EPOCH). Participants were aged 6-13 years. In addition, they were multiethnic offspring of singleton pregnancies born at a single hospital in Denver between 1992 and 2002. The mothers were members of the Kaiser Permanente of Colorado Health Plan and were still members and living in Colorado over the study period (2006-2009).
The study included 89 youths, who were exposed to diabetes in utero. The researchers also identified a random sample of 397 children who were not exposed to diabetes in utero. Children and their biological mothers were invited for a research visit between January 2006 and October 2009.
Physician-diagnosed maternal diabetes status was ascertained from the Kaiser Permanente Colorado perinatal database – an electronic database linking neonatal and perinatal medical records. Gestational diabetes mellitus was coded as present if diagnosed through the standard Kaiser screening protocol and absent if screening was negative. All pregnant women were offered screening at 24-28 weeks.
Exposure to diabetes in utero was defined as the presence of preexistent diabetes or gestational diabetes diagnosed during the index pregnancy. Birth weight, gestational age, and maternal prepregnancy weight also were obtained from the database.
Mothers were asked about breast- and formula-feeding, timing, and the introduction of other solid foods and beverages. Mixed feeding was commonly reported, so a measure of breast milk-months was developed that incorporated duration and exclusivity. For exclusively breastfed infants, duration was equal to the age of the child (months) when breastfeeding was stopped. Breastfeeding exclusivity was quantified using weights from 0 to 1, with exclusive breastfeeding having a weight of 1 and exclusive formula-feeding having a weight of 0. For infants who were ever fed formula, mothers classified their infant feeding as formula only (0), more formula than breast milk (0.25), equal breast milk and formula (0.50), or more breast milk than formula (0.75).
The breast milk-months measure incorporated duration and exclusivity to estimate an overall breast milk dose equivalent in months. Based on a formula that included breastfeeding exclusivity and duration, breastfeeding status was categorized as low (less than 6 breast milk-months) and adequate (at least 6 breast milk-months).
The subscapular-to-triceps skinfold ratio (STR) was calculated to assess regional differences in subcutaneous fat distribution. In addition, an MRI of the abdominal region was used to quantify VAT and SAT.
The mean age was 9.6 years for exposed youth and 10.6 years for unexposed youth at the study visit – a difference that was significant. Exposed youth were significantly more likely to be non-Hispanic white or Hispanic, and a larger proportion of exposed youth self-reported a Tanner stage less than 2 (prepubertal). Mothers with diabetes during pregnancy were significantly older on average than mothers whose pregnancies were not complicated by diabetes. Exposed and unexposed offspring were not significantly different in terms of intrauterine growth, socioeconomic factors or infant feeding practices.
Among adolescents with low breastfeeding status, exposure to diabetes in utero was associated with a 1.7 kg/m2 greater BMI (significant); a 5.8 cm greater waist circumference (significant); a 6.1 cm2 higher VAT; a 44.6 cm2 greater SAT (significant); and a 0.11 higher STR (significant). The association between exposure to diabetes in utero and the adiposity parameters was substantially reduced and not significant for adolescents with adequate breastfeeding in infancy with a 0.7 kg/m2 lower BMI (significant); a 2.7 cm greater waist circumference; a 2.1 cm2 greater VAT; a 23.4 cm2 greater SAT; and a 0.05 greater STR among exposed versus unexposed children.
Importantly, all measures of adiposity were influenced, including the more sensitive VAT and SAT, the investigators noted. Although the mechanisms that trigger adipose tissue deposition in specific locations at different periods of fetal development or in childhood remain unclear, the identification of strategies to alter the long-term development of fat deposition/accumulation is necessary to minimize the significant increased morbidity risk associated with childhood obesity. "Fetal life and early infancy both represent critical periods when obesity begins and may be effectively minimized by targeted prevention strategies," they said.
Further work is needed to confirm this finding in larger populations though, and to determine if the reductions in adiposity continue into adulthood.
Dr. Crume and her associates reported that they have no relevant financial relationships.
FROM DIABETES CARE
Major Finding: Adolescents with low breastfeeding status who were exposed to diabetes in utero had greater BMI and greater waist circumference than did children with low breastfeeding status who were not exposed to diabetes in utero. The association between exposure to diabetes in utero and the adiposity parameters was substantially reduced and not significant for adolescents with adequate breastfeeding in infancy.
Data Source: A retrospective analysis including 89 children (aged 6-13 years) who were exposed to diabetes in utero and 397 children who were not.
Disclosures: The investigators reported that they had no relevant financial relationships.