Large babies born to mothers with diabetes are at almost three times higher risk of obesity

New search published in diabetology (the journal of the European Association for the Study of Diabetes [EASD]) shows that children larger than the average at birth (great for gestational age or LGA) and born to mothers with gestational diabetes are almost three times more likely to be obese than children born to them. A normal size of mothers without diabetes. The study is led by Dr. Padma Kaul (Department of Medicine, University of Alberta, Edmonton, Alberta, Canada) and co-authors.

Overweight or obesity have multiple causes during childhood. Research has established that children born fat are more likely to be older in their childhood. Maternal weight, pre-pregnancy weight gain and pregnancy, as well as the status of maternal diabetes during pregnancy are established risk factors for infants with LGA. However, the relative impact of overweight and obesity during pregnancy on overweight and obesity during pregnancy is poorly understood.

The study badyzed 81,226 children born between January 2005 and August 2013. Almost all mothers lived in the Calgary area of ​​Alberta, Canada, and a lower proportion in the other provinces. regions of the state. Data on height and weight at the time of the offspring immunization visit (ages 4 to 6) between January 2009 and August 2017, as well as on the status of badfeeding during the first 5 years months of life, were related to the hospitalization of the mother. outpatient records and birth register data.

The children were grouped into six categories according to the state of maternal diabetes during pregnancy (no diabetes, gestational diabetes or pre-existing diabetes) and birth weight (appropriate for gestational age) [AGA] or LGA). The WHO criteria were used to identify overweight or obese children. There were 69,506 children in the group without diabetes / AGA (control group), 5926 in the group without diabetes / LGA, 4563 in the gestational diabetes / AGA group, 573 in the gestational diabetes / LGA group, 480 in pre-existing diabetes / AGA Group and 178 in the group on pre-existing diabetes / LGA.

Overweight / obesity rates at preschool age ranged from 21% in the control group to 43% in the gestational diabetes / LGA group. The rates of overweight / obesity were also high in the LGA / pre-existing diabetes group (36%) and in the group without diabetes / LGA (35%). Statistical calculations showed that the risk of overweight or obesity in a child was almost three times higher (2.79 times the increased risk) if it belonged to the gestational diabetic / LGA group compared to the non-diabetic control group / AGA. In the pre-existing diabetes / LGA group and the non-diabetic / LGA group, the risk was doubled compared to controls, clearly indicating that LGA is an independent risk factor for overweight / obesity in children.

Further badysis showed that the risk of childhood obesity alone accounted for 39%, which is much higher than that observed only for maternal gestational diabetes (16%) or pre-existing diabetes (15%); the contribution to risk for gestational diabetic diabetes / LGA and pre-existing diabetes / LGA combinations was 50% and 39%, respectively.

When the pre-existing diabetes group was further stratified into subgroups of types 1 and 2, the authors found that the prevalence of overweight / obese was 21% in the type 1 / AGA group, 31% in the type 1 / LGA group (similar to groups without diabetes), 27% in the type 2 / AGA group and 42% in the type 2 / LGA group.

The authors explain that being at birth at birth is a potentially modifiable factor and this study highlights the need to better understand the factors badociated with its incidence in order to develop strategies to reduce overweight / obesity rates in children . The authors believe that LGA could be a surrogate marker for two unmeasured variables in the study: maternal weight (excess before pregnancy or gestational weight gain) or glycemic control during pregnancy.

They say, "Our study finds that a greater proportion of overweight in childhood can be attributed to AGL than maternal diabetes during pregnancy." We hope these The results will strengthen public health campaigns advising women who are planning pregnancy, as well as smoking, alcohol and other lifestyle changes, their weight before pregnancy, as well as weight gain and control. blood sugar during pregnancy can have a significant impact on the future health of their children. "

Breastfeeding during the first five months of life was badociated with a probability of approximately 25% overweight / obese during childhood, both overall and in all groups except the gestational diabetes / LGA and pre-existing diabetes / LGA (type 1 and 2)).

The authors stated: "The protection afforded by bad milk does not extend to the gestational diabetes / LGA and pre-existing diabetes / LGA groups – neither overall nor 2 / LGA If, as far as possible, LGA is a marker of poor glycemic control during pregnancy, additional research is needed to determine whether, as previously suggested, glucose and insulin in mothers' milk with diabetes can increase the risk of childhood instead of protecting it from obesity. "

Explore further:
CDC: Prevalence of gestational diabetes by 6.0% in 2016

More information:
Padma Kaul et al, Association between Maternal Diabetes, Being Large for Gestational Age and Breastfeeding in Case of Overweight or Obesity in Childhood, diabetology (2018). DOI: 10.1007 / s00125-018-4758-0