, Volume 62, Issue 2, pp 249–258 | Cite as

Association between maternal diabetes, being large for gestational age and breast-feeding on being overweight or obese in childhood

  • Padma KaulEmail author
  • Samantha L. Bowker
  • Anamaria Savu
  • Roseanne O. Yeung
  • Lois E. Donovan
  • Edmond A. Ryan



This study aimed to examine the association of maternal diabetes, being large for gestational age (LGA) and breast-feeding with being overweight or obese in pre-school-aged children.


Data on height and weight at the time of their pre-school (age 4–6 years) immunisation visit between January 2009 and August 2017, as well as breast-feeding status in the first 5 months of life, for 81,226 children born between January 2005 and August 2013 were linked with maternal hospitalisation and outpatient records and birth registry data. Children were grouped into six categories based on maternal diabetes status during pregnancy (no diabetes, gestational diabetes or pre-existing diabetes) and birthweight (appropriate for gestational age [AGA] or LGA). WHO criteria were used to identify children who were overweight or obese.


There were 69,506 children in the no diabetes/AGA group (control), 5926 in the no diabetes/LGA group, 4563 in the gestational diabetes/AGA group, 573 in the gestational diabetes/LGA group, 480 in the pre-existing diabetes/AGA group and 178 in the pre-existing diabetes/LGA group. The rate of being overweight/obese at pre-school age ranged from 20.5% in the control group to 42.9% in the gestational diabetes/LGA group. The adjusted attributable risk per cent for LGA alone (39.4%) was significantly higher than that for maternal gestational diabetes (16.0%) or pre-existing diabetes alone (15.1%); the risk for the combinations of gestational diabetes/LGA and pre-existing diabetes/LGA were 50.1% and 39.1%, respectively. Further stratification of the pre-existing diabetes groups found the prevalence of being overweight/obese was 21.2% in the type 1/AGA group, 31.4% in the type 1/LGA group (similar to those in the no diabetes groups), 26.7% in the type 2/AGA group and 42.5% in the type 2/LGA group. Breast-feeding was associated with a lower likelihood of being overweight/obese in childhood in all groups except gestational diabetes/LGA and pre-existing diabetes/LGA (both type 1 and type 2).


LGA is a stronger marker for risk of being overweight/obese in early childhood, compared with maternal diabetes during pregnancy. Rates of being overweight/obese in childhood were highest in LGA children born to mothers with gestational diabetes or pre-existing type 2 diabetes. Breast-feeding was associated with a lower risk of being overweight/obese in childhood in the majority of children; however, this association was not maintained in LGA children of mothers with diabetes.


Childhood obesity Gestational diabetes mellitus Large for gestational age Pre-existing diabetes 



Appropriate for gestational age


Alberta Health Care Insurance Population registry


Adjusted OR


Caesarean section


International Classification of Diseases


Large for gestational age


Socioeconomic status


Small for gestational age



This study is based on data provided by Alberta Health. We thank Kenneth Morrison at Alberta Health for assistance in creating the linked database. The interpretation and conclusions contained herein are those of the researchers and do not necessarily represent the views of the Government of Alberta. The immunisation data were made available by R. Andersen and J. Coldham from the Calgary Zone Public Health System, Alberta Health Services, AB, Canada. The authors acknowledge L. Luoma for her critical review and editing of the manuscript.

Contribution statement

PK, SLB, LED, ROY and EAR conceived the study. PK, LED, and EAR obtained funding. PK and SLB drafted the manuscript. AS conducted all analyses. All authors edited subsequent versions of the manuscript and approved the final manuscript for submission. PK is the guarantor of this manuscript.


This study was funded by the Canadian Institutes of Health Research (CIHR) through a peer-reviewed operating grant (number RN125845–251412). The funding agencies did not have input into study design, data collection, interpretation of results, manuscript preparation or approval for submission.

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Supplementary material

125_2018_4758_MOESM1_ESM.pdf (326 kb)
ESM (PDF 326 kb)


  1. 1.
    Baird J, Fisher D, Lucas P et al (2005) Being big or growing fast: systematic review of size and growth in infancy and later obesity. BMJ 331(7522):929. CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Kc K, Shakya S, Zhang H (2015) Gestational diabetes mellitus and macrosomia: a literature review. Ann Nutr Metab 66(Suppl 2):14–20. CrossRefPubMedGoogle Scholar
  3. 3.
    He X-J, Qin F-Y, Hu C-L et al (2015) Is gestational diabetes mellitus an independent risk factor for macrosomia: a meta-analysis? Arch Gynecol Obstet 291(4):729–735. CrossRefPubMedGoogle Scholar
  4. 4.
    Mitanchez D, Burguet A, Simeoni U (2014) Infants born to mothers with gestational diabetes mellitus: mild neonatal effects, a long-term threat to global health. J Pediatr 164(3):445–450. CrossRefPubMedGoogle Scholar
  5. 5.
    Tyrrell J, Richmond RC, Palmer TM et al (2016) Genetic evidence for causal relationships between maternal obesity-related traits and birth weight. JAMA 315(11):1129–1140. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Hillier TA, Pedula KL, Vesco KK et al (2016) Impact of maternal glucose and gestational weight gain on child obesity over the first decade of life in normal birth weight infants. Matern Child Health J 20(8):1559–1568. CrossRefPubMedGoogle Scholar
  7. 7.
    Boney CM, Verma A, Tucker R, Vohr BR (2005) Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics 115(3):e290–e296. CrossRefPubMedGoogle Scholar
  8. 8.
    Owen CG, Martin RM, Whincup PH et al (2005) Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence. Pediatrics 115(5):1367–1377. CrossRefPubMedGoogle Scholar
  9. 9.
    Arenz S, Rückerl R, Koletzko B, Kries von R (2004) Breast-feeding and childhood obesity--a systematic review. Int J Obes Relat Metab Disord 28(10):1247–1256. CrossRefPubMedGoogle Scholar
  10. 10.
    Yan J, Liu L, Zhu Y et al (2014) The association between breastfeeding and childhood obesity: a meta-analysis. BMC Public Health 14(1):1267. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Dugas C, Perron J, Kearney M et al (2017) Postnatal prevention of childhood obesity in offspring prenatally exposed to gestational diabetes mellitus: where are we now? Obes Facts 10(4):396–406. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Gunderson EP (2008) Breast-feeding and diabetes: long-term impact on mothers and their infants. Curr Diab Rep 8(4):279–286. CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Mayer-Davis EJ, Rifas-Shiman SL, Zhou L et al (2006) Breast-feeding and risk for childhood obesity: does maternal diabetes or obesity status matter? Diabetes Care 29(10):2231–2237. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Alberta Health Services Calgary Zone. Available from Accessed 5 Feb 2018
  15. 15.
    Kaul P, Savu A, Nerenberg KA et al (2015) Impact of gestational diabetes mellitus and high maternal weight on the development of diabetes, hypertension and cardiovascular disease: a population-level analysis. Diabet Med 32(2):164–173. CrossRefPubMedGoogle Scholar
  16. 16.
    Bowker SL, Savu A, Yeung RO et al (2017) Patterns of glucose-lowering therapies and neonatal outcomes in the treatment of gestational diabetes in Canada, 2009-2014. Diabet Med 34(9):1296–1302. CrossRefPubMedGoogle Scholar
  17. 17.
    Beka Q, Bowker S, Savu A et al (2017) Development of perinatal mental illness in women with gestational diabetes mellitus: a population-based cohort study. Can J Diabetes.
  18. 18.
    Alberta Health. Interactive health data application. Available from Accessed 5 Feb 2018
  19. 19.
    Allen VM, Dodds L, Spencer A et al (2012) Application of a national administrative case definition for the identification of pre-existing diabetes mellitus in pregnancy. Chronic Dis Inj Can 32(3):113–120PubMedGoogle Scholar
  20. 20.
    Bowker SL, Savu A, Donovan LE et al (2017) Validation of administrative and clinical case definitions for gestational diabetes mellitus against laboratory results. Diabet Med 34(6):781–785. CrossRefPubMedGoogle Scholar
  21. 21.
    Bowker SL, Savu A, Lam NK et al (2015) Validation of administrative data case definitions for gestational diabetes mellitus. Diabet Med 34(1):51–55.
  22. 22.
    Shah BR, Chiu M, Amin S et al (2010) Surname lists to identify south Asian and Chinese ethnicity from secondary data in Ontario, Canada: a validation study. BMC Med Res Methodol 10(1):42. CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Quan H, Wang F, Schopflocher D et al (2006) Development and validation of a surname list to define Chinese ethnicity. Med Care 44(4):328–333. CrossRefPubMedGoogle Scholar
  24. 24.
    Kramer MS, Platt RW, Wen SW et al (2001) A new and improved population-based Canadian reference for birth weight for gestational age. Pediatrics 108(2):e35–e35. CrossRefPubMedGoogle Scholar
  25. 25.
    WHO Media Centre: Obesity and overweight. Available from Accessed 8 Jan 2018
  26. 26.
    WHO Growth reference 5–19 years: BMI-for-age (5–19 years). Available from Accessed 6 Dec 2017
  27. 27.
    WHO Child growth standards: BMI-for-age (2–5 years). Available from Accessed 6 Dec 2017
  28. 28.
    Hernan MA, Hernandez-Diaz S, Robins JM (2004) A structural approach to selection bias. Epidemiology 15(5):615–625. CrossRefPubMedGoogle Scholar
  29. 29.
    Yu Z, Han S, Zhu J et al (2013) Pre-pregnancy body mass index in relation to infant birth weight and offspring overweight/obesity: a systematic review and meta-analysis. PLoS One 8(4):e61627. CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Owens LA, Sedar J, Carmody L, Dunne F (2015) Comparing type 1 and type 2 diabetes in pregnancy- similar conditions or is a separate approach required? BMC Pregnancy Childbirth 15(1):69. CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Hillman N, Herranz L, Vaquero PM et al (2006) Is pregnancy outcome worse in type 2 than in type 1 diabetic women? Diabetes Care 29(11):2557–2558. CrossRefPubMedGoogle Scholar
  32. 32.
    Ray JG, Vermeulen MJ, Shapiro JL, Kenshole AB (2001) Maternal and neonatal outcomes in pregestational and gestational diabetes mellitus, and the influence of maternal obesity and weight gain: the DEPOSIT study. Diabetes Endocrine Pregnancy Outcome Study in Toronto. QJM 94(7):347–356. CrossRefPubMedGoogle Scholar
  33. 33.
    Bider-Canfield Z, Martinez MP, Wang X et al (2017) Maternal obesity, gestational diabetes, breastfeeding and childhood overweight at age 2 years. Pediatr Obes 12(2):171–178. CrossRefPubMedGoogle Scholar
  34. 34.
    Kim SY, Sharma AJ, Callaghan WM (2012) Gestational diabetes and childhood obesity: what is the link? Curr Opin Obstet Gynecol 24(6):376–381. CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Donovan LE, Cundy T (2015) Does exposure to hyperglycaemia in utero increase the risk of obesity and diabetes in the offspring? A critical reappraisal. Diabet Med 32(3):295–304. CrossRefPubMedGoogle Scholar
  36. 36.
    Murphy HR, Steel SA, Roland JM et al (2011) Obstetric and perinatal outcomes in pregnancies complicated by Type 1 and Type 2 diabetes: influences of glycaemic control, obesity and social disadvantage. Diabet Med 28(9):1060–1067. CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Rodekamp E, Harder T, Kohlhoff R et al (2005) Long-term impact of breast-feeding on body weight and glucose tolerance in children of diabetic mothers: role of the late neonatal period and early infancy. Diabetes Care 28(6):1457–1462. CrossRefPubMedGoogle Scholar
  38. 38.
    Plagemann A, Harder T, Franke K, Kohlhoff R (2002) Long-term impact of neonatal breast-feeding on body weight and glucose tolerance in children of diabetic mothers. Diabetes Care 25(1):16–22. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Padma Kaul
    • 1
    • 2
    Email author
  • Samantha L. Bowker
    • 1
  • Anamaria Savu
    • 1
  • Roseanne O. Yeung
    • 2
  • Lois E. Donovan
    • 3
  • Edmond A. Ryan
    • 2
  1. 1.Canadian VIGOUR CentreUniversity of AlbertaEdmontonCanada
  2. 2.Department of MedicineUniversity of AlbertaEdmontonCanada
  3. 3.Department of MedicineUniversity of CalgaryCalgaryCanada

Personalised recommendations