Mom’s diabetes and kids’ obesity
Posted by Lance Gravlee on September 5th, 2007 |
Yesterday in class I mentioned a study that has been in the news this week about the links between mother’s diabetes during pregnancy and their children’s risk of obesity five to six years later. This study is the latest in a growing body of research that shows how health is influenced by early-life experiences, including exposures in utero and even in previous generations.
This work draws on life course epidemiology and on research in developmental plasticity and health. It’s a thoroughly interdisciplinary field and has a new professional society to show for it. This area of research is fertile ground for biocultural approaches to medical anthropology, because it helps us to understand how sociocultural factors impact human biology over the life course and even across generations.
Of course, news coverage of this week’s study focuses narrowly on the links between gestational diabetes and children’s subsequent weight. It doesn’t address the sociocultural factors that put women at risk of developing gestational diabetes in the first place. Where would you begin to look for answers to that question?
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When pregnant women develop gestational diabetes, the child is born macrosomia (high birth weight). This may be a factor in why the child is still overweight in the following years. Developing children still need the proper amount of calories for growth and development. If the child starts out at a high weight, it may be a while until the weight comes off. Many children keep their “baby fat” for years. The study should look at the pre-existing conditions such as the mother’s weight before the pregnancy, since over or underweight can be a risk factor. Another thing that the study should look at is the mother’s and father’s weights since children are usually in the same weight category as the rest of the family. The study should also look at the children’s weight around puberty, when the “baby fat” is usually shed.
There are several points of clarification about the limitations of these findings. The first to consider is that this is a retrospective analysis of mothers who were “untreated” for gestational diabetes in pregnancy. While there is definitely a strong correlational association here between diabetes in pregnancy and obesity in 5 to 7 year olds, the relationship is simply that – association, not causation!
All mothers in the US who receive prenatal care are screened for gestational diabetes in pregnancy, and those who “fail” the screening test are given a diagnostic 3 hour test. If the reults of the 3 hour test are elevated, the mother is extensively counseled on her diet by a nutritionist and also treated with an antidiabetic agent or insulin as needed. How well the mother adheres to her diet and keeps her blood sugar under control influences her weight gain as well as the baby’s. As Meghan mentioned, macrosomia, or birth weight over 4,000 gms (8 Lbs. 13 oz.) may occur with persistent high blood sugar or wildly fluctuating levels.
The sociocultural challenge in prenatal care comes in when the mother has irregular or infrequent visits, misses the screening test,or doesn’t understand or appreciate the need for the test. There may be language and/or cultural barriers that prevent her from having a thorough understanding of the rationale for the test or treatment. Moreover, food choices may be culturally determined, and/or restricted by poverty or lack of availability. A woman may already be morbidly obese when she becomes pregnant, and this is thought to increase the risk of gestational diabetes in pregnancy.
Another limitation of this study is that family dietary habits, which are heavily influenced by culture and socioeconomic status, are difficult to change. Mothers who ate poorly in pregnancy are also more likely to feed their children the way they ate themselves. The poor rate of breastfeeding in the US is likely to be a confounding variable as well. A longitudinal study that takes into account some of these critical variables would be a better research design to address causality in this case.
Based on Meghan’s statement I agree with the idea of focusing on pre and post pregnancy stages linked to developing gestational diabetes. However, I’ve noticed that the study was centralized amongst women in the northern region of the United States. Before making a generalized statement about gestational diabetes and the prevalence of obesity in children several years later, we must first ask ourselves why only focus on women in the northern region? In addition to focusing on the pre and post stages of the pregnancy stages the study should focus on similarities/dissimilarities amongst women in various regions. In other words we should know how the environment of a specific area contributes to women developing gestational diabetes/obesity in their children. For instance, during the winter pregnant women in Utah may be less active then women in Florida because of the differences in temperature (assumed). The level of activity is different for various women.
Another factor that the study should focus on is on the cultural differences within these regions. We must understand the basis of why one specific ethnic group is more susceptible to gestational diabetes/having obese children verses the other. Lastly, the study should focus on the amount of children these women have and how this contributes to the way one group is more likely to have gestational diabetes/obese children. In doing so the study would be more focused not only on an individual region/ethnic group, but the study would focus on the broader context.
Like Kim and Joanne mentioned above, all expecting mothers in the U.S. who receive prenatal care are screened for gestational diabetes. And if for some reason the expecting mother fails the screening, they are given additional tests. And if they manage to fail these tests as well, the mothers are put through a rigorous nutrition education where they are taught the proper eating habits to keep their diabetes in check. Furthermore they are also given anti-diabetic drugs.
The news week’s article focuses narrowly on the links between gestational diabetes and children’s subsequent weight. It doesn’t address the sociocultural factors that put women at risk of developing gestational diabetes in the first place. Some of the sociocultural challenges are when the expecting mothers don’t understand the dangers of gestational diabetes and therefore tend to ignore the instruction given by the doctors and keep on continuing on the path they were previously on. While parents who do understand the danger of gestational diabetes can’t afford to get the proper treatment due to economic backgrounds. Also language barriers further add on the problem and put these expecting mothers at a greater risk for developing gestational diabetes. Further more family dietary habits also affect the risk. These are only few of the many sociocultural challenges that face women who are pregnant. And there is post natal care that also needs to be taken into account. One can’t just say gestational diabetes is what causes obesity in the kids, factors such as the above mentioned should also be taken into account.
I agree with all of the statements above. I definitely do not agree that gestational diabetes is the main cause of obesity in children. I grew up in Germany and when I went back to visit this summer, I noticed an increase of obese people around the city. I associated it with the increase of fast food restaurants that have been built compared to when I still lived there in 1995. Unfortunately, fast food is so much cheaper so for a person with a low socioeconomic status, it is more affordable to them. I would relate the same to pregnant women with gestational diabetes. Women that cannot afford the proper treatment or the expensive diet required for diabetes, would most likely have overweight children. It also makes sense to consider the mother’s diet before, during and after her pregnancy because the child will most likely have the same food habits as his/her mother.
I agree about the fast food restaurants. In the past few years, I have made it a point to counsel women in their initial prenatal visit to avoid fast food restaurants and to become label-readers for the foods they buy, with particular attention to fat, sugar, and sodium content. Many women have told me that they learned a lot about what they were actually eating and began to think about it more after this type of discussion. Sophie has a good point about low SES and the tendency to go for the fast foods. From what I have observed clinically, traditional diets, even if they are not ideal, are far better than the fast food track. A nutritionist I know in Jamaica told me that vitamin deficiencies were literally unheard of there prior to the last few years when processed and fast foods began to become readily available.
Whenever I am reading this kind of statements “fast food is cheaper”, I try to think how much it will cost to cook a healthy meal at home, and I wander if we should not be saying that fast food is cheaper than other kind of food outside home.
I grew up in Mexico and my culture tells me that I should cook everyday and leave restaurants for special situations. I do not think I spend more money cooking for 5 than if we were all eating out every day.
Are we giving to the public the right message? Should we promote “home cook meals” instead “avoid fast food”?
Unfortunately, articles in newspapers that address achievements in research tend to bypass the particularities and details, and focus on concepts, editorially tweaked or not, that they know will focus a reader’s attention.
Kim’s first comment brought to light many possible avenues for continued research in this area. The concept of an all-encompassing longitudinal study really would be a preferred, albeit ambitious, course of action. Further, I find that everything (and more), that I felt should have been addressed (socioculturally speaking), has already been brought up in the preceding comments.
In the end, it all comes down to the same things that were addressed in an earlier blog about racial inequalities in advertising. It does seem, to me, that childhood obesity is most likely a product of the lifestyle of the parents. How does one overcome such barriers, except through social change and nutrition education?
Reminds me of something I read earlier in the Summer:
http://www.nih.gov/news/pr/jul2007/nia-25.htm
Not entirely related, but both deal with the spread of obesity.
There are so many cultural factors that go into obesity. Kids are going to eat whatever their parents are buying them. Kids learn eating behaviors from their parents. If mom and dad snack 24-7 on chips, cookies, soda,and whatever else then kids are too. Also just having a “high” birth weight and your mother having gestational diabetes doesn’t mean your kid will be obese. My aunt had gestational diabetes when pregnant with her twins. She ate only healthy foods like yogurt, cheese, fresh fruits and veggies for snacks. Her twins were 7lbs 2oz and 6lbs 9oz, which are “huge” for twins. The twins just turned 2 and are now where close to being obese. So did the study look into what the mother’s diet was before and after the pregnancy?