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

Abstract

Background: Children exposed to gestational diabetes mellitus (GDM) or maternal obesity <i>in utero</i> 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. <p>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. <i>A priori</i> 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.</p> <p><a></a>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.</p> <p>Conclusions: Exposure to GDM <i>in utero</i>, 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. </p>