Impact of a Mother’s Weight History on Her Offspring

Dietary Intakes in the Nutritional Management Of Gestational Diabetes Mellitus

Purpose: Changes were examined in energy intakes and percentage of energy from macronutrients in response to nutritional intervention in women with gestational diabetes mellitus (GDM).

Methods: The study included 17 women with GDM and 27 women with normal glucose tolerance (controls). Women with GDM were followed by a multidisciplinary team; they received dietary counselling by a registered dietitian, and were prescribed diets with 40% to 45% energy from carbohydrate (CHO), 20% to 25% from protein, and 30% to 35% from fat. Dietary intakes were assessed with food frequency questionnaires before the intervention (26.9 ± 3.8 weeks) and after the intervention (32.6 ± 0.6 weeks).

Results: After the intervention, women with GDM reduced their total energy intake to reach lower values than did controls (P value for time-group interaction ≤0.05). A concomitant reduction in total CHO and glucose intakes in women with GDM led to significantly lower values compared with intakes in controls (P values for time-group interaction ≤0.001 for all). The post-intervention rate of weight gain in women with GDM was within the Institute of Medicine (IOM)-recommended values, while the post-intervention rate of weight gain in controls was above IOM-recommended values (0.30 ± 0.27 versus 0.61 ± 0.50 kg/week, P≤0.05).

Conclusions: These results suggest that this multidisciplinary medical and nutritional intervention was effective in the achievement of prescribed macronutrient distribution and controlling gestational weight gain in Canadian women with GDM.

Maternal birthweight is associated with subsequent risk of vitamin D deficiency in early pregnancy

BACKGROUND

Maternal low birthweight and vitamin D deficiency in pregnancy are associated with a similar spectrum of adverse pregnancy outcomes including pre-eclampsia and gestational diabetes. However, the relationship between maternal birthweight and subsequent vitamin D concentrations in early pregnancy is largely unknown.

METHODS

We assessed whether self-reported maternal birthweight was associated with risk of early pregnancy vitamin D deficiency (≤20 ng/mL) among a pregnancy cohort (n = 658). Serum 25-hydroxyvitamin D [25(OH)D] was measured using liquid chromatography-tandem mass spectroscopy.

RESULTS

Adjusting for maternal characteristics and month of blood draw, a 100-g higher maternal birthweight was associated with a 5.7% decreased risk of early pregnancy 25(OH)D deficiency [odds ratio (OR) = 0.94; 95% confidence interval (CI) 0.90, 0.99]. Low-birthweight (<2500 g) women were 3.7 times as likely to have early pregnancy 25(OH)D deficiency compared with normal-birthweight women [OR = 3.69; 95% CI 1.63, 8.34]. These relationships were not modified by either pre-pregnancy overweight status [body mass index (BMI) ≥25 kg/m(2)] or adulthood weight trajectory (BMI change ≥2 kg/m(2) from age 18 to pre-pregnancy).

CONCLUSIONS

Further research on shared developmental mechanisms that determine birthweight and vitamin D homeostasis may help identify targets and related preventative measures for adverse pregnancy and birth outcomes.

Cord blood C-peptide levels relate to the metabolic profile of women with and without gestational diabetes

Plasma C-peptide reflects the insulin-secretory activity of pancreatic β-cells which modulates fetal growth. Cord blood C-peptide levels were measured in women with gestational diabetes mellitus (GDM) and in women with normal glucose tolerance (NGT). Forty-one women underwent a 75-g oral glucose tolerance test (18 GDM, 23 NGT). Cord blood C-peptide (p = 0.09) and glucose levels (p = 0.08) from newborns of GDM women tended to be higher than those from NGT women. In the entire group, cord blood C-peptide correlated with maternal insulin, fasting C-peptide, insulin sensitivity, interleukin-6, weight and body mass index measured at screening (ρ from 0.34 to 0.48, all p < 0.05) and tended to correlate with offspring weight (ρ = 0.28, p = 0.08). Newborns of GDM women tended to have elevated cord blood C-peptide which correlated with maternal insulin, insulin sensitivity and anthropometric measures at diagnosis and with offspring characteristics. This suggests that insulin-secretory activity of the newborn is related to maternal metabolic parameters.

Peripheral adiposity in relation to offspring birth size in women with and without gestational diabetes: preliminary data

OBJECTIVE

To document the relationship between maternal body composition parameters and offspring anthropometric measurements.

METHODS

A prospective sample of 48 pregnant women with either gestational diabetes (GDM, n=21) or normal glucose tolerance (NGT, n=27) was studied. Maternal weight, hip circumference and skinfold thicknesses were obtained at 32 weeks of gestation. Offspring length and weight, as well as cranial and thoracic perimeters were obtained at birth.

RESULTS

Reported maternal pregravid BMI correlated with offspring thoracic perimeter (ρ=0.52, P<0.05) and tended to correlate with birth weight (ρ=0.41, P=0.07). There were significant correlations between hip circumference and pregravid BMI, and with biceps, triceps, subscapular, thigh and total sum of skinfold thicknesses (ρ=0.53-0.75, all P<0.01). Hip circumference also correlated with offspring length (ρ=0.61), weight (ρ=0.75) and thoracic perimeter (ρ=0.60, all P<0.05). Maternal hip circumference was an independent and significant predictor of offspring weight, explaining 14.1% of the observed variance (P<0.05).

CONCLUSION

In a sample of women with and without GDM, maternal hip circumference was strongly related to other body composition estimates and was also predictive of offspring size measurements at birth.