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Abstract
Objective Maternal glycaemia and anthropometry-derived newborn adiposity are strongly correlated. The children of mothers with diabetes are at greater risk of adverse metabolic health, and increased adiposity is a plausible mediator. We undertook a systematic review and meta-analysis to compare adiposity in infants of diabetic mothers (IDM) and infants of mothers without diabetes (NIDM).
Design We identified observational studies reporting adiposity in IDM and NIDM. We searched references, traced forward citations and contacted authors for additional data. We considered all body composition techniques and compared fat mass, fat-free mass, body fat % and skinfold thickness. We used random effects meta-analyses and performed subgroup analyses by maternal diabetes type (type 1, type 2 and gestational) and infant sex. We examined the influence of pre-pregnancy body mass index (BMI) and conducted sensitivity analyses.
Results We included data from 35 papers and over 24 000 infants. IDM have greater fat mass than NIDM (mean difference (95% CI)): 83 g (49 to 117). Fat mass is greater in infants of mothers with gestational diabetes: 62 g (29 to 94) and type 1 diabetes: 268 g (139 to 397). Insufficient studies reported data for type 2 diabetes separately. Compared with NIDM, fat mass was greater in IDM boys: 87 g (30 to 145), but not significantly different in IDM girls: 42 g (−33 to 116). There was no attenuation after adjustment for maternal BMI.
Conclusions IDM have significantly greater adiposity in comparison with NIDM. These findings are justification for studies to determine whether measures to reduce infant adiposity will improve later health.
- Neonatology
- Obesity
- Endocrinology
- Outcomes research
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Footnotes
▸ Additional material is published online only. Web references [57–64] are not cited in the text but cited in supplementary table S1. To view please visit the journal online (http://dx.doi.org/10.1136/archdischild-2015-309750).
Contributors All authors of the paper contributed to the writing of the study protocol. KML conducted the literature search, assisted by MJH; where required KML contacted the authors for further data; KML extracted the data from the relevant papers, checked by CG and KML, CG and MJH carried out a quality assessment of all included studies. KML and SS conducted the meta-analysis. KML, MJH and CG wrote the first draft of the paper. This was revised by NM. All authors contributed to the interim and final drafts of the paper. All authors approved the final version of the paper.
Funding This study was supported by an Action Medical Research Fellowship awarded to KML, grant number GN2008.
Competing interests KML and NM declare financial support for the submitted work from an Action Medical Research Fellowship; CG, MJH and SS have received funding from the National Institute of Health Research and NM has held research grants awarded by the National Institute of Health Research, Wellcome Trust, Action Medical Research, Child Growth Foundation, Department of Health, Westminster Medical School Research Trust, Healthcare Quality Improvement Partnership, HCA International and Bliss. CG's contribution to this study was supported by an Academy of Medical Sciences Starter Grant for Clinical Lecturers (supported by the Medical Research Council, Wellcome Trust, British Heart Foundation, Arthritis Research UK, Prostate Cancer UK and The Royal College of Physicians) and through a MRC Clinician Scientist Fellowship.
Provenance and peer review Not commissioned; externally peer reviewed.