PEDIATRICOBESITY ORIGINALRESEARCH
Association of gestational diabetes and breastfeeding on obesity prevalence in predominately Hispanic low-income youth G. E. Shearrer1, S. E. Whaley2, S. J. Miller1, B. T. House1, T. Held3 and J. N. Davis1 1
Department of Nutritional Sciences, The University of Texas, Austin, TX, USA; 2Department of Research and Evaluation, Public Health Foundation Enterprises Special Supplemental Nutrition Program for Women, Infants, and Children Program, Irwindale, CA, USA; 3Department of Gynecology and Obstetrics, University of Texas Southwestern, Dallas, TX, USA Received 29 October 2013; revised 22 April 2014; accepted 5 May 2014
Summary Objective: The goal of this study was to examine if breastfeeding duration by gestational diabetes mellitus status impacted the prevalence of obesity in offspring. Methods: Data were obtained from a 2011 phone survey with caregivers of low-income children (2–4 years) participating in the Women, Infants and Children programme in Los Angeles County. The final sample included 2295 children, 84% Hispanic and 48% female. Chi-square and binary logistic regression were used to assess gestational diabetes status and breastfeeding duration on the prevalence of obesity, with the following a priori covariates: child’s ethnicity, birth weight, age in months and sex. Results: Breastfeeding and gestational diabetes were significantly associated with obesity prevalence (P < 0.01). Using gestational diabetes mellitus and no breastfeeding as the referent category, gestational diabetes mellitus offspring who were breastfed ≥12 months had a 72% decrease in obesity prevalence (adjusted odds ratio = 0.28, confidence interval 0.89–0.03, P = 0.05).
Conclusions: These findings suggest that > 12 months of breastfeeding duration in the gestational diabetes mellitus group and any duration of breastfeeding in the non-gestational diabetes mellitus mothers is needed to reduce obesity levels in a primarily Hispanic population. Keywords: Breastfeeding, gestational diabetes mellitus, obesity.
Introduction In June 2013, the American Medical Society defined obesity (body mass index [BMI] ≥ 95th percentile for age) as a disease state (1), which affects 16.1% of Hispanic children ages 2 to 5 (2). While many factors contribute to the growing obesity prevalence in the United States, the research focus is shifting to in utero and early life events (3). One such event is maternal gestational diabetes mellitus (GDM), which has been shown to increase the risk of obesity in children ages 6 months to 8 years of age (4). In the United States, GDM, defined as carbohydrate intolerance with onset or recognition of pregnancy, is estimated to affect 3–7% of pregnancies (5). Children born to mothers with GDM are twice as likely to develop metabolic syndrome, including obesity, than those born to non-GDM mothers (6). Furthermore, risk of GDM has been shown to vary among racial/ ethnic groups, with increased risk among Hispanic
women (7). Obese Hispanic mothers are four times more likely to develop GDM than their non-Hispanic Caucasian counterparts (7), which in turn contributes to an increased overweight and obesity occurrence in Hispanic offspring compared with their Caucasian peers (8). Given that the birth rate for Hispanics in 2011 was 17.6% compared with 10.8% for Caucasians, interventions targeting overweight and obesity in the Hispanic population are particularly meaningful (9). Breastfeeding (BF) is recognized as a highly modifiable element to eliminate the ethnic/racial disparity in childhood obesity rates (8). The World Health Organization recommends exclusive BF for the first 6 months of a child’s life (10). Despite this recommendation, Hispanic mothers are less likely to exclusively breastfeed for the first 6 months compared with Caucasian mothers (11). The effect of BF by GDM mothers on the obesity prevalence of their offspring is unclear (12).
Address for correspondence: Dr JN Davis, 200 W 24th Street, Gearing Hall, Room 313A, Austin, TX 78712, USA. E-mail: [email protected] © 2014 The Authors Pediatric Obesity © 2014 World Obesity. Pediatric Obesity 10, 165–171
ORIGINALRESEARCH
doi:10.1111/ijpo.247
ORIGINALRESEARCH
166
|
G. E. Shearrer et al.
The goal of this study was to further examine the relationship between maternal GDM status and BF practices on the prevalence of overweight and obesity in the offspring, using data from the 2011 Los Angeles County Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Survey. We hypothesized that BF would reduce overweight and obesity prevalence in a dose-dependent manner in children born to non-GDM and GDM mothers.
Methods The 2011 Los Angeles County WIC survey, a triennial survey designed to assess key health indicators and behaviours as well as home and community indicators of support for families with young children, provided the data for this study. Details on the survey methodology has been published elsewhere (13). Approval from the Independent Review Consulting Institutional Review Board was obtained for all protocols prior to the start of the study. Of the 127 survey questions, this analysis focused on those related to early life feeding practices and GDM status. Mothers were asked, ‘During your pregnancy with (name of child), did you have gestational diabetes?’ to assess their diabetes status, they could answer, ‘yes’, ‘no’, ‘had diabetes before pregnancy’, ‘don’t know’ or refuse. To evaluate BF, mothers were asked the following questions: ‘How old was your child when you completely stopped breast-feeding (him/her)?’, ‘When were solids introduced?’, ‘Did you breastfeed in the hospital?’, ‘Are you currently breastfeeding?’, ‘When was the first time formula was given?’, ‘How old was your child the first time (he/she) was given anything besides breast milk? This includes formula, baby food, juice, cow’s milk, sugar water, or anything else you fed your baby?’. The mothers could respond with, ‘yes’, ‘no’, the number of months (if appropriate), ‘I don’t know’ or refuse to answer. For the question regarding the first time the child was given something besides breast milk, mothers could answer: ‘less than 1 week’, ‘one week but less than one month’, ‘one month but less than three months’, ‘three months but less than six months’, ‘at least six months’, ‘more than six months’, ‘don’t know’ or refuse. The survey also included questions on demographics of the mother and child including: ethnic and racial backgrounds, birth weights and gestational age. Children were coded as overweight if their BMI-for-age
Association of gestational diabetes and breastfeeding on obesity prevalence in predominately Hispanic low-income youth G. E. Shearrer1, S. E. Whaley2, S. J. Miller1, B. T. House1, T. Held3 and J. N. Davis1 1
Department of Nutritional Sciences, The University of Texas, Austin, TX, USA; 2Department of Research and Evaluation, Public Health Foundation Enterprises Special Supplemental Nutrition Program for Women, Infants, and Children Program, Irwindale, CA, USA; 3Department of Gynecology and Obstetrics, University of Texas Southwestern, Dallas, TX, USA Received 29 October 2013; revised 22 April 2014; accepted 5 May 2014
Summary Objective: The goal of this study was to examine if breastfeeding duration by gestational diabetes mellitus status impacted the prevalence of obesity in offspring. Methods: Data were obtained from a 2011 phone survey with caregivers of low-income children (2–4 years) participating in the Women, Infants and Children programme in Los Angeles County. The final sample included 2295 children, 84% Hispanic and 48% female. Chi-square and binary logistic regression were used to assess gestational diabetes status and breastfeeding duration on the prevalence of obesity, with the following a priori covariates: child’s ethnicity, birth weight, age in months and sex. Results: Breastfeeding and gestational diabetes were significantly associated with obesity prevalence (P < 0.01). Using gestational diabetes mellitus and no breastfeeding as the referent category, gestational diabetes mellitus offspring who were breastfed ≥12 months had a 72% decrease in obesity prevalence (adjusted odds ratio = 0.28, confidence interval 0.89–0.03, P = 0.05).
Conclusions: These findings suggest that > 12 months of breastfeeding duration in the gestational diabetes mellitus group and any duration of breastfeeding in the non-gestational diabetes mellitus mothers is needed to reduce obesity levels in a primarily Hispanic population. Keywords: Breastfeeding, gestational diabetes mellitus, obesity.
Introduction In June 2013, the American Medical Society defined obesity (body mass index [BMI] ≥ 95th percentile for age) as a disease state (1), which affects 16.1% of Hispanic children ages 2 to 5 (2). While many factors contribute to the growing obesity prevalence in the United States, the research focus is shifting to in utero and early life events (3). One such event is maternal gestational diabetes mellitus (GDM), which has been shown to increase the risk of obesity in children ages 6 months to 8 years of age (4). In the United States, GDM, defined as carbohydrate intolerance with onset or recognition of pregnancy, is estimated to affect 3–7% of pregnancies (5). Children born to mothers with GDM are twice as likely to develop metabolic syndrome, including obesity, than those born to non-GDM mothers (6). Furthermore, risk of GDM has been shown to vary among racial/ ethnic groups, with increased risk among Hispanic
women (7). Obese Hispanic mothers are four times more likely to develop GDM than their non-Hispanic Caucasian counterparts (7), which in turn contributes to an increased overweight and obesity occurrence in Hispanic offspring compared with their Caucasian peers (8). Given that the birth rate for Hispanics in 2011 was 17.6% compared with 10.8% for Caucasians, interventions targeting overweight and obesity in the Hispanic population are particularly meaningful (9). Breastfeeding (BF) is recognized as a highly modifiable element to eliminate the ethnic/racial disparity in childhood obesity rates (8). The World Health Organization recommends exclusive BF for the first 6 months of a child’s life (10). Despite this recommendation, Hispanic mothers are less likely to exclusively breastfeed for the first 6 months compared with Caucasian mothers (11). The effect of BF by GDM mothers on the obesity prevalence of their offspring is unclear (12).
Address for correspondence: Dr JN Davis, 200 W 24th Street, Gearing Hall, Room 313A, Austin, TX 78712, USA. E-mail: [email protected] © 2014 The Authors Pediatric Obesity © 2014 World Obesity. Pediatric Obesity 10, 165–171
ORIGINALRESEARCH
doi:10.1111/ijpo.247
ORIGINALRESEARCH
166
|
G. E. Shearrer et al.
The goal of this study was to further examine the relationship between maternal GDM status and BF practices on the prevalence of overweight and obesity in the offspring, using data from the 2011 Los Angeles County Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Survey. We hypothesized that BF would reduce overweight and obesity prevalence in a dose-dependent manner in children born to non-GDM and GDM mothers.
Methods The 2011 Los Angeles County WIC survey, a triennial survey designed to assess key health indicators and behaviours as well as home and community indicators of support for families with young children, provided the data for this study. Details on the survey methodology has been published elsewhere (13). Approval from the Independent Review Consulting Institutional Review Board was obtained for all protocols prior to the start of the study. Of the 127 survey questions, this analysis focused on those related to early life feeding practices and GDM status. Mothers were asked, ‘During your pregnancy with (name of child), did you have gestational diabetes?’ to assess their diabetes status, they could answer, ‘yes’, ‘no’, ‘had diabetes before pregnancy’, ‘don’t know’ or refuse. To evaluate BF, mothers were asked the following questions: ‘How old was your child when you completely stopped breast-feeding (him/her)?’, ‘When were solids introduced?’, ‘Did you breastfeed in the hospital?’, ‘Are you currently breastfeeding?’, ‘When was the first time formula was given?’, ‘How old was your child the first time (he/she) was given anything besides breast milk? This includes formula, baby food, juice, cow’s milk, sugar water, or anything else you fed your baby?’. The mothers could respond with, ‘yes’, ‘no’, the number of months (if appropriate), ‘I don’t know’ or refuse to answer. For the question regarding the first time the child was given something besides breast milk, mothers could answer: ‘less than 1 week’, ‘one week but less than one month’, ‘one month but less than three months’, ‘three months but less than six months’, ‘at least six months’, ‘more than six months’, ‘don’t know’ or refuse. The survey also included questions on demographics of the mother and child including: ethnic and racial backgrounds, birth weights and gestational age. Children were coded as overweight if their BMI-for-age
