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Breast-feeding linked to lower risk for obesity among infants exposed to diabetes during pregnancy
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Babies exposed to diabetes in utero who were breast-fed for at least 6 months appear to have considerably lower BMI, waist circumference, and subcutaneous and visceral abdominal fat during childhood, researchers found.
“Children born to mothers with diabetes during pregnancy have been shown to have a greater prevalence of obesity in childhood,” researchers in Colorado wrote in a new study. “These youth may be ‘programmed’ in utero for later development of obesity by exposure to excess maternal glucose (and other fuels) at a critical period of development (ie, the fetal overnutrition hypothesis).”
A retrospective cohort study included 89 children who were exposed to diabetes in utero and 379 unexposed children, all aged 6 to 13 years, from the Exploring Perinatal Outcomes among Children (EPOCH) study. The researchers defined diabetes exposure as pre-existing diabetes or gestational diabetes diagnosed during pregnancy, and breast-feeding status was obtained through self-report. Adiposity measures included BMI, waist circumference, subscapular-to-triceps skinfold ratio, and subcutaneous and visceral abdominal tissue.
Exposure vs. no exposure
Among exposed and unexposed children, at least 6 months of breast-feeding was associated with significantly lower BMI, waist circumference, and subcutaneous and visceral abdominal fat vs. children who were breast-fed for less than 6 months.
In the low breast-feeding group, exposure to diabetes correlated with a 1.7 higher BMI (P=.03); a 5.8 cm higher waist circumference (P=.008); a 6.1 cm2 higher amount of visceral fat tissue (P=.06); a 44.6 cm2 higher amount of subcutaneous adipose tissue (P=.03); and a 0.11 higher subscapular-to-triceps skinfold ratio (P=.008) vs. unexposed children. Among children who were breast-fed for 6 months or more, differences among exposed and unexposed children did not reach statistical significance.
“This study suggests that infants at high risk for future development of obesity, such as offspring of obese or diabetic mothers, would particularly benefit from an extended breast-feeding program,” lead researcher Dana Dabelea, MD, PhD, associate professor and director of graduate programs in epidemiology at the Colorado School of Public Health, told Endocrine Today. “Increased duration of breast-feeding should be recommended to such mothers because of important health benefits to their offspring.”
Dabelea also said these results should remind scientists that “the ‘fetal programming’ of childhood obesity does not stop at birth and can be reversed with measures as simple as breast-feeding.”
Future exploration
In an accompanying editorial, Andreas Plagemann, MD, and Thomas Harder, MD, of Charité-University Medicine Berlin in Germany, said breast-feeding also improves mother-child binding and protects from certain diseases, such as respiratory infections and asthma, adding that these results should prompt further investigation.
“If breast-feeding has the potential to change long-term risks in [gestational diabetes] offspring and, thereby, modify the consequences of exposure to a diabetic intrauterine environment, then we have to extend the historical concept of fuel-mediated teratogenesis beyond birth, opening important chances and challenges of neonatal diabetes prevention,” Plagemann and Harder wrote. – by Melissa Foster
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Disclosure: Drs. Dabelea, Plagemann and Harder report no relevant financial disclosures.
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