Neonatal Obesity-Adiposity is Largely Driven by Maternal Hyperglycemia in-utero: Analysis of Real-Life Data from a Diabetes Clinic in India

  1. Sayali S. Deshpande-Joshi
  2. Sonali S. Wagle
  3. Madhura K. Deshmukh
  4. Himangi Lubree
  5. Hemant S. Damle
  6. Suhas R. Otiv
  7. Sanat B. Phatak
  8. Rucha H. Wagh
  9. K. Meenakumari
  10. Smita N. Dhadge
  11. Rajashree P. Kamat
  12. Sayali G. Wadke
  13. Deepa A. Raut
  14. Dattatray S. Bhat
  15. Souvik Bandyopadhyay
  16. Chittaranjan S. Yajnik
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Abstract

Background

Segregation of the effect of maternal size and glycemia on fetal growth is difficult to understand in overweight-obese women with diabetes.

Aim

To examine the effect of maternal size and degree of hyperglycemia on neonatal obesity-adiposity in the relatively thin Indian population.

Study design

Analysis of real-life data collected in one diabetes clinic.

Methods

We 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 obesity-adiposity measurements (weight, ponderal index, abdominal circumference, and skinfold thickness) using multiple linear regression.

Results

We 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 obese-adipose, followed serially by those of mothers with type 2 diabetes, GDM, and NGT. Other obesity adiposity measurements showed a similar gradient. Compared to maternal type of diabetes, pre-pregnancy BMI and gestational weight gain (GWG) made a much smaller contribution to neonatal obesity-adiposity.

Conclusion

Our findings provide a clear answer that maternal hyperglycemia rather than size is the primary driver of neonatal obesity-adiposity. Adequate control of maternal hyperglycemia will help control neonatal obesity-adiposity.

RESEARCH IN CONTEXT

What is already known about this subject?

  • Maternal obesity and diabetes increase neonatal obesity-adiposity which contributes to bad pregnancy outcomes

  • Given the strong association between maternal obesity and diabetes in western populations, the dominant determinant of neonatal obesity-adiposity is difficult to assess

What is the key question?

  • Is maternal size or hyperglycemia the primary determinant of neonatal obesity-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 exposure

  • Neonates 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 obesity-adiposity

  • Strict control of maternal hyperglycemia will help reduce neonatal obesity-adiposity and associated adverse outcomes

Article activity feed

  1. Version published to 10.1101/2024.04.27.24306016v1 on medRxiv