Kaiser Permanente prospective study finds that easier-to-soothe babies were more likely to be obese by age 5, and more likely to have started drinking sugared beverages during the first 6 months of life.
Among children whose mothers had gestational diabetes, those who were easier to soothe as infants were more than twice as likely to subsequently be obese as toddlers.
“Assessing temperament during infancy may be a novel strategy for the early assessment of obesity risk and for developing personalized interventions,” said Myles S. Faith, PhD, professor with the University at Buffalo Graduate School of Education and lead author of a new study published in JAMA Pediatrics today. “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.
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, “Association of Infant Temperament With Subsequent Obesity in Young Children of Mothers With Gestational Diabetes Mellitus,” was funded by the National Institute of Diabetes, Digestive and Kidney Diseases, and the American Diabetes Association.