Children born to mothers with gestational diabetes, and who were easier to soothe as infants were linked with a higher risk of obesity as children, researchers found.
In a cohort of nearly 400 mothers with gestational diabetes mellitus and their children, infants who had higher “soothability” (defined as “reduction of fussing, crying or distress when soothing techniques were used by the caregiver”) were more likely to be obese at ages 2 through 5 (adjusted OR 2.22, 95% CI 1.04-4.73), reported Myles Faith, PhD, of the University of Buffalo — State University of New York, and colleagues.
Moreover, infants high in soothability were more likely to have started drinking fruit juice or sugar-sweetened beverages at age <6 months (20% vs 9.7% for those low in soothability), the authors wrote in JAMA Pediatrics.
“It may be that for infants high in soothability, sugary beverages are a way to help with emotion regulation, and then parents may have learned to use sugary beverages or perhaps foods to soothe distress,” Faith told MedPage Today.
The American Academy of Pediatrics currently recommends milk be the only nutrient fed to infants until they are 6 months old and that it is “optimal” for children to avoid juice until they reach age 1. The AAP guidelines also note that juice “should not be sipped throughout the day or used as a means to calm an upset child.”
Julie Lumeng, MD, of the University of Michigan in Ann Arbor, who was not involved with the research, said giving mammals sugar can cause pleasurable sensations and doing so has been shown to reduce crying and pain in newborns. She noted that contrary to this study, prior evidence has demonstrated an association between greater infant fussiness and future obesity. Obesity can be influenced by a host of factors and, as such, further research is needed to determine this association, she added.
But since this study did not have a comparator arm of mothers without gestational diabetes mellitus, it cannot be determined whether maternal high blood sugar or other metabolic changes played a role in shaping the development of an infant’s brain, Lumeng told MedPage Today.
Other genetic factors can have a larger impact on childhood obesity, said Fatima Cody Stanford, MD, MPH, of Massachusetts General Hospital in Boston, who was also not involved with the study. Maternal and paternal weight statuses or infant sleep patterns, for example, are all important to consider as these factors influence a child’s risk for obesity, she added.
“If you have a family that is extremely lean and everyone in that family has a history of being lean, introducing sugary-sweet beverages will probably have less of an impact on their weight status than someone who has a strong family history of obesity,” she told MedPage Today.
In this study, Faith and colleagues collected data from the Study of Women, Infant Feeding, and Type 2 Diabetes After Gestational Diabetes (SWIFT), which included women with gestational diabetes mellitus who delivered live births at ≥35 weeks’ gestation at Kaiser Permanente Northern California (KPNC) hospitals from 2008 through 2011.
Of the examined 382 mother-infant pairs, 130 infants were non-Hispanic white, 126 were Hispanic, 96 were Asian, and 26 were non-Hispanic black. Mothers were a mean age of 33 and about half (48.4%) completed ≥4-years of college.
Mothers completed the Rothbart Infant Behavior Questionnaire (IBQ-R) to assess soothability, activity levels, and children’s distress to limitations — defined as the tendency to fuss when in a confined place or being unable to perform a certain action. Measurements of temperament were recorded when infants were from the ages of 6 through 9 weeks and age 6 months.
Neither distress to limitations nor activity temperament was linked with increased odds of future obesity, the authors reported. However, infants with high activity levels were significantly more likely to have started drinking sugary beverages at age <6 months compared to children with low activity levels (20% vs 10.2%, respectively).
In addition, infants with high distress to limitations more frequently initiated complementary foods within the first 6 months versus those with low distress to limitations (27% vs 14.8%, respectively).
Finally, breastfeeding had protective associations with obesity onset, suggesting “exclusive or predominant breastfeeding may reduce obesity risk for all children, including infants with high soothability, who are more susceptible,” researchers reported.
The authors did not include observational or physiological measures of temperament, nor did they include a direct measure of what parents fed their children to soothe them, which they cited as limitations to their findings. They also acknowledged residual confounding might exist due to measurement errors of beverage and dietary intake.
Faith received funding from subcontracts to the University at Buffalo from the National Institutes of Health grants.
Co-authors received funding outside this work from pharmaceutical companies Takeda, Merck & Company Inc., Sanofi-Aventis, Lilly, Genentech, Valeant, Pfizer, and Janssen Pharmaceuticals, Inc.
The study was funded by the American Diabetes Association; the National Institute of Child Health and Human Development; the National Institutes of Diabetes, Digestive, and Kidney Diseases; and the National Institutes of Health’s National Center for Research Resources.