Easily Calmed Infants of Mothers With Gestational Diabetes May Be at Risk for Childhood Obesity

The risk for obesity at age 2 to 5 years was increased in easily calmed infants born to mothers with gestational diabetes.

The risk for obesity at age 2 to 5 years was increased in easily calmed infants born to mothers with gestational diabetes, according to study results published in JAMA Pediatrics. The researchers suspect that this might be related to the use of sugary drinks to soothe the infants.

Previous studies have suggested a possible association between childhood obesity and infant temperament, including soothability (defined as reduction of fussing, crying, or distress when soothing techniques are used by the caregiver), distress to limitations, and activity temperaments.

The researchers collected data from the Study of Women, Infant Feeding, and Type 2 Diabetes After Gestational Diabetes, a prospective cohort study including women diagnosed with gestational diabetes who delivered singleton live births at Kaiser Permanente Northern California hospital between 2008 and 2011.

Rothbart Infant Behavior Questionnaire was used to assess soothability, distress to limitations, and activity. The questionnaire was administered when infants were 6 to 9 weeks and 6 months old. The primary outcome was child overweight and obesity, as assessed at ages 2 to 5 years. For the statistical analysis, infants were scored as <75th percentile (not elevated) or ≥75th percentile (elevated) for each temperament variable.

The study enrolled 382 mother-infant pairs, and most were non-Hispanic white (34%), Hispanic (33%), or Asian (25%) infants.  

High soothability temperament in infancy was associated with more than two-fold increased risk for future obesity at age 2 to 5 years in children born to mothers with gestational diabetes (adjusted odds ratio, 2.22, 95% CI, 1.04-4.73). There was no association between distress to limitations or activity temperament and future risk for obesity.

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The researchers also found an association between infant temperament and the initiation of sugar-sweetened beverages and complementary food consumption. Infants high in soothability or activity temperament were more likely to initiate intake of fruit juice and/or sugar-sweetened beverages before age 6 months.

Furthermore, consistent with previous studies, this study’s results indicate that breastfeeding was protective against overweight and obesity, as greater breastfeeding intensity and duration were associated with lower risk for obesity.

The researchers specified several limitations to the study, including lack of observational or physiologic measures of temperament or direct measure of the food given to the infants by parents in the attempt to soothe the child. Furthermore, assessment of temperament was only completed at ages 6 to 9 weeks and 6 months, and not at a later stage.

“[A]mong infants at risk for developing obesity and type 2 diabetes, those higher in soothability temperament were more likely to become obese when followed up at ages 2 to 5 years,” concluded the researchers, adding that for health professionals, “discussions with parents regarding infant soothing strategies, food, and emotional regulation might be considered, particularly for infants exposed to [gestational diabetes] in utero.”

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Faith MS, Hittner JB, Hurston SR, et al. Association of infant temperament with subsequent obesity in young children of mothers with gestational diabetes mellitus [published online March 11, 2019]. JAMA Pediatr. doi:10.1001/jamapediatrics.2018.5199