Neonatal Adiposity is Largely Driven by Maternal Hyperglycemiain utero: Analysis of Routine Clinical Data from a Diabetes Clinic in India

Abstract

ABSTRACTAimTo examine the effect of maternal size and degree of hyperglycemia on neonatal adiposity in the relatively thin Indian population.Study designAnalysis of routine clinical data collected in one diabetes clinic.MethodsWe examined the association of maternal size (BMI) and degree of hyperglycemia (type of diabetes, type 1 being the thinnest and most hyperglycemic, type 2 and Gestational diabetes being overweight and obese but less hyperglycemic) with neonatal adiposity measurements (weight, ponderal index, abdominal circumference, and skinfold thickness) using multiple linear regression.ResultsWe included data on 772 pregnancies with diabetes (61 with type 1, 79 with type 2, and 632 with gestational) and 349 with normal glucose tolerance (NGT). Mothers with type 1 diabetes had the lowest BMI and highest HbA1c, however, their neonates were the most obese, centrally obese, and adipose. Compared to neonates of NGT mothers, those of mothers with type 1 diabetes were 370 g heavier, those of mothers with type 2 diabetes 265 g, and those of mothers with GDM by 200 g. Prediction models adjusted for gestational age at birth, neonatal sex, maternal age, parity, and year of birth confirmed that neonates of mothers with type 1 diabetes were the most adipose (ponderal index, abdominal circumference and skinfolds), followed serially by those of mothers with type 2 diabetes, GDM, and NGT. Compared to maternal type of diabetes, pre-pregnancy BMI and gestational weight gain (GWG) made a much smaller contribution to neonatal adiposity.ConclusionOur findings provide a clear answer that maternal hyperglycemia rather than BMI is the primary driver of neonatal adiposity. Adequate control of maternal hyperglycemia will help control neonatal adiposity.RESEARCH IN CONTEXTWhat is already known about this subject?Maternal obesity and diabetes increase neonatal adiposity which contributes to bad pregnancy outcomesGiven the strong association between maternal obesity and diabetes in western populations, the dominant determinant of neonatal adiposity is difficult to assessWhat is the key question?Is maternal BMI or hyperglycemia the primary determinant of neonatal adiposity?What are the new findings?Indian mothers with type 1 diabetes were the thinnest and the most hyperglycemic compared to mothers with type 2 diabetes and GDM who were more obese and less hyperglycemic, providing a contrasting exposureNeonates of mothers with type 1 diabetes were the most obese-adipose, those of mothers with type 2 diabetes and GDM were progressively less so.How might this impact on clinical practice in the foreseeable future?Our results clearly show that maternal hyperglycemia is the major driver of neonatal adiposity. Strict control of maternal hyperglycemia will help reduce neonatal adiposity and associated adverse outcomes