American Diabetes Association
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Associations Between Exposure to Gestational Diabetes Mellitus In Utero and Daily Energy Intake, Brain Responses to Food Cues, and Adiposity in Children

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posted on 2021-04-07, 15:54 authored by Shan Luo, Brendan C. Angelo, Ting Chow, John R. Monterosso, Paul M. Thompson, Anny H. Xiang, Kathleen A. Page
Background: Children exposed to gestational diabetes mellitus (GDM) or maternal obesity in utero have an increased propensity to develop obesity. Little is known about the mechanisms underlying this phenomenon. We aimed to examine relationships between exposure to GDM or maternal obesity and daily energy intake, brain responses to food cues within reward regions and adiposity in children.

Design: Participants were 159 children ages between 7-11. Repeated 24-hour recalls were conducted to assess mean daily energy intake (EI). A subset of children (N=102) completed a food cue task in the MRI scanner. A priori regions-of-interest included the orbital frontal cortex (OFC), insula, amygdala, ventral striatum and dorsal striatum. Adiposity measurements, BMI z-scores, percent body fat, waist to height ratio (WtHR) and waist to hip ratio (WHR) were assessed.

Results: Exposure to GDM was associated with greater daily EI, and children exposed to GDM diagnosed before 26 weeks gestation had greater OFC food cue reactivity. Children exposed to GDM also had larger WHR. Results remained significant after adjusting for child’s age, sex, maternal education and race/ethnicity, maternal pre-pregnancy BMI and child’s physical activity levels. Furthermore, children who consumed more daily calories had greater WHR, and the relationship between GDM exposure and WHR was attenuated after adjustment of daily EI. Pre-pregnancy BMI was not significantly related to daily EI nor food cue reactivity in reward regions. However, pre-pregnancy BMI was significantly related to all adiposity measurements; results remained significant for BMI z-scores, WtHR and WHR after controlling for child’s age, sex, maternal education and race/ethnicity, maternal GDM exposure and child’s physical activity levels.

Conclusions: Exposure to GDM in utero, in particular before 26 weeks gestation, is associated with increased EI, enhanced OFC food cue reactivity and increased WHR. Future study with longitudinal follow-up is merited to assess potential pathways of daily energy intake and food cue reactivity in reward regions on the associations between GDM exposure and childhood adiposity.


This work was supported by an American Diabetes Association Pathway Accelerator Award (#1-14-ACE-36) (PI: K.A.P) and in part by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH) R03DK103083 (PI: K.A.P), R01DK116858 (PIs: K.A.P, A.H.X), and K01DK115638 (PI: SL). A Research Electronic Data Capture, REDCap, database was used for this study, which is supported by the Southern California Clinical and Translational Science Institute (SC CTSI) through NIH UL1TR001855. P.M.T. is funded in part by NIH grant U54 EB020403.