Increased fetal adiposity: A very sensitive marker of abnormal in utero development

doi:10.1016/S0002-9378(03)00828-7

American Journal of Obstetrics and Gynecology

Volume 189, Issue 6, December 2003, Pages 1698-1704

https://doi.org/10.1016/S0002-9378(03)00828-7 Get rights and content

Abstract

Objective

Because offspring of women with gestational diabetes mellitus have an increased risk of obesity and diabetes mellitus as young adults, our purpose was to characterize body composition at birth in infants of women with gestational diabetes mellitus and normal glucose tolerance.

Study design

One hundred ninety-five infants of women with gestational diabetes mellitus and 220 infants of women with normal glucose tolerance had anthropometric measurements and total body electrical conductivity body composition evaluations at birth. Parental demographic, anthropometric, medical and family history data, and diagnostic glucose values were used to develop a stepwise regression model that related to fetal growth and body composition.

Results

There was no significant difference in birth weight (gestational diabetes mellitus [3398±550 g] vs normal glucose tolerance [3337±549 g], P = .26) or fat-free mass (gestational diabetes mellitus [2962±405 g] vs normal glucose tolerance [2975±408 g], P = .74) between groups. However, infants of women with gestational diabetes mellitus had significantly greater skinfold measures (P = .0001) and fat mass (gestational diabetes mellitus [436±206 g] vs normal glucose tolerance [362±198 g], P = .0002) compared with infants of women with normal glucose tolerance. In the gestational diabetes mellitus group, although gestational age had the strongest correlation with birth weight and fat-free mass, fasting glucose level had the strongest correlation with neonatal adiposity.

Conclusion

Infants of women with gestational diabetes mellitus, even when they are average weight for gestational age, have increased body fat compared with infants of women with normal glucose tolerance. Maternal fasting glucose level was the strongest predictor of fat mass in infants of women with gestational diabetes mellitus. This increase in body fat may be a significant risk factor for obesity in early childhood and possibly in later life.

Section snippets

Material and methods

The protocol was approved by the hospital Institutional Review Board. Written informed consent was obtained from each subject before evaluation in the General Clinical Research Center. Subjects were recruited on the basis of availability to participate in this prospective protocol that evaluated fetal growth. Women with NGT were recruited from the general population, and women with GDM were recruited from our Pregnancy Diabetes Clinic from 1990 through 2000. All women in these clinics were

Results

One hundred ninety-five women with GDM and 220 women with NGT were recruited. Demographics are shown in Table I. Of the 195 women with GDM, 67 women (34%) required insulin to maintain fasting and preprandial and postprandial glucose values within the target range. One hundred twenty-eight women with GDM (66%) were able to maintain glucose values within the normal range using diet and exercise. Women with GDM were older, shorter, and smoked more frequently and had greater pregravid weight

Comment

The most significant finding of our study was that of a significant increase in adiposity of average for gestational aged infants of women with GDM. Previous studies by Pettitt et al³ and Silverman et al⁷ have shown that infants of women with GDM have an increased risk of adolescent obesity and glucose intolerance. However, detailed body composition data at the time of birth was not available. Earlier studies ascribed the increases in birth weight of infants of diabetic women to either fat mass

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^☆: Supported by National Institutes of Health grants No. HD-22965, PERC-11089, General Clinical Research Center MO1-RR-80, and the Weight Watchers Foundation.

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Increased fetal adiposity: A very sensitive marker of abnormal in utero development☆

Abstract

Objective

Study design

Results

Conclusion

Section snippets

Material and methods

Results

Comment

Am J Obstet Gynecol

Lancet

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

The pregnant diabetic and her newborn: problems and management

Age dependent insulin secretion of the endocrine pancreas in vitro from fetuses of diabetic and nondiabetic patients

Diabetes Care

Excessive obesity in offspring of Pima Indian women with diabetes during pregnancy

N Engl J Med

The organizing committee: summary and recommendations of the third international workshop: conference on gestational diabetes mellitus

Diabetes

Human intrauterine growth and nutrient accretion

Semin Perinatol

Diabetes trends in the US: 1990-1998

Diabetes Care

Long-term effects of the intrauterine environment: the Northwestern University Diabetes in Pregnancy Center

Diabetes Care