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In utero exposure to gestational diabetes and adiposity: does breastfeeding make a difference?

International Journal of Obesityvolume 42pages13171325 (2018) | Download Citation



Short-term breastfeeding from mothers with gestational diabetes (GDM) may programme metabolism and increase offspring diabetes risk. We examined the association of in utero GDM exposure with adiposity from infancy to adolescence, and whether any association was modified by breastfeeding during early infancy.


In the prospective Chinese birth cohort “Children of 1997” (n = 7342, 88% follow-up rate), generalised estimate equations with multiple imputation were used to assess associations of in utero GDM exposure with age- and sex-specific body mass index (BMI) z-score during infancy (3 and 9 months), childhood (2– < 8 years) and adolescence (8–16 years), adjusted for sex, parity, maternal age, birth place, preeclampisa, smoking, and family socio-economic position. We also tested whether the associations differed by mode of infant feeding (always formula-fed, mixed, always breastfed) during the first three months of life.


In utero GDM exposure (7.5%) was associated with a lower BMI z-score during infancy (−0.13, 95% confidence interval (CI) −0.22, −0.05) but higher BMI z-scores during childhood (0.14, 95% CI 0.03, 0.25) and adolescence (0.25 95% CI 0.11, 0.38). Breastfeeding for the first three months did not modify the association of in utero GDM status with subsequent BMI (all p values for interaction >0.4).


In utero GDM exposure was associated with greater adiposity during childhood and adolescence. Breastfeeding in early infancy from mothers with GDM was not associated with greater adiposity in children and thus should still be encouraged.

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We thank colleagues at the Student Health Service and Family Health Service of the Department of Health for their assistance and collaboration. We also thank the late Dr. Connie O for coordinating the project and all the fieldwork for the initial study in 1997–1998. This work is a sub-study of the “Children of 1997” birth cohort which was initially supported by the Health Care and Promotion Fund, Health and Welfare Bureau, Government of the Hong Kong SAR [HCPF Grant # 216106] and re-established in 2005 with support from the Health and Health Services Research Fund [HHSRF Grant # 03040771], and the University Research Committee Strategic Research Theme (SRT) of Public Health, The University of Hong Kong. This sub-study builds on information added to the birth cohort by RFCID grant # 04050172 and HHSRF grant # 08090761, and was funded by the Health and Health Services Research Fund [HHSRF Grant # 12132731], Government of the Hong Kong SAR.

Author contributions

Drs Hui and Schooling developed the study conception, directed the study’s analytic strategy and wrote the manuscript. Drs Li, Nelson, Lee, and Leung contributed to the interpretation of the data and critically revised the paper. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Author information


  1. Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China

    • L. L. Hui
    • , A. M. Li
    • , E. A. S. Nelson
    •  & G. M. Leung
  2. School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China

    • L. L. Hui
    •  & C. M. Schooling
  3. Department of Paediatrics & Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China

    • S. L. Lee
  4. CUNY Graduate School of Public Health and Health Policy, New York, NY, USA

    • C. M. Schooling


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The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to C. M. Schooling.

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