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Tryggestad JB, Kelsey MM, Drews KL, Zhou S, Chang N, Escaname E, Gidding SS, Isganaitis E, McKay S, Shah R, Van Name M. Clinical Characteristics of Offspring Born to Parents with Type 2 Diabetes Diagnosed in Youth: Observations from TODAY. CHILDREN (BASEL, SWITZERLAND) 2024; 11:630. [PMID: 38929210 PMCID: PMC11201816 DOI: 10.3390/children11060630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024]
Abstract
Diabetes exposure during pregnancy affects health outcomes in offspring; however, little is known about in utero exposure to preexisting parental youth-onset type 2 diabetes. Offspring born to participants during the Treatment Options for Type 2 Diabetes in Adolescent and Youth (TODAY) study were administered a questionnaire at the end of the study. Of 457 participants, 37% of women and 18% of men reported 228 offspring, 80% from female participants. TODAY mothers had lower household income (<$25,000) compared to TODAY fathers (69.4% vs. 37.9%, p = 0.0002). At 4.5 years of age (range 0-18 years), 16.7% of offspring were overweight according to the parental report of their primary care provider, with no sex difference. Offspring of TODAY mothers reported more daily medication use compared to TODAY fathers (50/183, 27.7% vs. 6/46, 12.2%, [p = 0.04]), a marker of overall health. TODAY mothers also reported higher rates of recidivism (13/94) than TODAY fathers (0/23). An Individualized Education Plan was reported in 20/94 (21.3%) offspring of TODAY mothers compared to 2/23 (8.7%) of TODAY fathers. This descriptive study, limited by parental self-reports, indicated offspring of participants in TODAY experience significant socioeconomic disadvantages, which, when combined with in utero diabetes exposure, may increase their risk of health and educational disparities.
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Affiliation(s)
- Jeanie B. Tryggestad
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA
| | - Megan M. Kelsey
- Department of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO 80045, USA
| | | | - Shirley Zhou
- Biostatistics Center, George Washington University, Rockville, MD 20852, USA
| | - Nancy Chang
- Children’s Hospital of Los Angeles, Los Angeles, CA 90027, USA
| | - Elia Escaname
- Department of Pediatrics, UT Health San Antonio, San Antonio, TX 78229, USA
| | | | - Elvira Isganaitis
- Department of Pediatrics, Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, USA
| | - Siripoom McKay
- Department of Pediatric Diabetes and Endocrinology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Rachana Shah
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Michelle Van Name
- Department of Endocrinology, Yale School of Medicine, New Haven, CT 06510, USA
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Sneed NM, Heerman WJ, Shaw PA, Han K, Chen T, Bian A, Pugh S, Duda S, Lumley T, Shepherd BE. Associations Between Gestational Weight Gain, Gestational Diabetes, and Childhood Obesity Incidence. Matern Child Health J 2024; 28:372-381. [PMID: 37966561 PMCID: PMC10922599 DOI: 10.1007/s10995-023-03853-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 11/16/2023]
Abstract
INTRODUCTION Excessive maternal gestational weight gain (GWG) is strongly correlated with childhood obesity, yet how excess maternal weight gain and gestational diabetes mellitus (GDM) interact to affect early childhood obesity is poorly understood. The purpose of this study was to investigate whether overall and trimester-specific maternal GWG and GDM were associated with obesity in offspring by age 6 years. METHODS A cohort of 10,335 maternal-child dyads was established from electronic health records. Maternal weights at conception and delivery were estimated from weight trajectory fits using functional principal components analysis. Kaplan-Meier curves and Cox regression, together with generalized raking, examined time-to-childhood-obesity. RESULTS Obesity diagnosed prior to age 6 years was estimated at 19.7% (95% CI: 18.3, 21.1). Maternal weight gain during pregnancy was a strong predictor of early childhood obesity (p < 0.0001). The occurrence of early childhood obesity was lower among mothers with GDM compared with those without diabetes (adjusted hazard ratio = 0.58, p = 0.014). There was no interaction between maternal weight gain and GDM (p = 0.55). Higher weight gain during the first trimester was associated with lower risk of early childhood obesity (p = 0.0002) whereas higher weight gain during the second and third trimesters was associated with higher risk (p < 0.0001). DISCUSSION Results indicated total and trimester-specific maternal weight gain was a strong predictor of early childhood obesity, though obesity risk by age 6 was lower for children of mothers with GDM. Additional research is needed to elucidate underlying mechanisms directly related to trimester-specific weight gain and GDM that impede or protect against obesity prevalence during early childhood.
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Affiliation(s)
- Nadia M Sneed
- Department of Pediatrics, Vanderbilt University Medical Center, 2146 Belcourt Ave., Nashville, TN, 37212, USA.
- Center for Research Development and Scholarship, Vanderbilt University School of Nursing, 319E Godchaux Hall, Nashville, TN, 37240, USA.
| | - William J Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, 2146 Belcourt Ave., Nashville, TN, 37212, USA
| | - Pamela A Shaw
- Biostatistics Unit, Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave Suite 1600, Seattle, WA, 98101, USA
| | - Kyunghee Han
- Department of Mathematics, Statistics, and Computer Science, University of Illinois at Chicago, 851 S Morgan St, 503 Science and Engineering Offices, Chicago, IL, 60607, USA
| | - Tong Chen
- Department of Statistics, University of Auckland, 38 Princes St., Auckland, 1010, New Zealand
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Ave., Room/Suite 11124, Nashville, TN, 37203, USA
| | - Shannon Pugh
- Department of Emergency Medicine, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA
| | - Stephany Duda
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Ave., Nashville, TN, 37203, USA
| | - Thomas Lumley
- Department of Statistics, University of Auckland, 38 Princes St., Auckland, 1010, New Zealand
| | - Bryan E Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Ave., Room/Suite 11124, Nashville, TN, 37203, USA
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Hoodbhoy Z, Mohammed N, Nathani KR, Sattar S, Chowdhury D, Maskatia S, Tierney S, Hasan B, Das JK. The Impact of Maternal Preeclampsia and Hyperglycemia on the Cardiovascular Health of the Offspring: A Systematic Review and Meta-analysis. Am J Perinatol 2023; 40:363-374. [PMID: 33940650 DOI: 10.1055/s-0041-1728823] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The objective of this review was to assess the impact of maternal preeclampsia or hyperglycemia on the body composition and cardiovascular health in the offspring. STUDY DESIGN We conducted a systematic review utilizing PubMed, EBSCO, CINAHLPlus, Cochrane Library, and Web of Science to include all studies assessing the impact of preeclampsia/eclampsia and/or gestational/pregestational diabetes mellitus on the health of the offspring (children <10 years of age). The health measures included anthropometry, cardiac dimensions and function, and vascular function. We performed a meta-analysis using Review Manager software and computed net risk ratio (RR) with 95% confidence interval (CI) for dichotomous data and mean difference (MD) with 95% CI for continuous data. RESULTS There were 6,376 studies in total, of which 45 were included in the review and 40 in the meta-analysis. The results demonstrated higher birth weight (MD: 0.12 kg; 95% CI: 0.06-0.18) and systolic and diastolic blood pressure (BP; MD: 5.98 mm Hg; 95% CI: 5.64-6.32 and MD: 3.27 mm Hg; 95% CI: 0.65-5.89, respectively) in the offspring of mothers with gestational diabetes compared to controls. In contrast, the offspring of mothers with preeclampsia had lower birth weight (MD: -0.41 kg; 95% CI: -0.7 to -0.11); however, they had increased systolic (MD: 2.2 mm Hg; 95% CI: 1.28-3.12) and diastolic BP (MD: 1.41 mm Hg; 95% CI: 0.3-2.52) compared to controls. There is lack of data to conduct a meta-analysis of cardiac morphology, functional, and vascular imaging parameters. CONCLUSION These findings suggest that the in-utero milieu can have a permanent impact on the body composition and vascular health of the offspring. Future work warrants multicenter prospective studies to understand the mechanism and the actual effect of exposure to maternal hyperglycemia and high BP on the cardiovascular health of the offspring and long-term outcomes. KEY POINTS · Adverse in-utero exposures may have an impact on cardiovascular risk in children.. · Maternal hyperglycemia/preeclampsia lead to changes in birthweight and BP.. · Limited echocardiographic and vascular imaging data in these cohorts necessitates future work..
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Affiliation(s)
- Zahra Hoodbhoy
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Nuruddin Mohammed
- Department of Obstetrics and Gynecology, The Aga Khan University, Karachi, Pakistan
| | | | - Saima Sattar
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | | | - Shiraz Maskatia
- Department of Paediatrics, Stanford University, Stanford, California
| | - Seda Tierney
- Department of Paediatrics, Stanford University, Stanford, California
| | - Babar Hasan
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Jai K Das
- Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan
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Clark JM, Garvey WT, Niswender KD, Schmidt AM, Ahima RS, Aleman JO, Battarbee AN, Beckman J, Bennett WL, Brown NJ, Chandler‐Laney P, Cox N, Goldberg IJ, Habegger KM, Harper LM, Hasty AH, Hidalgo BA, Kim SF, Locher JL, Luther JM, Maruthur NM, Miller ER, Sevick MA, Wells Q. Obesity and Overweight: Probing Causes, Consequences, and Novel Therapeutic Approaches Through the American Heart Association's Strategically Focused Research Network. J Am Heart Assoc 2023; 12:e027693. [PMID: 36752232 PMCID: PMC10111504 DOI: 10.1161/jaha.122.027693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/03/2023] [Indexed: 02/09/2023]
Abstract
As the worldwide prevalence of overweight and obesity continues to rise, so too does the urgency to fully understand mediating mechanisms, to discover new targets for safe and effective therapeutic intervention, and to identify biomarkers to track obesity and the success of weight loss interventions. In 2016, the American Heart Association sought applications for a Strategically Focused Research Network (SFRN) on Obesity. In 2017, 4 centers were named, including Johns Hopkins University School of Medicine, New York University Grossman School of Medicine, University of Alabama at Birmingham, and Vanderbilt University Medical Center. These 4 centers were convened to study mechanisms and therapeutic targets in obesity, to train a talented cadre of American Heart Association SFRN-designated fellows, and to initiate and sustain effective and enduring collaborations within the individual centers and throughout the SFRN networks. This review summarizes the central themes, major findings, successful training of highly motivated and productive fellows, and the innovative collaborations and studies forged through this SFRN on Obesity. Leveraging expertise in in vitro and cellular model assays, animal models, and humans, the work of these 4 centers has made a significant impact in the field of obesity, opening doors to important discoveries, and the identification of a future generation of obesity-focused investigators and next-step clinical trials. The creation of the SFRN on Obesity for these 4 centers is but the beginning of innovative science and, importantly, the birth of new collaborations and research partnerships to propel the field forward.
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Affiliation(s)
- Jeanne M. Clark
- Division of General Internal Medicine, Department of MedicineThe Johns Hopkins University School of MedicineBaltimoreMD
- Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMD
- Welch Center for Prevention, Epidemiology and Clinical ResearchThe Johns Hopkins UniversityBaltimoreMD
| | - W. Timothy Garvey
- Department of Nutrition SciencesUniversity of Alabama at BirminghamBirminghamAL
| | - Kevin D. Niswender
- Tennessee Valley Healthcare SystemVanderbilt University Medical CenterNashvilleTN
- Division of Diabetes, Department of Medicine, Endocrinology and MetabolismVanderbilt University Medical CenterNashvilleTN
| | - Ann Marie Schmidt
- Department of Medicine, Diabetes Research Program, Division of Endocrinology, Diabetes and MetabolismNew York University Grossman School of MedicineNew YorkNY
| | - Rexford S. Ahima
- Department of Medicine, Division of Endocrinology, Diabetes and MetabolismThe Johns Hopkins University School of MedicineBaltimoreMD
| | - Jose O. Aleman
- Division of Endocrinology, Department of Medicine, Diabetes and MetabolismNew York University Grossman School of MedicineNew YorkNY
| | - Ashley N. Battarbee
- Division of Maternal Fetal Medicine, Department of Obstetrics and GynecologyUniversity of Alabama at BirminghamBirminghamAL
| | - Joshua Beckman
- Division of Cardiovascular Medicine, Department of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Wendy L. Bennett
- Division of General Internal Medicine, Department of MedicineThe Johns Hopkins University School of MedicineBaltimoreMD
- Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMD
- Welch Center for Prevention, Epidemiology and Clinical ResearchThe Johns Hopkins UniversityBaltimoreMD
- Department of Population, Family and Reproductive HealthThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | | | - Nancy Cox
- Vanderbilt Genetics Institute and Division of Genetic Medicine, Department of MedicineVanderbilt University Medical CenterNashvilleTNUSA
| | - Ira J. Goldberg
- Division of Endocrinology, Department of Medicine, Diabetes and MetabolismNew York University Grossman School of MedicineNew YorkNY
| | - Kirk M. Habegger
- Division of Endocrinology, Department of Medicine, Diabetes, and MetabolismUniversity of Alabama at BirminghamBirminghamAL
| | - Lorie M. Harper
- Division of Maternal Fetal Medicine, Department of Obstetrics and GynecologyUniversity of Alabama at BirminghamBirminghamAL
- Division of Maternal‐Fetal Medicine, Department of Women’s Health, Dell Medical SchoolUniversity of Texas at AustinAustinTXUSA
| | - Alyssa H. Hasty
- Department of Molecular Physiology and BiophysicsVanderbilt University School of MedicineNashvilleTN
- VA Tennessee Valley Healthcare SystemNashvilleTN
| | - Bertha A. Hidalgo
- Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamAL
| | - Sangwon F. Kim
- Department of Medicine, Division of Endocrinology, Diabetes and MetabolismThe Johns Hopkins University School of MedicineBaltimoreMD
- Department of NeuroscienceThe Johns Hopkins University School of MedicineBaltimoreMD
| | - Julie L. Locher
- Division of Gerontology, Department of Medicine, Geriatrics, and Palliative CareUniversity of Alabama at BirminghamBirminghamAL
| | - James M. Luther
- Division of Clinical Pharmacology, Department of MedicineVanderbilt University Medical Center TennesseeNashvilleTN
| | - Nisa M. Maruthur
- Division of General Internal Medicine, Department of MedicineThe Johns Hopkins University School of MedicineBaltimoreMD
- Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMD
- Welch Center for Prevention, Epidemiology and Clinical ResearchThe Johns Hopkins UniversityBaltimoreMD
| | - Edgar R. Miller
- Division of General Internal Medicine, Department of MedicineThe Johns Hopkins University School of MedicineBaltimoreMD
- Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMD
- Welch Center for Prevention, Epidemiology and Clinical ResearchThe Johns Hopkins UniversityBaltimoreMD
| | - Mary Ann Sevick
- Division of Endocrinology, Department of Medicine, Diabetes and MetabolismNew York University Grossman School of MedicineNew YorkNY
- Department of Population Health, Center for Healthful Behavior ChangeNew York University Langone HealthNew YorkNY
| | - Quinn Wells
- Department of PharmacologyVanderbilt UniversityNashvilleTN
- Department of MedicineVanderbilt University Medical CenterNashvilleTN
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5
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Zakaria H, Abusanana S, Mussa BM, Al Dhaheri AS, Stojanovska L, Mohamad MN, Saleh ST, Ali HI, Cheikh Ismail L. The Role of Lifestyle Interventions in the Prevention and Treatment of Gestational Diabetes Mellitus. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020287. [PMID: 36837488 PMCID: PMC9966224 DOI: 10.3390/medicina59020287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023]
Abstract
Gestational diabetes mellitus (GDM) is one of the most common pregnancy-related endocrinopathies, affecting up to 25% of pregnancies globally. GDM increases the risk of perinatal and delivery complications, and the chance of developing type 2 diabetes mellitus and its complications, including cardiovascular diseases. This elevated risk is then passed on to the next generation, creating a cycle of metabolic dysfunction across generations. For many years, GDM preventive measures have had inconsistent results, but recent systematic reviews and meta-analyses have identified promising new preventative routes. This review aims to summarize the evidence investigating the efficacy of lifestyle treatments for the prevention of GDM and to summarize the effects of two lifestyle interventions, including physical activity and dietary interventions. Based on the present research, future studies should be conducted to investigate whether initiating lifestyle interventions during the preconception period is more beneficial in preventing GDM. In addition, research targeting pregnancy should be designed with a personalized approach. Therefore, studies should customize intervention approaches depending on the presence of modifiable and non-modifiable risk factors at the individual level.
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Affiliation(s)
- Hala Zakaria
- Clinical Science Department, College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Salah Abusanana
- Clinical Science Department, College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
- Diabetes and Endocrinology Department, University Hospital Sharjah, Sharjah 27272, United Arab Emirates
| | - Bashair M. Mussa
- Clinical Science Department, College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Ayesha S. Al Dhaheri
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Lily Stojanovska
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
- Institute for Health and Sport, Victoria University, Melbourne, VIC 3011, Australia
| | - Maysm N. Mohamad
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Sheima T. Saleh
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Habiba I. Ali
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Leila Cheikh Ismail
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford OX1 2JD, UK
- Correspondence:
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Dugas C, Laberee L, Perron J, St-Arnaud G, Richard V, Perreault V, Leblanc N, Marc I, Di Marzo V, Doyen A, Veilleux A, Robitaille J. Gestational Diabetes Mellitus, Human Milk Composition, and Infant Growth. Breastfeed Med 2023; 18:14-22. [PMID: 36409543 DOI: 10.1089/bfm.2022.0085] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Gestational diabetes mellitus (GDM) is known to affect human milk composition. Aims of this study were to compare macronutrient and energy content of human milk of women with (GDM+) and without GDM (GDM-), to assess the association between maternal health and human milk macronutrient and energy content and association between human milk macronutrient and energy content and infant growth. Study Design and Methods: Two months after delivery, hindmilk samples were collected. Triglyceride (TG), lactose, and protein content of human milk were measured. An oral glucose tolerance test was performed. Infant weight and length at birth and 2 months were collected. Weight-for-age (WAZ) and weight-for-length z-scores were calculated. Results: Twenty-four GDM+ and 29 GDM- women were included. Protein, lactose, and energy content of human milk were similar between groups. TG concentration was higher in GDM+ than in GDM- women (6.3 ± 2.0 versus 5.3 ± 1.2, p = 0.04). This difference was no longer significant after adjustment for maternal age and infant sex (p = 0.23). Maternal age was associated with TG (r = 0.28, p = 0.04) and lactose (r = -0.30, p = 0.03), while fasting glucose was associated with proteins (r = 0.30, p = 0.03) and tended to be associated with TG (r = 0.27, p = 0.05) and energy (r = 0.24, p = 0.08). TG levels in human milk were associated with weight (β: 0.26, 95% confidence interval [CI]: 0.02 to 0.50) and WAZ (β: 0.40, 95% CI: 0.05 to 0.75) at 2 months among children unexposed (GDM-) to GDM, but not among children exposed (GDM+) Conclusions: In conclusion, GDM status, maternal age, and fasting glucose level were associated with human milk composition. Finally, TG in human milk was associated with infant growth among GDM- children but not among GDM+ children. ClinicalTrials.gov NCT02872402.
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Affiliation(s)
- Camille Dugas
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec City, Canada.,School of Nutrition, Université Laval, Quebec City, Canada
| | | | - Julie Perron
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec City, Canada
| | - Gabrielle St-Arnaud
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec City, Canada.,School of Nutrition, Université Laval, Quebec City, Canada
| | - Véronique Richard
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec City, Canada
| | | | - Nadine Leblanc
- School of Nutrition, Université Laval, Quebec City, Canada.,Canada Excellence Research Chair on the Microbiome-Endocannabinoidome Axis in Metabolic Health, Université Laval, Quebec City, Canada
| | - Isabelle Marc
- Department of Pediatrics, Université Laval, Centre de recherche du CHU de Quebec, Quebec, Canada
| | - Vincenzo Di Marzo
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec City, Canada.,Canada Excellence Research Chair on the Microbiome-Endocannabinoidome Axis in Metabolic Health, Université Laval, Quebec City, Canada.,Heart and Lung Research Institute of Université Laval, Quebec City, Canada
| | - Alain Doyen
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec City, Canada.,Department of Food Sciences, Université Laval, Quebec City, Canada
| | - Alain Veilleux
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec City, Canada.,School of Nutrition, Université Laval, Quebec City, Canada.,Canada Excellence Research Chair on the Microbiome-Endocannabinoidome Axis in Metabolic Health, Université Laval, Quebec City, Canada
| | - Julie Robitaille
- Centre de recherche Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec City, Canada.,School of Nutrition, Université Laval, Quebec City, Canada
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7
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Martin SL, Zhang L, Callahan ML, Bahorski J, Lewis CE, Hidalgo BA, Durant N, Harper LM, Battarbee AN, Habegger K, Moore BA, Everett A, Aslibekyan S, Sertie R, Yi N, Garvey WT, Chandler‐Laney P. Mother-child cardiometabolic health 4-10 years after pregnancy complicated by obesity with and without gestational diabetes. Obes Sci Pract 2022; 8:627-640. [PMID: 36238222 PMCID: PMC9535673 DOI: 10.1002/osp4.599] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/20/2021] [Accepted: 01/30/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Obesity in pregnancy and gestational diabetes (GDM) increase cardiometabolic disease risk but are difficult to disentangle. This study aimed to test the hypothesis that 4-10 years after a pregnancy complicated by overweight/obesity and GDM (OB-GDM), women and children would have greater adiposity and poorer cardiometabolic health than those with overweight/obesity (OB) or normal weight (NW) and no GDM during the index pregnancy. Methods In this cross-sectional study, mother-child dyads were stratified into three groups based on maternal health status during pregnancy (OB-GDM = 67; OB = 76; NW = 76). Weight, height, waist and hip circumferences, and blood pressure were measured, along with fasting glucose, insulin, HbA1c, lipids, adipokines, and cytokines. Results Women in the OB and OB-GDM groups had greater current adiposity and poorer cardiometabolic health outcomes than those in the NW group (p < 0.05). After adjusting for current adiposity, women in the OB-GDM group had higher HbA1c, glucose, HOMA-IR and triglycerides than NW and OB groups (p < 0.05). Among children, adiposity was greater in the OB-GDM versus NW group (p < 0.05), but other indices of cardiometabolic health did not differ. Conclusions Poor cardiometabolic health in women with prior GDM is independent of current adiposity. Although greater adiposity among children exposed to GDM is evident at 4-10 years, differences in cardiometabolic health may not emerge until later.
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Affiliation(s)
- Samantha L. Martin
- Department of Nutrition SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Li Zhang
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Makenzie L. Callahan
- Department of Nutrition SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Jessica Bahorski
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Cora E. Lewis
- Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Bertha A. Hidalgo
- Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Nefertiti Durant
- Department of PediatricsDivision of Adolescent MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Lorie M. Harper
- Department of Women's HealthDivision of Maternal‐Fetal MedicineDell Medical SchoolThe University of Texas at AustinAustinTexasUSA
| | - Ashley N. Battarbee
- Department of Obstetrics and GynecologyDivision of Maternal Fetal MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Kirk Habegger
- Department of MedicineDivision of Endocrinology, Diabetes, and MetabolismUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Bethany A. Moore
- Department of Nutrition SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Alysha Everett
- Department of Nutrition SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Stella Aslibekyan
- Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Rogerio Sertie
- Department of Nutrition SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Nengjun Yi
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - W. Timothy Garvey
- Department of Nutrition SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Paula Chandler‐Laney
- Department of Nutrition SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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8
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Positive Effects of α-Lactalbumin in the Management of Symptoms of Polycystic Ovary Syndrome. Nutrients 2022; 14:nu14153220. [PMID: 35956395 PMCID: PMC9370664 DOI: 10.3390/nu14153220] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 11/18/2022] Open
Abstract
To date, the involvement of α-Lactalbumin (α-LA) in the management of polycystic ovary syndrome (PCOS) refers to its ability to improve intestinal absorption of natural molecules like inositols, overcoming the inositol resistance. However, due to its own aminoacidic building blocks, α-LA is involved in various biological processes that can open new additional applications. A great portion of women with PCOS exhibit gastrointestinal dysbiosis, which is in turn one of the triggering mechanisms of the syndrome. Due to its prebiotic effect, α-LA can recover dysbiosis, also improving the insulin resistance, obesity and intestinal inflammation frequently associated with PCOS. Further observations suggest that altered gut microbiota negatively influence mental wellbeing. Depressive mood and low serotonin levels are indeed common features of women with PCOS. Thanks to its content of tryptophan, which is the precursor of serotonin, and considering the strict link between gut and brain, using α-LA contributes to preserving mental well-being by maintaining high levels of serotonin. In addition, considering women with PCOS seeking pregnancy, both altered microbiota and serotonin levels can induce later consequences in the offspring. Therefore, a deeper knowledge of potential applications of α-LA is required to transition to preclinical and clinical studies extending its therapeutic advantages in PCOS.
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Huang S, Wischik DL, Whittemore R, Jeon S, Qing L, Guo J. Determinants of elevated depressive symptoms in Chinese women with gestational diabetes mellitus. Birth 2022; 49:289-297. [PMID: 34927281 DOI: 10.1111/birt.12605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/19/2021] [Accepted: 12/08/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Pregnant women with gestational diabetes mellitus (GDM) have a higher risk of developing elevated depressive symptoms than women without GDM. The aim of this study was to investigate the sociodemographic (eg, location), clinical (eg, health care-seeking behaviors), and psychological (eg, active coping skills) factors associated with elevated depressive symptoms in Chinese women with GDM. METHODS This was a secondary data analysis of a cross-sectional study among Chinese women with GDM. Data (n = 323) were collected in 2018 from two hospitals in Hunan Province in China. The Center for Epidemiological Survey Depression Scale was used, with a criterion score ≥20 indicative of clinically elevated depressive symptoms. Descriptive, bivariate, and multiple logistic regression analyses were completed. FINDINGS The women had a mean age of 32.71 (SD = 5.17), and the majority were married (84.2%), college-educated (65.6%), and with Han ethnicity (89.8%). About 68% of women had elevated depressive symptoms. Women with higher active coping scores were less likely (OR = 0.19, 95% CI: 0.10-0.38) to have elevated depressive symptoms. Women from one geographical location (Changde) who had more emergency room visits had higher odds (OR = 3.10, 95% CI: 1.88-5.10) of elevated depressive symptoms. DISCUSSION There was a high co-occurrence of GDM and elevated depressive symptoms among pregnant women in our sample. Assessment for depressive symptoms in women with GDM is warranted. More research about increasing active coping skills may improve health outcomes in women with GDM.
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Affiliation(s)
| | | | | | | | - Long Qing
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Jia Guo
- Xiangya School of Nursing, Central South University, Changsha, China
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10
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Carbonneau E, Dumas A, Brodeur-Doucet A, Fontaine-Bisson B. A Community Prenatal Intervention in Social Nutrition: Evaluating the Impact on Pregnancy and Birthweight Outcomes. Nutrients 2022; 14:nu14061151. [PMID: 35334807 PMCID: PMC8951613 DOI: 10.3390/nu14061151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 02/04/2023] Open
Abstract
This study aims to assess the associations between structural features of the Montreal Diet Dispensary’s social nutrition intervention and pregnancy (i.e., anemia, gestational diabetes mellitus (GDM), gestational weight gain (GWG), hypertension) and birthweight outcomes (i.e., small- or large-for-gestational-age) among pregnant women, most of them recent immigrants. The study consists of a secondary analysis of the digital client database of the Montreal Diet Dispensary (n = 2925). Logistic regressions were used to estimate the odds of pregnancy and birthweight outcomes, depending on structural features of the intervention. Pregnant women who attended a welcoming group session presented lower odds of GDM and anemia compared to those who did not attend. A longer duration of intervention was also associated with lower odds of GDM and anemia. Each additional appointment with a dietitian was associated with higher odds of excessive GWG and lower odds of insufficient GWG only among women with a pre-pregnancy BMI lower than 25 kg/m2. This study emphasizes the importance of providing nutritional services early in pregnancy to reduce the risk of GDM and anemia. It also stresses the importance of using appropriate nutritional guidelines to avoid increasing the risk of excessive GWG.
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Affiliation(s)
- Elise Carbonneau
- School of Nutrition Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
- Centre NUTRISS—Nutrition, Santé et Société, Institut sur la Nutrition et les Aliments Fonctionnels, Université Laval, Quebec, QC G1V 0A6, Canada
- School of Nutrition, Université Laval, Quebec, QC G1V 0A6, Canada
- Correspondence:
| | - Alex Dumas
- School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
- Institut du Savoir Montfort, Montfort Hospital, Ottawa, ON K1K 0T2, Canada
| | | | - Bénédicte Fontaine-Bisson
- School of Nutrition Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
- Institut du Savoir Montfort, Montfort Hospital, Ottawa, ON K1K 0T2, Canada
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11
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Chung HR, Moon JH, Lim JS, Lee YA, Shin CH, Hong JS, Kwak SH, Choi SH, Jang HC. Maternal Hyperglycemia during Pregnancy Increases Adiposity of Offspring. Diabetes Metab J 2021; 45:730-738. [PMID: 33618504 PMCID: PMC8497931 DOI: 10.4093/dmj.2020.0154] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/04/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The effect of intrauterine hyperglycemia on fat mass and regional fat proportion of the offspring of mothers with gestational diabetes mellitus (OGDM) remains to be determined. METHODS The body composition of OGDM (n=25) and offspring of normoglycemic mothers (n=49) was compared using dualenergy X-ray absorptiometry at age 5 years. The relationship between maternal glucose concentration during a 100 g oral glucose tolerance test (OGTT) and regional fat mass or proportion was analyzed after adjusting for maternal prepregnancy body mass index (BMI). RESULTS BMI was comparable between OGDM and control (median, 16.0 kg/m2 vs. 16.1 kg/m2 ). Total, truncal, and leg fat mass were higher in OGDM compared with control (3,769 g vs. 2,245 g, P=0.004; 1,289 g vs. 870 g, P=0.017; 1,638 g vs. 961 g, P=0.002, respectively), whereas total lean mass was lower in OGDM (15,688 g vs. 16,941 g, P=0.001). Among OGDM, total and truncal fat mass were correlated with fasting and 3-hour glucose concentrations of maternal 100 g OGTT during pregnancy (total fat mass, r=0.49, P=0.018 [fasting], r=0.473, P=0.023 [3-hour]; truncal fat mass, r=0.571, P=0.004 [fasting], r=0.558, P=0.006 [3-hour]), but there was no correlation between OGDM leg fat mass and maternal OGTT during pregnancy. Regional fat indices were not correlated with concurrent maternal 75 g OGTT values. CONCLUSION Intrauterine hyperglycemia is associated with increased fat mass, especially truncal fat, in OGDM aged 5 years.
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Affiliation(s)
- Hye Rim Chung
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joon Ho Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Sub Lim
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, Korea
| | - Joon-Seok Hong
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soo Heon Kwak
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sung Hee Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Corresponding author: Hak Chul Jang https://orcid.org/0000-0002-4188-6536 Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea E-mail:
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12
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Zengul AG, Hoover SET, Chandler-Laney PC. Secondary analysis of gut hormone data from children with and without in utero exposure to gestational diabetes: Differences in the associations among ghrelin, GLP-1, and insulin secretion. Pediatr Obes 2021; 16:e12757. [PMID: 33236516 PMCID: PMC8105267 DOI: 10.1111/ijpo.12757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/05/2020] [Accepted: 11/09/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Intrauterine exposure to gestational diabetes mellitus (GDM) increases risk for type 2 diabetes (T2D). Ghrelin and GLP-1 have opposite functions in nutritional homeostasis and are associated with insulin secretion, but it is not known if individuals exposed to GDM exhibit dysregulation in these associations. OBJECTIVE Test the hypothesis that children exposed to GDM in utero will exhibit dysregulation among ghrelin, GLP-1, and C-peptide (reflecting insulin secretion). METHODS Data from N = 43 children aged 5 to 10 years were included in this secondary analysis of ghrelin, GLP-1, and C-peptide response to a liquid meal test. Repeated measures mixed model analyses were used to measure associations among hormones. RESULTS The association of ghrelin and GLP-1 was moderated by GDM group (P < .01), such that ghrelin was inversely associated with GLP-1 in children without GDM exposure, but not for those exposed to GDM. GLP-1 was positively associated with C-peptide in both groups, but the association was stronger in those exposed to GDM (estimate = 1.06 vs 1.01). CONCLUSIONS Differences in the associations among ghrelin, GLP-1, and C-peptide displayed here suggest novel lines of research about whether the regulation of gut hormones and insulin secretion contribute to obesity and risk for T2D in children exposed to GDM.
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Affiliation(s)
- Ayse G. Zengul
- Department of Nutrition Sciences, the University of Alabama at Birmingham (UAB), 1720 2nd Avenue South, Birmingham, AL 35294, USA
| | - Sarah ET Hoover
- Department of Nutrition Sciences, the University of Alabama at Birmingham (UAB), 1720 2nd Avenue South, Birmingham, AL 35294, USA
| | - Paula C. Chandler-Laney
- Department of Nutrition Sciences, the University of Alabama at Birmingham (UAB), 1720 2nd Avenue South, Birmingham, AL 35294, USA
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13
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Soepnel LM, Nicolaou V, Slater C, Chidumwa G, Levitt NS, Klipstein-Grobusch K, Norris SA. Obesity and adiposity of 3- to 6-year-old children born to mothers with hyperglycaemia first detected in pregnancy in an urban South African setting. Ann Hum Biol 2021; 48:81-92. [PMID: 33955800 DOI: 10.1080/03014460.2021.1918245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Understanding the association between maternal metabolic conditions in pregnancy and the risk of childhood overweight, a growing concern in sub-Saharan Africa (SSA), helps to identify opportunities for childhood obesity prevention. AIM To assess the association between hyperglycaemia first detected in pregnancy (HFDP) (gestational diabetes mellitus [GDM] and diabetes in pregnancy [DIP]) and child obesity and adiposity in pre-school-aged children in South Africa, independently of maternal BMI. SUBJECTS AND METHODS Measurement of anthropometry and fat mass index (FMI) by the deuterium dilution method was done for 102 3-6-year-old children born to mothers with HFDP and 102 HFDP-unexposed children. Hierarchical regression analysis and generalised structural equation modelling (GSEM) were performed. RESULTS The prevalence of overweight/obesity was 10.5% and 11.1% in children exposed to GDM and DIP, respectively, and 3.9% in the HFDP-unexposed group. Log-transformed FMI was significantly higher in the DIP-exposed group (β = 0.166, 95% CI = 0.014-0.217 p= .026), but not when adjusting for maternal pregnancy BMI (β = 0.226, 95% CI = 0.003-0.015, p = .004). GSEM showed significant total effects of maternal BMI and birth weight on FMI/BMI. CONCLUSIONS Maternal pregnancy BMI seems to play a greater role in the development of childhood adiposity than maternal hyperglycaemia, requiring further research and identifying maternal BMI as a relevant prevention target in our setting.
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Affiliation(s)
- Larske M Soepnel
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Veronique Nicolaou
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Glory Chidumwa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Naomi S Levitt
- Department of Medicine, Chronic Disease Initiative for Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Global Health Research Institute, School of Human Development and Health, University of Southampton, Southampton, UK
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14
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Hu J, Liu Y, Wei X, Li L, Gao M, Liu Y, Ma Y, Wen D. Association of gestational diabetes mellitus with offspring weight status across infancy: a prospective birth cohort study in China. BMC Pregnancy Childbirth 2021; 21:21. [PMID: 33407256 PMCID: PMC7789150 DOI: 10.1186/s12884-020-03494-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/11/2020] [Indexed: 01/22/2023] Open
Abstract
Background The association between gestational diabetes mellitus (GDM) and childhood body weight remains controversial, and additional study is needed, especially in Asian populations. Methods This prospective study investigated the association between maternal glucose concentration, and GDM status and infant body weight from birth to 12 months of age. Linear mixed effects (LME) models and multiple linear regression were used to assess the longitudinal association of GDM with infant growth measured by weight-for-length z-scores (WFLZ), weight-for-age z-scores (WFAZ), and length-for-age z-scores (LFAZ) at birth, 1, 3, 6, 8, and 12 months of age. Results Offspring born to mothers with GDM had higher WFLZ [β: 0.26 SD units (95% CI: 0.13–0.40)] across infancy than those of mothers without GDM. When stratified analysis by maternal pre-pregnancy body mass index (BMI) status, the association was pronounced in normal-weight [β:0.28 SD units (95% CI: 0.11–0.45)] and overweight/obese women [β: 0.34 SD units (95% CI: 0.09–0.58)] but not in underweight women (P for interaction < 0.05). Multiple linear regression found that the effect estimate of GDM on infant WFLZ was highest at birth [β: 0.36 SD units (95% CI: 0.11–0.61)], remained significant at 1 [β: 0.22 SD units (95% CI: 0.03–0.41)] and 3 [β:0.19 SD units (95% CI: 0.01–0.37)] months of age and decreased across infancy. Maternal GDM status was not associated with infant WFAZ or LFAZ. Conclusions Maternal GDM status was associated with infant WFLZ, but not WFAZ or LFAZ. The association between GDM status and offspring WFLZ was more pronounced in early infancy or in normal-weight and overweight/obese women. Increased public health efforts to prevent GDM in normal-weight and overweight/obese pre-pregnancy mothers are recommended to control offspring overweight or obesity. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-020-03494-7.
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Affiliation(s)
- Jiajin Hu
- Institute of Health Sciences, China Medical University, Shenyang, 110122, Liaoning, China.,Research Center of China Medical University Birth Cohort, China Medical University, Shenyang, 110122, Liaoning, China.,Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Boston, MA, 02215, USA
| | - Yilin Liu
- Institute of Health Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Xiaotong Wei
- Institute of Health Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Lin Li
- Institute of Health Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Ming Gao
- Institute of Health Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Yang Liu
- Institute of Health Sciences, China Medical University, Shenyang, 110122, Liaoning, China
| | - Yanan Ma
- Department of Epidemiology and Health Statistics, School of Public Health, China Medical University, Shenyang, 110122, Liaoning, China
| | - Deliang Wen
- Institute of Health Sciences, China Medical University, Shenyang, 110122, Liaoning, China.
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15
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Christoforou ER, Sferruzzi-Perri AN. Molecular mechanisms governing offspring metabolic programming in rodent models of in utero stress. Cell Mol Life Sci 2020; 77:4861-4898. [PMID: 32494846 PMCID: PMC7658077 DOI: 10.1007/s00018-020-03566-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 12/13/2022]
Abstract
The results of different human epidemiological datasets provided the impetus to introduce the now commonly accepted theory coined as 'developmental programming', whereby the presence of a stressor during gestation predisposes the growing fetus to develop diseases, such as metabolic dysfunction in later postnatal life. However, in a clinical setting, human lifespan and inaccessibility to tissue for analysis are major limitations to study the molecular mechanisms governing developmental programming. Subsequently, studies using animal models have proved indispensable to the identification of key molecular pathways and epigenetic mechanisms that are dysregulated in metabolic organs of the fetus and adult programmed due to an adverse gestational environment. Rodents such as mice and rats are the most used experimental animals in the study of developmental programming. This review summarises the molecular pathways and epigenetic mechanisms influencing alterations in metabolic tissues of rodent offspring exposed to in utero stress and subsequently programmed for metabolic dysfunction. By comparing molecular mechanisms in a variety of rodent models of in utero stress, we hope to summarise common themes and pathways governing later metabolic dysfunction in the offspring whilst identifying reasons for incongruencies between models so to inform future work. With the continued use and refinement of such models of developmental programming, the scientific community may gain the knowledge required for the targeted treatment of metabolic diseases that have intrauterine origins.
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Affiliation(s)
- Efthimia R Christoforou
- Department of Physiology, Development and Neuroscience, Centre for Trophoblast Research, University of Cambridge, Downing Site, Cambridge, UK
| | - Amanda N Sferruzzi-Perri
- Department of Physiology, Development and Neuroscience, Centre for Trophoblast Research, University of Cambridge, Downing Site, Cambridge, UK.
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16
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Alves JM, Zink J, Chow T, Luo S, Belcher BR, Xiang AH, Page KA. Contributions of Prenatal Exposures and Child Lifestyle to Insulin Sensitivity. J Clin Endocrinol Metab 2020; 105:dgaa201. [PMID: 32301999 PMCID: PMC7271763 DOI: 10.1210/clinem/dgaa201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 04/14/2020] [Indexed: 02/03/2023]
Abstract
CONTEXT Prenatal exposures and lifestyle factors are important for metabolic health. OBJECTIVE Determine how prenatal exposures to maternal obesity and/or gestational diabetes mellitus (GDM) and childhood lifestyle factors independently contribute to child insulin sensitivity. DESIGN AND PARTICIPANTS Ninety children aged 7 to 11 years (56% girls, 60% exposed to GDM), born at Kaiser-Permanente Southern California, completed an oral glucose tolerance test (OGTT) as part of the BrainChild Study. Matsuda insulin sensitivity index (ISI) was used to estimate insulin sensitivity. Participants completed two 24-hour dietary recalls, and daily energy intake (EI), dietary added sugar, and total sugar were calculated. The 3-day physical activity recall determined the average minutes per day of moderate to vigorous physical activity (MVPA) and the average minutes per day spent sedentary. Maternal prepregnancy body mass index (BMI) and GDM status were extracted from electronic medical records. MAIN OUTCOME MEASURE Matsuda-ISI. RESULTS Linear regression showed that children who spent more time in MVPA had better ISI (β = 0.33; P = 0.001), and results remained after adjustment for maternal prepregnancy BMI, GDM exposure, child age, sex, daily EI, dietary added sugar (β = 0.34; P = 0.001), and further adjustment for child adiposity (β = 0.29; P = 0.001). Time spent sedentary, maternal prepregnancy BMI, GDM exposure, dietary added sugar, total sugar, and EI were not associated with ISI. CONCLUSIONS Physical activity was the only predictor of ISI at this age, suggesting that engaging in physical activity during childhood is beneficial for insulin sensitivity and may ameliorate future risk for metabolic disease.
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Affiliation(s)
- Jasmin M Alves
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jennifer Zink
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Ting Chow
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Shan Luo
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Britni R Belcher
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Anny H Xiang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Kathleen A Page
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
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Maternal exercise during gestation and lactation decreases high-fat diet preference by altering central reward system gene expression in adult female offspring from high-fat fed dams. Behav Brain Res 2020; 390:112660. [PMID: 32387350 DOI: 10.1016/j.bbr.2020.112660] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 12/21/2022]
Abstract
Exposure to maternal high-fat (HF) diet during gestation and lactation alters adult offspring's feeding behavior and diet preference. However, the impact of maternal exercise on offspring's diet preference and reward system development is less studied. In this study, we investigate the effect of perinatal maternal exercise on the development of diet preference, dopamine- and opioid-related gene expression in the central reward system in female offspring from HF-fed Sprague-Dawley rat dams. We found maternal HF diet did not alter adult offspring HF preference, but influenced offspring's dopamine and opioid system both at weaning and in adulthood, and these offspring retained higher body weight in adulthood. However, offspring from dams exposed to both HF diet and exercise during gestation and lactation had normalized body weight, decreased fat mass and lower HF-diet preference but increased energy intake in adulthood. The dopamine- and opioid-related gene expression in central reward system and POMC expression in hypothalamus was elevated in these adult offspring. We conclude that maternal exercise during gestation and lactation can potentially overcome the negative effects of perinatal exposure to HF diet in female offspring by altering their diet preference, central reward system signaling and hypothalamus neuropeptide expression.
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Cardiovascular risk factors in offspring exposed to gestational diabetes mellitus in utero: systematic review and meta-analysis. J Dev Orig Health Dis 2020; 11:599-616. [PMID: 31902382 DOI: 10.1017/s2040174419000850] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Gestational diabetes mellitus (GDM) is a pregnancy complication that affects one in seven pregnancies. Emerging evidence demonstrates that children born of pregnancies complicated by GDM may be at increased risk of cardiovascular disease (CVD) in adulthood. Therefore, the aim of this study was to determine cardiovascular risk factors in offspring exposed to GDM in utero. PubMed, CINAHL, SCOPUS, and EMBASE databases were searched. Information was extracted on established CVD risk factors including blood pressure, lipids, blood glucose, fasting insulin, body mass index (BMI), and endothelial/microvascular function. The review protocol is registered in PROSPERO (CRD42018094983). Prospective and retrospective studies comparing offspring exposed to GDM compared to controls (non-GDM pregnancies) were considered. We included studies that defined GDM based on the International Association of Diabetes and Pregnancy Study Groups (IADPSG) definition, or prior definitions. The PRISMA guidelines were followed in conducting this systematic review. Methodological quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Study selection, data extraction, and quality assessment were done by two independent reviewers. The data were pooled using a random-effects model. Of 59 eligible studies, 24 were included in the meta-analysis. Offspring exposed to GDM had higher systolic blood pressure (mean difference (MD): 1.75 mmHg, 95% CI 0.57-2.94; eight studies, 7264 participants), BMI z-score (MD 0.11, 95% CI 0.02-0.20; nine studies, 8759 participants), and glucose (standard MD 0.43, 95% CI 0.08-0.77; 11 studies, 6423 participants) than control participants. In conclusion, offspring exposed to GDM have elevated systolic blood pressure, BMI, and glucose. Those exposed to GDM in utero may benefit from early childhood blood pressure measurements.
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Ponzo V, Ferrocino I, Zarovska A, Amenta MB, Leone F, Monzeglio C, Rosato R, Pellegrini M, Gambino R, Cassader M, Ghigo E, Cocolin L, Bo S. The microbiota composition of the offspring of patients with gestational diabetes mellitus (GDM). PLoS One 2019; 14:e0226545. [PMID: 31841548 PMCID: PMC6913919 DOI: 10.1371/journal.pone.0226545] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/23/2019] [Indexed: 02/07/2023] Open
Abstract
The microbiota composition of the offspring of women with gestational diabetes mellitus (GDM), a common pregnancy complication, is still little known. We investigated whether the GDM offspring gut microbiota composition is associated with the maternal nutritional habits, metabolic variables or pregnancy outcomes. Furthermore, we compared the GDM offspring microbiota to the microbiota of normoglycemic-mother offspring. Fecal samples of 29 GDM infants were collected during the first week of life and assessed by 16S amplicon-based sequencing. The offspring's microbiota showed significantly lower α-diversity than the corresponding mothers. Earlier maternal nutritional habits were more strongly associated with the offspring microbiota (maternal oligosaccharide positively with infant Ruminococcus, maternal saturated fat intake inversely with infant Rikenellaceae and Ruminococcus) than last-trimester maternal habits. Principal coordinate analysis showed a separation of the infant microbiota according to the type of feeding (breastfeeding vs formula-feeding), displaying in breast-fed infants a higher abundance of Bifidobacterium. A few Bacteroides and Blautia oligotypes were shared by the GDM mothers and their offspring, suggesting a maternal microbial imprinting. Finally, GDM infants showed higher relative abundance of pro-inflammatory taxa than infants from healthy women. In conclusion, many maternal conditions impact on the microbiota composition of GDM offspring whose microbiota showed increased abundance of pro-inflammatory taxa.
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Affiliation(s)
- Valentina Ponzo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Ilario Ferrocino
- Department of Agricultural, Forestry, and Food Science, University of Turin, Turin, Italy
| | - Adriana Zarovska
- Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Filomena Leone
- Clinical Nutrition Unit, S. Anna Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Clara Monzeglio
- Gynecology and Obstetrics Unit, S. Anna Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Rosalba Rosato
- Department of Psychology, University of Turin, Turin, Italy
| | | | - Roberto Gambino
- Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Ezio Ghigo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Luca Cocolin
- Department of Agricultural, Forestry, and Food Science, University of Turin, Turin, Italy
| | - Simona Bo
- Department of Medical Sciences, University of Turin, Turin, Italy
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20
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Bélanger M, Dugas C, Perron J, Ruchat SM, Weisnagel SJ, Marc I, Tchernof A, Robitaille J. Association between lifestyle habits and adiposity values among children exposed and unexposed to gestational diabetes mellitus in utero. Diabetes Metab Syndr 2019; 13:2947-2952. [PMID: 31425961 DOI: 10.1016/j.dsx.2019.07.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/29/2019] [Indexed: 12/25/2022]
Abstract
AIMS The objectives of this study were to assess the profile of lifestyle habits among children exposed (GDM+) or unexposed (GDM-) to GDM and to assess whether a healthy lifestyle profile is associated with lower adiposity values among these children. METHODS A total of 105 GDM+ and 38 GDM- children aged 2-14 years were included. Vegetables and fruit intakes were collected using two 24-h dietary recalls. Physical activity and sedentary time were measured with accelerometers. Screen and sleep time were assessed using questionnaires. Weight, height and waist circumference were measured. Body composition was assessed by absorptiometry. RESULTS GDM+ children had lower moderate-to-vigorous physical activity practice (p = 0.043) and fruit intake (p = 0.020) than GDM- children. Among children with an unhealthy lifestyle (meeting 0-2 lifestyle recommendations), GDM+ children had greater percentage of fat mass (p = 0.021) and android fat mass (p = 0.020) than GDM- children. Moreover, among GDM+ children, children with a healthy lifestyle (meeting 3-4 lifestyle recommendations) tended to have lower percentage of fat mass (p = 0.053) and android fat mass (p = 0.071) than those with an unhealthy lifestyle. CONCLUSION Improving lifestyle habits among GDM+ children could represent a promising approach to prevent deteriorated adiposity values.
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Affiliation(s)
- Mélissa Bélanger
- School of Nutrition, Laval University, Québec, Québec, Canada; Institute of Nutrition and Functional Foods (INAF), Laval University, Québec, Québec, Canada
| | - Camille Dugas
- School of Nutrition, Laval University, Québec, Québec, Canada; Institute of Nutrition and Functional Foods (INAF), Laval University, Québec, Québec, Canada
| | - Julie Perron
- Institute of Nutrition and Functional Foods (INAF), Laval University, Québec, Québec, Canada
| | - Stephanie-May Ruchat
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - S John Weisnagel
- Endocrinology and Nephrology Axis, CHU de Quebec Research Center, Québec, Québec, Canada; Diabetes Research Unit, Laval University Medical Research Center, Québec, Québec, Canada
| | - Isabelle Marc
- Department of Pediatrics, Laval University, CHU de Quebec Research Center, Québec, Québec, Canada
| | - André Tchernof
- School of Nutrition, Laval University, Québec, Québec, Canada; Quebec Heart and Lung Institute, Laval University, Québec, Québec, Canada
| | - Julie Robitaille
- School of Nutrition, Laval University, Québec, Québec, Canada; Institute of Nutrition and Functional Foods (INAF), Laval University, Québec, Québec, Canada; Endocrinology and Nephrology Axis, CHU de Quebec Research Center, Québec, Québec, Canada.
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21
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Solomonian L, Kwan V, Bhardwaj S. Group-Based Naturopathic Education for Primary Prevention of Noncommunicable Disease in Families and Children: A Feasibility Study. J Altern Complement Med 2019; 25:740-752. [PMID: 31314562 DOI: 10.1089/acm.2019.0067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives: Naturopathic medicine has demonstrated efficacy at reducing risk factors for chronic disease. Targeting health behaviors of parents and caregivers in a group-based setting may improve the behaviors of children in their care. This study sought to assess the feasibility of such a program. Design: Participants of a six-session health education series were invited to respond to surveys and participate in a focus group about their health behaviors and their experience in the program. Subjects: Caregivers of children aged 0-6 attending publicly funded community centers in Ontario, Canada. Interventions: A 6-week group-based naturopathic education program to promote healthy lifestyle behaviors among caregivers. Outcome measures: Satisfaction with content and delivery, and frequency of healthy behaviors. Results: The majority of responses indicated satisfaction with the program, and an ongoing benefit 6 weeks and more after completion. There was a clear correlation between healthy behaviors of parents and children. Conclusions: A group-based naturopathic education program may be a feasible method of delivering primary-prevention education to caregivers, particularly in the domains of practicality and acceptability.
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Affiliation(s)
| | - Vivian Kwan
- Canadian College of Naturopathic Medicine, Toronto, Canada
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22
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Suzuki A, Correia-Santos AM, Vicente GC, Velarde LGC, Boaventura GT. Effects of Maternal Flaxseed Supplementation on Female Offspring of Diabetic Rats in Serum Concentration of Glucose, Insulin, and Thyroid Hormones. INT J VITAM NUTR RES 2019; 89:45-54. [PMID: 30957705 DOI: 10.1024/0300-9831/a000259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Objective: This study aimed to evaluate the effect of maternal consumption of flaxseed flour and oil on serum concentrations of glucose, insulin, and thyroid hormones of the adult female offspring of diabetic rats. Methods: Wistar rats were induced to diabetes by a high-fat diet (60%) and streptozotocin (35 mg/kg). Rats were mated and once pregnancy was confirmed, were divided into the following groups: Control Group (CG): casein-based diet; High-fat Group (HG): high-fat diet (49%); High-fat Flaxseed Group (HFG): high-fat diet supplemented with 25% flaxseed flour; High-fat Flaxseed Oil group (HOG): high-fat diet, where soya oil was replaced with flaxseed oil. After weaning, female pups (n = 6) from each group were separated, received a commercial rat diet and were sacrificed after 180 days. Serum insulin concentrations were determined by ELISA, the levels of triiodothyronine (T3), thyroxine (T4) and thyroid-stimulating hormone (TSH) were determined by chemiluminescence. Results: There was a significant reduction in body weight at weaning in HG (-31%), HFG (-33%) and HOG (44%) compared to CG (p = 0.002), which became similar by the end of 180 days. Blood glucose levels were reduced in HFG (-10%, p = 0.044) when compared to CG, and there was no significant difference between groups in relation to insulin, T3, T4, and TSH after 180 days. Conclusions: Maternal severe hyperglycemia during pregnancy and lactation resulted in a microsomal offspring. Maternal consumption of flaxseed reduces blood glucose levels in adult offspring without significant effects on insulin levels and thyroid hormones.
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Affiliation(s)
- Akemi Suzuki
- 1Laboratory of Experimental Nutrition, Department of Nutrition and Dietetics, Fluminense Federal University, Rio de Janeiro, Brazil
| | - André Manoel Correia-Santos
- 1Laboratory of Experimental Nutrition, Department of Nutrition and Dietetics, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Gabriela Câmara Vicente
- 1Laboratory of Experimental Nutrition, Department of Nutrition and Dietetics, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Luiz Guillermo Coca Velarde
- 1Laboratory of Experimental Nutrition, Department of Nutrition and Dietetics, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Gilson Teles Boaventura
- 1Laboratory of Experimental Nutrition, Department of Nutrition and Dietetics, Fluminense Federal University, Rio de Janeiro, Brazil
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23
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Gilbert L, Gross J, Lanzi S, Quansah DY, Puder J, Horsch A. How diet, physical activity and psychosocial well-being interact in women with gestational diabetes mellitus: an integrative review. BMC Pregnancy Childbirth 2019; 19:60. [PMID: 30732571 PMCID: PMC6367798 DOI: 10.1186/s12884-019-2185-y] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/08/2019] [Indexed: 12/13/2022] Open
Abstract
Background Gestational Diabetes Mellitus (GDM) is associated with future cardio-metabolic risks for the mother and her child. In addition, one-third of women with recent GDM develop postpartum depression. Given these adverse impacts of GDM on the health of the mother and her offspring, it is important to intervene on modifiable factors, such as diet, physical activity, and psychosocial well-being. This integrative review therefore explored evidence on how these modifiable factors interact in women with GDM and their offspring, and how effective combined interventions are on reducing adverse impacts of GDM. Methods A comprehensive search strategy included carefully selected terms that corresponded to the domains of interest (diet, physical activity and psychosocial well-being). The databases searched for articles published between 1980 and February 2018 were: CINAHL, PsycINFO, Embase, Pubmed and Cochrane. Studies that were included in this review were either observational or intervention studies that included at least two domains of interest. Articles had to at least report data on maternal outcomes of women with GDM. Results The search strategies identified 14′419 citations after excluding duplicates. After screening titles and then abstracts, 114 articles were selected for detailed evaluation of their full text, and 16 were included in this review: two observational and 14 intervention studies. Results from observational studies showed that psychosocial well-being (social support and self-efficacy) were positively associated with physical activity and dietary choice. Intervention studies always included diet and physical activity interventions, although none integrated psychosocial well-being in the intervention. These lifestyle interventions mostly led to increased physical activity, improved diet and lower stress perception. Many of these lifestyle interventions also reduced BMI and postpartum diabetes status, improved metabolic outcomes and reduced the risk of preterm deliveries and low birth weight. Conclusion This integrative review showed that psychosocial well-being interacted with diet as well as with physical activity in women with GDM. We recommend that future studies consider integrating psychosocial well-being in their intervention, as observational studies demonstrated that social support and self-efficacy helped with adopting a healthy lifestyle following GDM diagnosis. Electronic supplementary material The online version of this article (10.1186/s12884-019-2185-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leah Gilbert
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, 1011, Lausanne, Switzerland.
| | - Justine Gross
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, 1011, Lausanne, Switzerland.,Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Stefano Lanzi
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, 1011, Lausanne, Switzerland.,Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Dan Yedu Quansah
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Jardena Puder
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, 1010, Lausanne, Switzerland.,Neonatology service, Department Woman-Mother-Child, Lausanne University Hospital, 1011, Lausanne, Switzerland
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24
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Kearney M, Perron J, Marc I, Weisnagel SJ, Tchernof A, Robitaille J. Association of prenatal exposure to gestational diabetes with offspring body composition and regional body fat distribution. Clin Obes 2018; 8:81-87. [PMID: 29239129 DOI: 10.1111/cob.12237] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 11/14/2017] [Indexed: 12/21/2022]
Abstract
The aim of this cohort study was to compare body composition and regional body fat distribution between children exposed (GDM+) or unexposed (GDM-) in utero to gestational diabetes mellitus (GDM) and to investigate the association with the glycaemic and the insulin profile. Data from 56 GDM+ and 30 GDM- were analysed. Height, weight and waist circumference were measured. Total and regional body composition was measured by dual-energy X-ray absorptiometry. Insulin, glucose and HbA1c were obtained from a fasting plasma sample, and the HOMA-IR index was calculated. anova was performed to compare adiposity measures between GDM+ and GDM-. Associations between the glycaemic and insulin profile and adiposity measures were studied using partial Pearson correlations. Mean age was 6.6 ± 2.3 years. Waist circumference, fat mass percentage, android fat mass, android fat mass percentage and android-to-gynoid fat mass ratio were higher among GDM+, and lean mass percentage was lower (P < 0.05). Among GDM+ children, body mass index (BMI) z score, waist circumference, fat mass percentage, android fat mass percentage and android-to-gynoid fat mass ratio were all positively correlated with HbA1C (r = 0.32-0.43, P < 0.05). Prenatal exposure to GDM is associated with increased total and abdominal adiposity. This increased adiposity observed among GDM+ children is associated with an altered glycaemic profile. This study is registered in the Clinical Trials.gov registry (NCT01340924).
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Affiliation(s)
- M Kearney
- School of Nutrition, Laval University, Québec, Canada
- Institute of Nutrition and Functional Foods (INAF), Laval University, Québec, Canada
| | - J Perron
- Institute of Nutrition and Functional Foods (INAF), Laval University, Québec, Canada
| | - I Marc
- Endocrinology and Nephrology Axis, CHU de Québec Research Center, Québec, Canada
| | - S J Weisnagel
- Endocrinology and Nephrology Axis, CHU de Québec Research Center, Québec, Canada
- Diabetes Research Unit, Laval University Medical Research Center, Québec, Canada
| | - A Tchernof
- School of Nutrition, Laval University, Québec, Canada
- Institute of Nutrition and Functional Foods (INAF), Laval University, Québec, Canada
- Endocrinology and Nephrology Axis, CHU de Québec Research Center, Québec, Canada
| | - J Robitaille
- School of Nutrition, Laval University, Québec, Canada
- Institute of Nutrition and Functional Foods (INAF), Laval University, Québec, Canada
- Endocrinology and Nephrology Axis, CHU de Québec Research Center, Québec, Canada
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25
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Horsch A, Gilbert L, Lanzi S, Gross J, Kayser B, Vial Y, Simeoni U, Hans D, Berney A, Scholz U, Barakat R, Puder JJ. Improving cardiometabolic and mental health in women with gestational diabetes mellitus and their offspring: study protocol for MySweetHeart Trial, a randomised controlled trial. BMJ Open 2018; 8:e020462. [PMID: 29487077 PMCID: PMC5855393 DOI: 10.1136/bmjopen-2017-020462] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/10/2017] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) carries prenatal and perinatal risk for the mother and her offspring as well as longer-term risks for both the mother (obesity, diabetes, cardiovascular disease) and her child (obesity, type 2 diabetes). Compared with women without GDM, women with GDM are twice as likely to develop perinatal or postpartum depression. Lifestyle interventions for GDM are generally limited to physical activity and/or nutrition, often focus separately on the mother or the child and take place either during or after pregnancy, while their results are inconsistent. To increase efficacy of intervention, the multifactorial origins of GDM and the tight link between mental and metabolic as well as maternal and child health need to be heeded. This calls for an interdisciplinary transgenerational approach starting in, but continuing beyond pregnancy. METHODS AND ANALYSIS This randomised controlled trial will assess the effect of a multidimensional interdisciplinary lifestyle and psychosocial intervention aimed at improving the metabolic and mental health of 200 women with GDM and their offspring. Women with GDM at 24-32 weeks gestational age who understand French or English, and their offspring and partners can participate. The intervention components will be delivered on top of usual care during pregnancy and the first year postpartum. Metabolic and mental health outcomes will be measured at 24-32 weeks of pregnancy, shortly after birth and at 6-8 weeks and 1 year after childbirth. Data will be analysed using intention-to-treat analyses. The MySweetHeart Trial is linked to the MySweetHeart Cohort (clinicaltrials.gov/ct2/show/NCT02872974). ETHICS AND DISSEMINATION We will disseminate the findings through regional, national and international conferences and through peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02890693; Pre-results.
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Affiliation(s)
- Antje Horsch
- Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Lausanne, Switzerland
| | - Leah Gilbert
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Stefano Lanzi
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Service of Angiology, Heart and Vessel Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Justine Gross
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Bengt Kayser
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Yvan Vial
- Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Umberto Simeoni
- DOHad Laboratory, Pediatrics Division, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Didier Hans
- Center of Bone Diseases, Rheumatology Service, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Alexandre Berney
- Consultation Liaison Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Urte Scholz
- Applied Social and Health Psychology, Department of Psychology, University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Lausanne, Switzerland
| | - Ruben Barakat
- Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | - Jardena J Puder
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Lausanne, Switzerland
- Service of Pediatric Endocrinology, Diabetology and Obesity, Lausanne University Hospital, Lausanne, Switzerland
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26
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Gowey MA, Chandler-Laney PC. Children's food and satiety responsiveness in association with post-prandial glucose following a standardized liquid meal. Clin Obes 2018; 8:39-42. [PMID: 28834164 PMCID: PMC5760444 DOI: 10.1111/cob.12210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 11/29/2022]
Abstract
Children's responsiveness to food cues and satiety may put them at greater risk for obesity; however, little is known about the physiological mechanisms underlying children's responsiveness to food and satiety. The objective of this study was to examine the association between children's post-prandial glucose responses and maternal report of their eating behaviours. A secondary data analysis was conducted using partial correlation analyses adjusted for gender in a sample of children aged 5-10 years and their mothers (N = 28 dyads). Standardized liquid meal tests were administered to children and blood samples were obtained over the following 4 h. Mothers completed the Children's Eating Behaviour Questionnaire. An earlier post-prandial peak glucose concentration was associated with greater food responsiveness (r = -0.39, P = 0.04) but not satiety responsiveness. The percent increase in glucose from fasting to peak also tended to be inversely associated with greater food responsiveness (r = -0.38, P = 0.05). Results suggest that earlier and smaller post-prandial glucose excursions may be related to children's response to food cues. Future research should use objective methods to examine whether the association of post-prandial glucose with food responsiveness prospectively contributes to weight gain.
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Affiliation(s)
- M A Gowey
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - P C Chandler-Laney
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
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Dabelea D, Sauder KA. Intrauterine Exposure to Maternal Diabetes and Childhood Obesity. CONTEMPORARY ENDOCRINOLOGY 2018. [DOI: 10.1007/978-3-319-68192-4_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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28
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Bremer AA. Commentary: Research Gaps in Gestational Diabetes Mellitus: Executive Summary of a National Institute of Diabetes and Digestive and Kidney Diseases Workshop. Front Endocrinol (Lausanne) 2018; 9:627. [PMID: 30405533 PMCID: PMC6203030 DOI: 10.3389/fendo.2018.00627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/02/2018] [Indexed: 12/04/2022] Open
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29
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Grunnet LG, Hansen S, Hjort L, Madsen CM, Kampmann FB, Thuesen ACB, Granstrømi C, Strøm M, Maslova E, Frikke-Schmidt R, Damm P, Chavarro JE, Hu FB, Olsen SF, Vaag A. Adiposity, Dysmetabolic Traits, and Earlier Onset of Female Puberty in Adolescent Offspring of Women With Gestational Diabetes Mellitus: A Clinical Study Within the Danish National Birth Cohort. Diabetes Care 2017; 40:1746-1755. [PMID: 29038315 PMCID: PMC5711331 DOI: 10.2337/dc17-0514] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 09/06/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Offspring of pregnancies affected by gestational diabetes mellitus (GDM) are at increased risk of the development of type 2 diabetes. However, the extent to which these dysmetabolic traits may be due to offspring and/or maternal adiposity is unknown. We examined body composition and associated cardiometabolic traits in 561 9- to 16-year-old offspring of mothers with GDM and 597 control offspring. RESEARCH DESIGN AND METHODS We measured anthropometric characteristics; puberty status; blood pressure; and fasting glucose, insulin, C-peptide, and lipid levels; and conducted a DEXA scan in a subset of the cohort. Differences in the outcomes between offspring of mothers with GDM and control subjects were examined using linear and logistic regression models. RESULTS After adjustment for age and sex, offspring of mothers with GDM displayed higher weight, BMI, waist-to-hip ratio (WHR), systolic blood pressure, and resting heart rate and lower height. Offspring of mothers with GDM had higher total and abdominal fat percentages and lower muscle mass percentages, but these differences disappeared after correction for offspring BMI. The offspring of mothers with GDM displayed higher fasting plasma glucose, insulin, C-peptide, HOMA-insulin resistance (IR), and plasma triglyceride levels, whereas fasting plasma HDL cholesterol levels were decreased. Female offspring of mothers with GDM had an earlier onset of puberty than control offspring. Offspring of mothers with GDM had significantly higher BMI, WHR, fasting glucose, and HOMA-IR levels after adjustment for maternal prepregnancy BMI, and glucose and HOMA-IR remained elevated in the offspring of mothers with GDM after correction for both maternal and offspring BMIs. CONCLUSIONS In summary, adolescent offspring of women with GDM show increased adiposity, an adverse cardiometabolic profile, and earlier onset of puberty among girls. Increased fasting glucose and HOMA-IR levels among the offspring of mothers with GDM may be explained by the programming effects of hyperglycemia in pregnancy.
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Affiliation(s)
- Louise G Grunnet
- Department of Endocrinology, Diabetes and Metabolism, Rigshospitalet, Copenhagen, Denmark .,The Danish Diabetes Academy, Odense, Denmark
| | - Susanne Hansen
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut
| | - Line Hjort
- Department of Endocrinology, Diabetes and Metabolism, Rigshospitalet, Copenhagen, Denmark.,The Danish Diabetes Academy, Odense, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Camilla M Madsen
- Department of Endocrinology, Diabetes and Metabolism, Rigshospitalet, Copenhagen, Denmark
| | - Freja B Kampmann
- Department of Endocrinology, Diabetes and Metabolism, Rigshospitalet, Copenhagen, Denmark.,Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut.,Division for Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Søborg, Denmark
| | | | - Charlotta Granstrømi
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut
| | - Marin Strøm
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut.,Faculty of Natural and Health Sciences, University of the Faroe Islands, Tórshavn, Faroe Islands
| | - Ekaterina Maslova
- The Danish Diabetes Academy, Odense, Denmark.,Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut.,Department of Primary Care and Public Health, Imperial College, London, U.K
| | | | - Peter Damm
- Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jorge E Chavarro
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Frank B Hu
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Allan Vaag
- Department of Endocrinology, Diabetes and Metabolism, Rigshospitalet, Copenhagen, Denmark.,AstraZeneca, Early Clinical Development, Göteborg, Sweden
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Dugas C, Perron J, Kearney M, Mercier R, Tchernof A, Marc I, Weisnagel SJ, Robitaille J. Postnatal Prevention of Childhood Obesity in Offspring Prenatally Exposed to Gestational Diabetes mellitus: Where Are We Now? Obes Facts 2017; 10:396-406. [PMID: 28848122 PMCID: PMC5644967 DOI: 10.1159/000477407] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 05/02/2017] [Indexed: 12/15/2022] Open
Abstract
Children exposed to gestational diabetes mellitus (GDM) in utero are at high risk of developing many health problems such as obesity. There is an urgent need to find new strategies to prevent obesity development among high-risk populations such as those children. Accordingly, the aim of this review was to summarize current knowledge on the postnatal prevention of childhood obesity in offspring born from mothers with GDM. Specifically, this review addresses the impact of breastfeeding, complementary feeding practices as well as dietary intake and physical activity during childhood on obesity risk of children exposed to GDM in utero. Furthermore, breast milk composition of diabetic mothers and its potential impact on growth is discussed. According to the available literature, breastfeeding may reduce obesity risk in children exposed to GDM in utero but a longer duration seems necessary to achieve its protective effect against obesity. Detailed analysis of breast milk composition of mothers with GDM will be necessary to fully understand the relationship between breastfeeding and obesity in this specific population. This review highlights the need for more studies addressing the impact of complementary feeding practices and lifestyle habits during childhood on obesity risk of children exposed to GDM in utero.
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Affiliation(s)
- Camille Dugas
- School of Nutrition, Laval University, Quebec City, Quebec City, Canada
- Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec City, Quebec City, Canada
- Endocrinology and Nephrology Axis, CHU de Québec Research Center, Quebec City, Quebec City, Canada
| | - Julie Perron
- Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec City, Quebec City, Canada
| | - Michèle Kearney
- School of Nutrition, Laval University, Quebec City, Quebec City, Canada
- Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec City, Quebec City, Canada
| | - Roxanne Mercier
- School of Nutrition, Laval University, Quebec City, Quebec City, Canada
- Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec City, Quebec City, Canada
| | - André Tchernof
- School of Nutrition, Laval University, Quebec City, Quebec City, Canada
- Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec City, Quebec City, Canada
- Endocrinology and Nephrology Axis, CHU de Québec Research Center, Quebec City, Quebec City, Canada
| | - Isabelle Marc
- Endocrinology and Nephrology Axis, CHU de Québec Research Center, Quebec City, Quebec City, Canada
| | - S. John Weisnagel
- Endocrinology and Nephrology Axis, CHU de Québec Research Center, Quebec City, Quebec City, Canada
- Diabetes Research Unit, Laval University Medical Research Center, Quebec City, Quebec City, Canada
| | - Julie Robitaille
- School of Nutrition, Laval University, Quebec City, Quebec City, Canada
- Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec City, Quebec City, Canada
- Endocrinology and Nephrology Axis, CHU de Québec Research Center, Quebec City, Quebec City, Canada
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Santos S, Severo M, Gaillard R, Santos AC, Barros H, Oliveira A. The role of prenatal exposures on body fat patterns at 7 years: Intrauterine programming or birthweight effects? Nutr Metab Cardiovasc Dis 2016; 26:1004-1010. [PMID: 27461861 DOI: 10.1016/j.numecd.2016.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/03/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS It remains unknown whether the effects of prenatal exposures on child's adiposity reflect entirely intrauterine programming. We aimed to assess the effects of maternal gestational weight gain, diabetes and smoking on the child's body fat patterns, disentangling the direct (through intrauterine programming) and indirect (through birthweight) effects. METHODS AND RESULTS We included 4747 singleton 7-year-old children from the Generation XXI birth cohort (Porto, Portugal). At birth, maternal and newborn's characteristics were obtained. Anthropometrics were measured at age 7 years and body fat patterns were identified by principal component analysis. Path analysis was used to quantify direct, indirect and total effects of gestational weight gain, diabetes and smoking on body fat patterns. Pattern 1 was characterized by strong factor loadings with body mass index, fat mass index and waist-to-height ratio (fat quantity) and pattern 2 with waist-to-hip ratio, waist-to-thigh ratio, and waist-to-weight ratio (fat distribution). The positive total effect of maternal gestational weight gain and diabetes on the child's fat quantity was mainly through a direct pathway, responsible for 91.7% and 83.7% of total effects, respectively (β = 0.022; 95% Confidence Interval (CI): 0.017, 0.027; β = 0.041; 95% CI: -0.011, 0.093). No effects on fat distribution were found. Maternal prenatal smoking had a positive direct effect on patterns 1 and 2, explaining 94.9% and 76.1% of total effects, respectively. CONCLUSION The effects of maternal gestational weight gain, diabetes and smoking on a child's fat quantity seem to be mainly through intrauterine programming. Maternal smoking also showed a positive direct effect on child's fat distribution.
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Affiliation(s)
- S Santos
- EPI-Unit, Institute of Public Health, University of Porto, Porto, Portugal
| | - M Severo
- EPI-Unit, Institute of Public Health, University of Porto, Porto, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - R Gaillard
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - A C Santos
- EPI-Unit, Institute of Public Health, University of Porto, Porto, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - H Barros
- EPI-Unit, Institute of Public Health, University of Porto, Porto, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - A Oliveira
- EPI-Unit, Institute of Public Health, University of Porto, Porto, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
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Abstract
PURPOSE OF REVIEW The huge percentages of persons with obesity in many countries constitute a public health crisis. The severe consequences of obesity for physical health and emotional wellbeing already emerge in childhood. Therefore, the acknowledgment of early risk factors is essential to provide recommendations for prevention strategies. This review outlines the current state of research concerning early risk factors for obesity, that is, factors that even contribute to later obesity of the offspring during gestation. In this regard, this review specifically addresses the link between restricted eating behavior of the mother and obesity in her offspring. We systematically searched for articles in PsychINFO, PsychINDEX, MEDLINE, PubMed, MEDPILOT, and Web of Science, and we identified additional studies in bibliographies. RECENT FINDINGS Although some risk factors (e.g., short period of breastfeeding, gestational diabetes, and high maternal BMI) have a vast evidence base, others (e.g., restricted eating behavior and second-hand smoking) are insufficiently studied. SUMMARY Physical activity and diet programs in pregnancy can reduce not only the occurrence of gestational diabetes, but also the risk of inappropriate weight gain. As smoking during pregnancy and inappropriate eating behavior are associated with lower education, psychoeducation, for instance in sex education classes, could be easily conceivable.
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Nutrition in the First 1000 Days: The Origin of Childhood Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13090838. [PMID: 27563917 PMCID: PMC5036671 DOI: 10.3390/ijerph13090838] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/12/2016] [Accepted: 08/18/2016] [Indexed: 12/13/2022]
Abstract
Childhood obesity is a major global issue. Its incidence is constantly increasing, thereby offering a threatening public health perspective. The risk of developing the numerous chronic diseases associated with this condition from very early in life is significant. Although complex and multi-factorial, the pathophysiology of obesity recognizes essential roles of nutritional and metabolic aspects. Particularly, several risk factors identified as possible determinants of later-life obesity act within the first 1000 days of life (i.e., from conception to age 2 years). The purpose of this manuscript is to review those key mechanisms for which a role in predisposing children to obesity is supported by the most recent literature. Throughout the development of the human feeding environment, three different stages have been identified: (1) the prenatal period; (2) breast vs. formula feeding; and (3) complementary diet. A deep understanding of the specific nutritional challenges presented within each phase might foster the development of future preventive strategies.
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Barthow C, Wickens K, Stanley T, Mitchell EA, Maude R, Abels P, Purdie G, Murphy R, Stone P, Kang J, Hood F, Rowden J, Barnes P, Fitzharris P, Craig J, Slykerman RF, Crane J. The Probiotics in Pregnancy Study (PiP Study): rationale and design of a double-blind randomised controlled trial to improve maternal health during pregnancy and prevent infant eczema and allergy. BMC Pregnancy Childbirth 2016; 16:133. [PMID: 27255079 PMCID: PMC4891898 DOI: 10.1186/s12884-016-0923-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 05/26/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Worldwide there is increasing interest in the manipulation of human gut microbiota by the use of probiotic supplements to modify or prevent a range of communicable and non-communicable diseases. Probiotic interventions administered during pregnancy and breastfeeding offer a unique opportunity to influence a range of important maternal and infant outcomes. The aim of the Probiotics in Pregnancy Study (PiP Study) is to assess if supplementation by the probiotic Lactobacillus rhamnosus HN001 administered to women from early pregnancy and while breastfeeding can reduce the rates of infant eczema and atopic sensitisation at 1 year, and maternal gestational diabetes mellitus, bacterial vaginosis and Group B Streptococcal vaginal colonisation before birth, and depression and anxiety postpartum. METHODS/DESIGN The PiP Study is a two-centre, randomised, double-blind placebo-controlled trial in Wellington and Auckland, New Zealand. Four hundred pregnant women expecting infants at high risk of allergic disease will be enrolled in the study at 14-16 weeks gestation and randomised to receive either Lactobacillus rhamnosus HN001 (6 × 10(9) colony-forming units per day (cfu/day)) or placebo until delivery and then continuing until 6 months post-partum, if breastfeeding. Primary infant outcomes are the development and severity of eczema and atopic sensitisation in the first year of life. Secondary outcomes are diagnosis of maternal gestational diabetes mellitus, presence of bacterial vaginosis and vaginal carriage of Group B Streptococcus (at 35-37 weeks gestation). Other outcome measures include maternal weight gain, maternal postpartum depression and anxiety, infant birth weight, preterm birth, and rate of caesarean sections. A range of samples including maternal and infant faecal samples, maternal blood samples, cord blood and infant cord tissue samples, breast milk, infant skin swabs and infant buccal swabs will be collected for the investigation of the mechanisms of probiotic action. DISCUSSION The study will investigate if mother-only supplementation with Lactobacillus rhamnosus HN001 in pregnancy and while breastfeeding can reduce rates of eczema and atopic sensitisation in infants by 1 year, and reduce maternal rates of gestational diabetes mellitus, bacterial vaginosis, vaginal carriage of Group B Streptococcus before birth and maternal depression and anxiety postpartum. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registration: ACTRN12612000196842. Date Registered: 15/02/12.
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Affiliation(s)
- Christine Barthow
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand.
| | - Kristin Wickens
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand
| | - Thorsten Stanley
- Department of Paediatrics, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand
| | - Edwin A Mitchell
- Department of Paediatrics: Child and Youth Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Robyn Maude
- Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, P O Box 7625, Newtown, Wellington, 6242, New Zealand
| | - Peter Abels
- Department of Obstetrics and Gynaecology, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand
| | - Gordon Purdie
- Dean's Department, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand
| | - Rinki Murphy
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Peter Stone
- Department of Obstetrics and Gynaecology, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Janice Kang
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand
| | - Fiona Hood
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand
| | - Judy Rowden
- Department of Paediatrics: Child and Youth Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Phillipa Barnes
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand
| | - Penny Fitzharris
- Immunology Department, Auckland Hospital, Private Bag 92024, Auckland Mail Centre, Auckland, 1142, New Zealand
| | - Jeffrey Craig
- Murdoch Children's Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Melbourne, Victoria, 3052, Australia
| | - Rebecca F Slykerman
- Department of Paediatrics: Child and Youth Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Julian Crane
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand
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Woo Baidal JA, Locks LM, Cheng ER, Blake-Lamb TL, Perkins ME, Taveras EM. Risk Factors for Childhood Obesity in the First 1,000 Days: A Systematic Review. Am J Prev Med 2016; 50:761-779. [PMID: 26916261 DOI: 10.1016/j.amepre.2015.11.012] [Citation(s) in RCA: 580] [Impact Index Per Article: 72.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 11/17/2015] [Accepted: 11/18/2015] [Indexed: 12/27/2022]
Abstract
CONTEXT Mounting evidence suggests that the origins of childhood obesity and related disparities can be found as early as the "first 1,000 days"-the period from conception to age 2 years. The main goal of this study is to systematically review existing evidence for modifiable childhood obesity risk factors present from conception to age 2 years. EVIDENCE ACQUISITION PubMed, Embase, and Web of Science were searched for studies published between January 1, 1980, and December 12, 2014, of childhood obesity risk factors present during the first 1,000 days. Prospective, original human subject, English-language research with exposure occurrence during the first 1,000 days and with the outcome of childhood overweight or obesity (BMI ≥85th percentile for age and sex) collected between age 6 months and 18 years were analyzed between December 13, 2014, and March 15, 2015. EVIDENCE SYNTHESIS Of 5,952 identified citations, 282 studies met inclusion criteria. Several risk factors during the first 1,000 days were consistently associated with later childhood obesity. These included higher maternal pre-pregnancy BMI, prenatal tobacco exposure, maternal excess gestational weight gain, high infant birth weight, and accelerated infant weight gain. Fewer studies also supported gestational diabetes, child care attendance, low strength of maternal-infant relationship, low SES, curtailed infant sleep, inappropriate bottle use, introduction of solid food intake before age 4 months, and infant antibiotic exposure as risk factors for childhood obesity. CONCLUSIONS Modifiable risk factors in the first 1,000 days can inform future research and policy priorities and intervention efforts to prevent childhood obesity.
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Affiliation(s)
- Jennifer A Woo Baidal
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Medical Center, New York City, New York
| | - Lindsey M Locks
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Erika R Cheng
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Tiffany L Blake-Lamb
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts; Kraft Center for Community Health Leadership, Partners Healthcare, Boston, Massachusetts
| | - Meghan E Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
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Lettieri Barbato D, Tatulli G, Vegliante R, Cannata SM, Bernardini S, Ciriolo MR, Aquilano K. Dietary fat overload reprograms brown fat mitochondria. Front Physiol 2015; 6:272. [PMID: 26483700 PMCID: PMC4586425 DOI: 10.3389/fphys.2015.00272] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/14/2015] [Indexed: 12/18/2022] Open
Abstract
Chronic nutrient overload accelerates the onset of several aging-related diseases reducing life expectancy. Although the mechanisms by which overnutrition affects metabolic processes in many tissues are known, its role on BAT physiology is still unclear. Herein, we investigated the mitochondrial responses in BAT of female mice exposed to high fat diet (HFD) at different steps of life. Although adult mice showed an unchanged mitochondrial amount, both respiration and OxPHOS subunits were strongly affected. Differently, offspring pups exposed to HFD during pregnancy and lactation displayed reduced mitochondrial mass but high oxidative efficiency that, however, resulted in increased bioenergetics state of BAT rather than augmented uncoupling respiration. Interestingly, the metabolic responses triggered by HFD were accompanied by changes in mitochondrial dynamics characterized by decreased content of the fragmentation marker Drp1 both in mothers and offspring pups. HFD-induced inactivation of the FoxO1 transcription factor seemed to be the up-stream modulator of Drp1 levels in brown fat cells. Furthermore, HFD offspring pups weaned with normal diet only partially reverted the mitochondrial dysfunctions caused by HFD. Finally these mice failed in activating the thermogenic program upon cold exposure. Collectively our findings suggest that maternal dietary fat overload irreversibly commits BAT unresponsiveness to physiological stimuli such as cool temperature and this dysfunction in the early stage of life might negatively modulate health and lifespan.
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Affiliation(s)
| | | | - Rolando Vegliante
- Department of Biology, University of Rome "Tor Vergata," Rome, Italy
| | - Stefano M Cannata
- Department of Biology, University of Rome "Tor Vergata," Rome, Italy
| | - Sergio Bernardini
- Department of Biology, University of Rome "Tor Vergata," Rome, Italy
| | - Maria R Ciriolo
- Department of Biology, University of Rome "Tor Vergata," Rome, Italy ; IRCCS San Raffaele Roma Rome, Italy
| | - Katia Aquilano
- Department of Biology, University of Rome "Tor Vergata," Rome, Italy ; IRCCS San Raffaele Roma Rome, Italy
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Shearrer GE, Whaley SE, Miller SJ, House BT, Held T, Davis JN. Association of gestational diabetes and breastfeeding on obesity prevalence in predominately Hispanic low-income youth. Pediatr Obes 2015; 10:165-71. [PMID: 25044818 DOI: 10.1111/ijpo.247] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 04/22/2014] [Accepted: 05/05/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The goal of this study was to examine if breastfeeding duration by gestational diabetes mellitus status impacted the prevalence of obesity in offspring. METHODS Data were obtained from a 2011 phone survey with caregivers of low-income children (2-4 years) participating in the Women, Infants and Children programme in Los Angeles County. The final sample included 2295 children, 84% Hispanic and 48% female. Chi-square and binary logistic regression were used to assess gestational diabetes status and breastfeeding duration on the prevalence of obesity, with the following a priori covariates: child's ethnicity, birth weight, age in months and sex. RESULTS Breastfeeding and gestational diabetes were significantly associated with obesity prevalence (P < 0.01). Using gestational diabetes mellitus and no breastfeeding as the referent category, gestational diabetes mellitus offspring who were breastfed ≥12 months had a 72% decrease in obesity prevalence (adjusted odds ratio = 0.28, confidence interval 0.89-0.03, P = 0.05). CONCLUSIONS These findings suggest that > 12 months of breastfeeding duration in the gestational diabetes mellitus group and any duration of breastfeeding in the non-gestational diabetes mellitus mothers is needed to reduce obesity levels in a primarily Hispanic population.
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Affiliation(s)
- G E Shearrer
- Department of Nutritional Sciences, The University of Texas, Austin, TX, USA
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Fetal hyperglycemia and a high-fat diet contribute to aberrant glucose tolerance and hematopoiesis in adult rats. Pediatr Res 2015; 77:316-25. [PMID: 25412163 PMCID: PMC4297501 DOI: 10.1038/pr.2014.185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 08/11/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Children exposed to gestational diabetes mellitus (GDM) during pregnancy are at increased risk of obesity, diabetes, and hypertension. Our goal was to identify metabolic and hematopoietic alterations after intrauterine exposure to maternal hyperglycemia that may contribute to the pathogenesis of chronic morbidities. METHODS Streptozotocin treatment induced maternal hyperglycemia during the last third of gestation in rat dams. Offspring of control mothers (OCM) and diabetic mothers (ODM) were evaluated for weight, glucose tolerance, insulin tolerance, and hematopoiesis defects. The effects of aging were examined in normal and high-fat diet (HFD)-fed young (8-wk-old) and aged (11-mo-old) OCM and ODM rats. RESULTS Young adult ODM males on a normal diet, but not females, displayed improved glucose tolerance due to increased insulin levels. Aged ODM males and females gained more weight than OCM on a HFD and had worse glucose tolerance. Aged ODM males fed a HFD were also neutrophilic. Increases in bone marrow cellularity and myeloid progenitors preceded neutrophilia in ODM males fed a HFD. CONCLUSION When combined with other risk factors like HFD and aging, changes in glucose metabolism and hematopoiesis may contribute to the increased risk of obesity, type 2 diabetes, and hypertension observed in children of GDM mothers.
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Donnelly JM, Walsh JM, Byrne J, Molloy EJ, McAuliffe FM. Impact of maternal diet on neonatal anthropometry: a randomized controlled trial. Pediatr Obes 2015; 10:52-6. [PMID: 24443392 DOI: 10.1111/j.2047-6310.2013.00216.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/15/2013] [Accepted: 11/19/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Large for gestational age infants are at increased risk of childhood obesity and maternal nutrition impacts birthweight. The aim of this study was to assess the impact of a maternal low glycaemic index (GI) diet on neonatal anthropometry. METHODS The ROLO (Randomised Control Trial of Low Glycaemic Index Diet in Pregnancy) study was a randomized controlled trial to assess the impact of a low GI diet versus usual diet on birthweight. It took place in a tertiary maternity hospital in Ireland and women were randomized to receive either a low GI diet or no dietary intervention from early pregnancy to term. Two hundred sixty-five neonates had anthropometric measurements on day 1-2 of life, 126 in the intervention group and 139 in the control group. Measurements included birthweight, length and circumferences of the head, chest, abdominal, thigh and mid-upper arm. A subgroup of 219 (82%) neonates also had skin-fold measurements. RESULTS Neonates whose mothers had a low GI diet in pregnancy had lower thigh circumference (15.9 ± 1.7 cm vs. 16.6 ± 1.5 cm, P = 0.04). There was no difference between the intervention and control groups in head, chest abdominal or mid-upper arm circumferences. No difference was noted between the two groups for any skin-fold measurements (subscapular, thigh, biceps and triceps). CONCLUSION Neonatal thigh circumference was altered by maternal low GI diet in pregnancy. These findings suggest that maternal low GI diet is safe in pregnancy and may positively impact infant adiposity.
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Affiliation(s)
- J M Donnelly
- UCD, Department of Obstetrics and Gynaecology, School of Medicine and Medical Science, Dublin, Ireland
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Gugusheff JR, Ong ZY, Muhlhausler BS. The early origins of food preferences: targeting the critical windows of development. FASEB J 2014; 29:365-73. [PMID: 25466884 DOI: 10.1096/fj.14-255976] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The nutritional environment to which an individual is exposed during the perinatal period plays a crucial role in determining his or her future metabolic health outcomes. Studies in rodent models have demonstrated that excess maternal intake of high-fat and/or high-sugar "junk foods" during pregnancy and lactation can alter the development of the central reward pathway, particularly the opioid and dopamine systems, and program an increased preference for junk foods in the offspring. More recently, there have been attempts to define the critical windows of development during which the opioid and dopamine systems within the reward pathway are most susceptible to alteration and to determine whether it is possible to reverse these effects through nutritional interventions applied later in development. This review discusses the progress made to date in these areas, highlights the apparent importance of sex in determining these effects, and considers the potential implications of the findings from rodent models in the human context.
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Affiliation(s)
- Jessica Rose Gugusheff
- *FOODplus Research Centre, School of Agriculture Food and Wine, The University of Adelaide, Adelaide, South Australia, Australia; Sansom Institute for Health Research, School of Pharmacy and Medical Science, University of South Australia, Adelaide, South Australia, Australia; and Department of Psychology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zhi Yi Ong
- *FOODplus Research Centre, School of Agriculture Food and Wine, The University of Adelaide, Adelaide, South Australia, Australia; Sansom Institute for Health Research, School of Pharmacy and Medical Science, University of South Australia, Adelaide, South Australia, Australia; and Department of Psychology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Beverly Sara Muhlhausler
- *FOODplus Research Centre, School of Agriculture Food and Wine, The University of Adelaide, Adelaide, South Australia, Australia; Sansom Institute for Health Research, School of Pharmacy and Medical Science, University of South Australia, Adelaide, South Australia, Australia; and Department of Psychology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Chandler-Laney PC, Bush NC, Rouse DJ, Mancuso MS, Gower BA. Gut hormone activity of children born to women with and without gestational diabetes. Pediatr Obes 2014; 9:53-62. [PMID: 23364910 PMCID: PMC3651744 DOI: 10.1111/j.2047-6310.2012.00140.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 11/30/2012] [Accepted: 12/03/2012] [Indexed: 01/01/2023]
Abstract
UNLABELLED What is already known about this subject Children born to women with gestational diabetes have greater risk for obesity. Obesity in adults and children is associated with blunted postprandial gut hormone responses. What this study adds Children of women with gestational diabetes have a blunted postprandial response of GLP-1. Children of women with gestational diabetes have high fasting PYY concentrations. BACKGROUND Intrauterine exposure to gestational diabetes mellitus (GDM) increases risk for obesity. Obesity is associated with a blunted postprandial gut hormone response, which may impair satiety and thereby contribute to weight gain. The postprandial response of gut hormones among children of women with GDM has not previously been investigated. OBJECTIVE To examine whether children of women with GDM have suppressed peptide-tyrosine-tyrosine (PYY) and glucagon-like-peptide-1 (GLP-1), and higher concentrations of ghrelin, following a meal challenge. A secondary objective was to investigate associations of these hormones with children's free-living energy intake. METHODS Children (n = 42) aged 5-10 years were stratified into two groups: offspring of GDM mothers (OGD) and of non-diabetic mothers (CTRL). Body composition was measured by dual-energy X-ray absorptiometry, and circulating PYY, GLP-1 and total ghrelin were measured during a liquid meal challenge. Energy intake was assessed by three 24-h diet recalls. RESULTS Between-groups analyses of fasting and incremental area under the curve (AUC) found no differences in ghrelin. Incremental AUC for GLP-1 was greater among the CTRL vs. OGD (P < 0.05), and fasting PYY, but not incremental AUC, was higher among OGD vs. CTRL (P < 0.01). Associations of fasting and incremental AUC for each gut hormone with children's usual energy intake did not differ significantly by group. CONCLUSIONS Further research is needed to more fully examine the potential role of postprandial GLP-1 suppression and high-fasting PYY concentrations on the feeding behaviour and risk for obesity among children exposed to GDM in utero.
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Affiliation(s)
| | - Nikki C. Bush
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dwight J. Rouse
- Department of Obstetrics and Gynecology, Alpert School of Medicine of Brown University, Providence, RI, USA
| | - Melissa S. Mancuso
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Barbara A. Gower
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
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Gui J, Li A, Su X, Feng L. Association between hyperglycemia in middle and late pregnancy and maternal-fetal outcomes: a retrospective study. BMC Pregnancy Childbirth 2014; 14:34. [PMID: 24438028 PMCID: PMC3930106 DOI: 10.1186/1471-2393-14-34] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 01/14/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The purposes of this study were to explore whether the maternal-fetal outcomes differed among various types of hyperglycemia during pregnancy and whether the values of glycemic screening in the middle phase of pregnancy could predict maternal-fetal outcomes. METHODS A retrospective study was conducted to study the incidence of maternal-fetal outcomes in 383 singleton pregnant women with diabetes or gestational diabetes admitted to our hospital from November 2007 to March 2013. Patients were divided into three groups: DM (Type 1 and Type 2 diabetes mellitus) group, mGDM (mild gestational diabetes mellitus) group and sGDM (severe gestational diabetes mellitus) group. Maternal basic characteristics, results of oral glucose tolerance test (OGTT), antenatal random glycemia and maternal-fetal outcomes were collected. Binary logistic regression was used to estimate the association of blood glucose with the maternal-fetal outcomes. Predictive accuracy was assessed by calculating the areas under the receiver operating characteristic curves. RESULTS The maternal basic characteristics, maternal complications and neonatal complications did not differ significantly between DM group and sGDM group, except neonatal intensive care units admission (NICU). Incidences of preterm, NICU and preeclampsia were significantly lower in the mGDM group than in the DM and sGDM groups (P < 0.05). After adjusted by confounding factors, the value of OGTT 0 h could predict pregnancy induced hypertension (PIH) (OR = 1.24, 95% CI [1.04 to 1.46], P = 0.015), preterm birth (OR = 1.23, 95% CI [1.03 to 1.47], P = 0.025) and stillbirth (OR = 1.55, 95% CI [1.14 to 2.10], P = 0.005); antenatal random glycemia could predict preterm birth (OR = 1.19, 95% CI [1.08 to 1.31], P < 0.001) and stillbirth (OR = 1.41, 95% CI [1.17 to 1.71], P < 0.001). CONCLUSIONS Pregnant women in the mGDM group have better outcomes than those in the DM and sGDM groups. The values of OGTT in the middle phase of pregnancy and antenatal random glycemia could predict PIH, preterm birth or stillbirth to some extent.
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Affiliation(s)
| | | | | | - Ling Feng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji medical college, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Nehring I, Chmitorz A, Reulen H, von Kries R, Ensenauer R. Gestational diabetes predicts the risk of childhood overweight and abdominal circumference independent of maternal obesity. Diabet Med 2013; 30:1449-56. [PMID: 23869909 DOI: 10.1111/dme.12286] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2013] [Indexed: 12/12/2022]
Abstract
AIM Gestational diabetes mellitus is believed to be a risk factor for childhood overweight/obesity. We aimed to assess whether this association is either a reflection or independent of confounding by maternal BMI. METHODS Data from 7355 mother-child dyads of the German Perinatal Prevention of Obesity cohort with full anthropometric information on mothers and children, gestational diabetes and confounding factors were obtained at school entry health examination. We calculated crude and adjusted logistic regression models for the association of gestational diabetes and childhood overweight/obesity and abdominal adiposity defined by age- and sex-specific percentiles for BMI and waist circumference. RESULTS Among all children (mean age 5.8 years), 8.1% were overweight, 2.6% were obese and 15.5% had abdominal adiposity. The prevalence of overweight (obesity) was 21% (8.2%) in children of mothers with gestational diabetes and 10.4% (2.4%) in children of healthy mothers. Analyses with adjustment for maternal BMI and other potential confounders yielded an odds ratio of 1.81 (95% CI 1.23-2.65) and 2.80 (95% CI 1.58-4.99) for the impact of gestational diabetes on childhood overweight and obesity, respectively. Similar results were obtained for the risk of childhood abdominal adiposity (odds ratio 1.64, 95% CI 1.16-2.33) by maternal gestational diabetes. CONCLUSIONS The postulated increased risk of overweight and abdominal adiposity in offspring of mothers with gestational diabetes cannot be explained by maternal BMI alone and may be stronger for childhood obesity than for overweight.
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Affiliation(s)
- I Nehring
- Division of Epidemiology, Institute of Social Paediatrics and Adolescent Medicine, Germany
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