Long-term impact of neonatal breastfeeding on childhood adiposity and fat distribution among children exposed to diabetes in utero

Abstract

Objective: To evaluate whether breastfeeding attenuates increased childhood adiposity associated with exposure to diabetes in utero.

Research design and methods: Retrospective cohort study of 89 children exposed to diabetes in utero and 379 unexposed youth with measured BMI, waist circumference, skinfolds, visceral (VAT) and subcutaneous (SAT) abdominal fat. A measure of breast milk-months was derived from maternal self-report and used to categorize breastfeeding status as low (<6) and adequate (≥ 6 breast milk-months). Multiple linear regression was used to model the relationship between exposure to diabetes in utero and offspring adiposity outcomes among youth stratified according to breastfeeding status.

Results: Adequate (vs. low) breastfeeding status was associated with significantly lower BMI, waist circumference, SAT, and VAT at ages 6-13 years. Among youth in the low breastfeeding category, exposure to diabetes in utero was associated with a 1.7 kg/m(2) higher BMI (P = 0.03), 5.8 cm higher waist circumference (P = 0.008), 6.1 cm(2) higher VAT (P = 0.06), 44.6 cm(2) higher SAT (P = 0.03), and 0.11 higher ratio of subscapular-to-triceps skinfold ratio (P = 0.008). Among those with adequate breastfeeding in infancy, the effect of prenatal exposure to diabetes on childhood adiposity outcomes was not significant.

Conclusions: Adequate breastfeeding protects against childhood adiposity and reduces the increased adiposity levels associated with exposure to diabetes in utero. These data provide support for mothers with diabetes during pregnancy to breastfeed their infants in order to reduce the risk of childhood obesity.

Figure 1

A–E: Effect of exposure to diabetes in utero on mean levels of childhood adiposity parameters. Stratified by breastfeeding (BF) status, data are adjusted for age, sex, race/ethnicity, Tanner stage, and age × Tanner stage interaction. A: BMI: P = 0.03 for youth with low breastfeeding; P = 0.4 for youth with adequate breastfeeding. B: Waist circumference (WC): P = 0.008 for youth with low breastfeeding; P = 0.10 for youth with adequate breastfeeding. C: VAT: P = 0.06 for youth with low breastfeeding; P = 0.40 for youth with adequate breastfeeding. D: SAT: P = 0.03 for youth with low breastfeeding; P = 0.11 for youth with adequate breastfeeding. E: STR: P = 0.008 for youth with low breastfeeding; P = 0.14 for youth with adequate breastfeeding.