Overweight and obesity in infants of mothers with long-term insulin-dependent diabetes or gestational diabetes

Abstract

OBJECTIVES: To analyse the development of body weight and frequencies of overweight and obesity in infants of long-term insulin-dependent diabetic mothers as compared to those of gestational diabetic mothers. DESIGN: Retrospective study. SUBJECTS: Two hundred infants of mothers with pregestational insulin-dependent diabetes mellitus (IDM) and 117 infants of gestational diabetic mothers (IGDM) born between 1980 and 1990 at the Clinic of Obstetrics and Gynaecology, Berlin-Kaulsdorf, Germany. MEASUREMENTS: Birth weight, birth length, plasma insulin, interscapular skinfold, symmetry index (SI) and body mass index (BMI) at birth; SI and BMI in childhood (1–9 y of age). RESULTS: Neonatally, mean relative weight (SI) was found to be increased in both groups of infants. It was positively correlated to interscapular skinfold (P<0.001) and insulin (P<0.005). However, IDM had higher insulin levels (P<0.001) and a higher frequency of obesity (P<0.05) than IGDM at birth. Throughout childhood frequencies of overweight (SI>1.1) were elevated in both IDM as well as IGDM. In IDM the percentage of obesity (SI>1.2) displayed a significant increase from 11.2% in children 1–4 y old up to 25.8% at 5–9 y (P<0.05). Similar frequencies and a highly significant increase of overweight during childhood of IDM (P<0.005) were observed when BMI≥95th percentile was used to determine overweight. Relative weight in childhood was positively correlated to relative weight at birth (P<0.05). Large-for-gestational-age infants displayed a significantly higher percentage of overweight (SI>1.1) in childhood than appropriate-for-gestational-age infants (P<0.05). CONCLUSIONS: Infants of mothers with diabetes during pregnancy are predisposed to develop overweight and obesity during childhood. These alterations seem to be related to insulin and relative body weight at birth. Pathophysiological mechanisms which might be involved into the development of these changes are discussed. Prophylactic measures are recommended to reduce morbidity in infants of diabetic mothers.