Infant body composition trajectories differ by in utero exposure to gestational diabetes mellitus: a prospective cohort from birth to 12 months

Background: Infants exposed to gestational diabetes mellitus (GDM) in utero are known to have higher fat mass (FM) and less fat-free mass (FFM) at birth, but little is known about how their adiposity changes over the fi rst year of life. Objectives: We identified growth and body composition patterns across the fi rst year and evaluated for differences by GDM exposure status. Methods: Among 198 infants (52% GDM exposed), growth and body composition with total body electrical conductivity were obtained from birth to 1 y. Latent class mixed modeling (LCMM) trajectories were fi t for weight-, length-, and body mass index (BMI)-for-age World Health Organization z-scores, as well as percent body fat, FM, and FFM. Adjusted associations between GDM with trajectory classes were evaluated with multiple logistic regression. Results: At birth, infants exposed to GDM had higher FM, higher percent body fat, and a higher BMI compared with infants unexposed. A larger proportion of infants exposed to GDM were classified into LCMM growth trajectory classes that experienced less FM (67% GDM exposed) and percent body fat gain (79% GDM exposed), compared with the other classes (& KHcy;2 P values < 0.05). In adjusted models, infants exposed to GDM were 69% less likely (Relative Risk Ratios (RRR) 1 / 4 0.39, 95% confidence interval: 0.11, 0.82) to belong in the highest FM trajectory that reached 4 kg of FM at 1 y of age. In adjusted models, GDM exposure was not associated with FFM, weight-, length-, or BMI-for-age trajectories. Conclusions: In a cohort of infants exposed and unexposed to GDM in utero, infants exposed had increased weight, FM, and percent body fat at birth. However, more infants exposed to GDM had less fat accrual over the fi rst year of life, compared with those unexposed. The long-term effects of these growth patterns in the fi rst year challenge current concepts and support further investigation of neonatal body composition.