OVERWEIGHT AND OBESITY IN INFANTS OF MOTHERS WITH LONG-TERM INSULIN-DEPENDENT DIABETES OR GESTATIONAL DIABETES

OBJECTIVES: To analyse the development of body weight and frequencies of overweight and obesity in infants of long-term insulin-dependent di abetic mothers as compared to those of gestational diabetic mothers. D ESIGN: Retrospective study. SUBJECTS: Two hundred infants of mothers w ith pregestational insulin-dependent diabetes mellitus (IDM) and 117 i nfants of gestational diabetic mothers (IGDM) born between 1980 and 19 90 at the Clinic: of Obstetrics and Gynaecology, Berlin-Kaulsdorf, Ger many. MEASUREMENTS: Birth weight, birth length, plasma insulin, inters capular skinfold, symmetry index (SI) and body mass index (BMI) at bir th; SI and BMI in childhood (1-9 y of age). RESULTS: Neonatally, mean relative weight (SI) was found to be increased in both groups of infan ts. It was positively correlated to interscapular skinfold (P<0.001) a nd insulin (P<0.005). However, IDM had higher insulin revels (P<0.001) and a higher frequency of obesity (P<0.05) than IGDM at birth. Throug hout childhood frequencies of overweight (SI>1.1) were elevated in bot h IDM as well as IGDM. In IDM the percentage of obesity (SI>1.2) displ ayed a significant increase from 11.2% in children 1-4 y old up to 25. 8% at 5-9 y (P<0.05). Similar frequencies and a highly significant inc rease of overweight during childhood of IDM (P<0.005) were observed wh en BMI greater than or equal to 95th percentile was used to determine overweight. Relative weight in childhood was positively correlated to relative weight at birth (P<0.05). Large-for-gestational-age infants d isplayed a significantly higher percentage of overweight (SI>1.1) in c hildhood than appropriate-for-gestational-age infants (P<0.05). CONCLU SIONS: Infants of mothers with diabetes during pregnancy are predispos ed to develop overweight and obesity during childhood. These alteratio ns seem to be related to insulin and relative body weight at birth. Pa thophysiological mechanisms which might be involved into the developme nt of these changes are discussed. Prophylactic measures are recommend ed to reduce morbidity in infants of diabetic mothers.