“Assessing
temperament during infancy may be a novel strategy for the early
assessment of obesity risk and for developing personalized
interventions,” said lead author Myles S. Faith, PhD,
professor with the University at Buffalo Graduate School of Education.
“This may help equip parents with tools for healthy feeding behaviors
and soothing strategies in the face of infant distress.”
Gestational
diabetes is characterized by elevated blood sugar during pregnancy,
which can adversely affect the child’s health. According to the Centers
for Disease Control and Prevention, it develops in up to 10 percent of
all pregnancies in the United States.
“We’re not aware of any
prior research examining the role of infant temperament in influencing
the subsequent risk of obesity among children whose mothers had
pregnancies complicated by gestational diabetes,” said senior author and
study principal investigator, Erica P. Gunderson, PhD, MPH, RD, of the Kaiser Permanente Northern California Division of Research.
Study senior author Erica P. Gunderson, PhD, MS, MPH
Mother and baby pairs
The
Study of Women, Infant Feeding and Type 2 Diabetes After Gestational
Diabetes and Growth of their Offspring (SWIFT Offspring Study) enrolled
382 racially and ethnically diverse pairs of mothers with gestational
diabetes and their infants between 2009 and 2011; all were members of
the Kaiser Permanente Northern California health system.
Researchers
followed the infants from birth through ages 2 to 5 years. They
conducted multiple examinations during the first year, and later
evaluated infant weight and height at ages 2 to 5 years, with more than
80 percent of children measured at age 5 years. The mothers answered a
validated questionnaire about their babies’ temperaments at ages 6 to 9
weeks and/or age 6 months.
Infants scored in the top quarter were
defined as having high soothability — meaning that they were easier to
soothe than infants in the lower three-quarters of scores. Mothers also
reported how often they fed their infants sugar-sweetened beverages,
fruit juice, and other foods, as well as breastmilk and infant formula,
throughout the first year of life. The study accounted for breastfeeding
intensity and duration, infant feeding practices, prenatal course and
outcomes, race/ethnicity, newborn size at birth, and maternal
pre-pregnancy body mass index (BMI) and the severity of prenatal glucose
intolerance.
BMI was calculated based on weight and height
measurements obtained at 2 to 5 years of age. Children who had BMIs at
or above the 85th percentile to less than the 95th percentile were classified as overweight, and those at or above the 95th percentile as obese.
Soothability linked to obesity
The study found that infants with:
*
High soothability were 2.2 to 2.5 times more likely to be a child who
was obese at age 2 to 5 years compared to infants with lower
soothability.
* The highest level of soothability were 10 percent
more likely to have started drinking sugary beverages before 6 months of
age, or to have initiated foods other than breast milk before 4 months
old.
* High activity were 10 percent more likely to have initiated
sugar-sweetened beverages before 6 months old compared to infants with
lower activity.
Role of sugared beverages
The American Academy of Pediatrics does not recommend introducing fruit juices to children until at least age one.
“These
results emphasize the importance of not having babies drink anything
except breast milk or formula, with occasional water, but no
sugar-containing drinks,” said co-author Louise Greenspan,
MD, pediatric endocrinologist with Kaiser Permanente in San Francisco.
“Even if those pure fruit juice or sugary drinks help soothe babies, it
is best to find other ways to soothe them.”
Faith added that the
research points toward the need for public health professionals to
initiate discussions with parents about soothing strategies, especially
those with infants born to mothers with gestational diabetes. “More
research is needed to understand why and how high soothability
temperament contributes to childhood obesity.”
In addition to
Faith, Gunderson, and Greenspan, co-authors of the study were James B.
Hittner, PhD, College of Charleston; and Shanta R. Hurston, MPA, Jie
Yin, MPH, and Charles P. Quesenberry, Jr., PhD, of Kaiser Permanente Northern California.
This
study was funded by the National Institute of Diabetes, Digestive and
Kidney Diseases, and the American Diabetes Association.
