Infants of mothers with gestational diabetes associated with increased adiposity

1. In a prospective study of 42 infants of mothers with gestational diabetes (GDM), there was a significant increase in total adipose tissue (AT) volume at 10 weeks of age compared to the control group.

2. There was no significant change in AT distribution or intrahepatocellular lipid (IHCL) content between infants of mothers with GDM and control infants.

Evidence Rating Level: 2 (Good)

Study Rundown: GDM affects up to 8% of all pregnant women in the United States and has been associated with a number of adverse outcomes in pregnancy including macrosomia and increased risk of metabolic abnormalities in childhood. However, the mechanism of these metabolic sequelae in the offspring is not well understood. Previous studies have demonstrated an association between maternal hyperglycemia and increased adiposity in newborns. The purpose of this study was to further quantify this association using direct adipose tissue measurements via whole-body magnetic resonance imaging (MRI).

The study prospectively analyzed 42 infants of mothers with GDM and 44 control infants with MRI and spectroscopy for total AT volume, distribution, and IHCL. At the conclusion of the study, total AT volume was significantly higher in infants born to mothers with GDM at 10 weeks of age compared to controls. This was not associated with differences in AT distribution or changes in IHCL content and is independent of maternal pre-pregnancy body mass index. The results of this study support the hypothesis that infants born to mothers with GDM develop increased adiposity compared to controls, which may contribute to the risk of future metabolic sequelae in this patient population. The study is strengthened by the prospective nature of the study and the use of direct measurements of AT. Further studies to elucidate the downstream effects of increased AT in childhood and beyond is warranted in this patient population.

Click to read the study in Diabetes Care

Relevant Reading: Association of maternal diabetes mellitus in pregnancy with offspring adiposity into early adulthood: sibling study in a prospective cohort of 280,866 men from 248,293 families

In-Depth [prospective cohort]: This was a prospective, observational study of AT deposition in infants born to mothers with GDM in a single teaching hospital in the United Kingdom. Full-term infants (37 to 42 weeks gestation) born to mothers with confirmed GDM were recruited. GDM was diagnosed in mothers using criteria of fasting plasma glucose ≥5.3 mmol/L or 2-h plasma glucose concentration of ≥7.8 mmol/L.  Key exclusion criteria includes mothers with pre-existing diabetes mellitus and small-for-gestational age infants.  MRI and spectroscopy were used to quantify volume and distribution of AT as well as the IHCL content in infants participating in this study. Overall, 42 infants born to mothers with GDM and 44 control infants were recruited to the study. At the conclusion of the trial, there was a significant increase in AT volumes in infants born to mothers with GDM compared to controls at 10 weeks (Difference: 16.0%; 95%CI: 6.0 to 27.1%; p = 0.002). The effect remained after adjustments for infant gender and pre-pregnancy BMI (Difference: 12.5%; 95%CI: 1.0 to 25.0; p = 0.03). There was no significant difference in AT distribution (p = 0.98) or IHCL (p = 0.89).

Image: PD

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