Do Gestational Obesity and Gestational Diabetes Have an Independent Effect on Neonatal Adiposity? Results of Mediation Analysis from a Cohort Study in South India
Received 10 July 2019
Accepted for publication 12 December 2019
Published 27 December 2019 Volume 2019:11 Pages 1067—1080
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Professor Eyal Cohen
Giridhara R Babu,1 R Deepa,1 Melissa Glenda Lewis,2 Eunice Lobo,1 Anjaly Krishnan,1 Yamuna Ana,1 Jodie G Katon,3,4 Daniel A Enquobahrie,5 Onyebuchi A Arah,6–8 Sanjay Kinra,9 GVS Murthy2,10
1Indian Institute of Public Health-Bangalore, Public Health Foundation of India (PHFI), Bangalore, India; 2Indian Institute of Public Health-Hyderabad, Public Health Foundation of India (PHFI), Hyderabad, India; 3Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA; 4Department of Health Services, University of Washington, Seattle, WA, USA; 5Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA; 6Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA; 7California Center for Population Research, University of California, Los Angeles (UCLA), Los Angeles, CA, USA; 8UCLA Center for Health Policy Research, Los Angeles, CA, USA; 9Non-communicable Disease Epidemiology , London School of Hygiene & Tropical Medicine and, University College London Hospital, London, UK; 10International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
Correspondence: Giridhara R Babu
Indian Institute of Public Health-Bangalore, Public Health Foundation of India (PHFI), Bangalore, India, Besides Leprosy Hospital, 1st Cross, Magadi Road, Bangalore 560023, India
Purpose: Neonates born to mothers with obesity or gestational diabetes mellitus (GDM) have an increased chance of various metabolic disorders later in life. In India, it is unclear whether maternal obesity or GDM is related to offspring adiposity. We aimed to understand the independent effect of maternal obesity and GDM with neonatal adiposity and whether GDM has a mediating effect between maternal obesity and neonatal adiposity.
Methods: We recruited a cohort of 1120 women (between April 2016 and February 2019) from the public hospitals in Bangalore, India, who voluntarily agreed to participate and provided written informed consent. The primary outcome was neonatal adiposity, defined as the sum of skinfold thickness >85th percentile. Exposure included maternal obesity, defined as >90th percentile of skinfold thickness. GDM, the potential mediator, was classified using the World Health Organization criteria by oral glucose tolerance test. Binary logistic regression was applied to test the effect of maternal obesity and GDM on neonatal adiposity, adjusting for potential confounders. We used Paramed command in STATA version 14 for analyzing mediating effects.
Results: We found that maternal obesity (odds ratio (OR)=2.16, 95% CI 1.46, 3.18) and GDM (OR=2.21, 95% CI1.38, 3.52) have an independent effect on neonatal adiposity. GDM significantly mediates 25.2% of the total effect between maternal obesity and neonatal adiposity, (natural direct effect OR = 1.16 95% CI 1.04, 1.30) with significant direct effect of maternal obesity (natural direct effect OR = 1.90 95% CI 1.16, 3.10) and significant total effect (OR=2.20 95% CI 1.35, 3.58).
Conclusion: We showed that maternal obesity and GDM are independently associated with offspring adiposity. Also, GDM mediates the association of maternal obesity on adiposity in children. Interventions focused on obesity prevention in women, and effective screening and management of GDM may contribute to reducing childhood obesity in India.
Keywords: mediation effects, skinfold thickness, GDM, obesity in pregnancy, childhood obesity
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