ESPE Yearbook of Paediatric Endocrinology

Diabetologia 2019 Feb;62(2):249–258. doi: 10.1007/s00125-018-4758-0.

This is the first population-based study to examine the relative contribution of maternal diabetes, excess birthweight and breast-feeding on the risk of being overweight and obese in childhood.

Being large for gestational at birth is a potentially modifiable factor and this study highlights the need to better understand the factors associated with its incidence in order to develop strategies to reduce the number of children who are overweight/obese. Children who are large at birth are more likely to be obese in early childhood and maternal diabetes during pregnancy is associated with excess weight in the offspring during childhood. Breast feeding is associated with a lower risk of excess weight in childhood. Both large for gestational age and maternal diabetes during pregnancy are associated with an increased risk of the offspring being overweight/obese in early childhood. Large for gestational age is a stronger marker for risk of being overweight/obese in early childhood than maternal diabetes. Breast feeding is associated with a lower risk of being overweight/obese in a majority of children, however this association is not maintained in large for gestational age children of mothers with diabetes.

This study establishes that a larger proportion of excess weight in childhood can be attributed to being born large for gestational age than maternal diabetes during pregnancy. The findings should reinforce public health advice for women who are planning to get pregnant that, just like smoking, alcohol consumption and other lifestyle choices, their weight prior to, and weight gain and glycaemic control during, pregnancy may have a significant impact on the future health of their children.