Infant Temperament and Early Infant Growth and Child Overweight in GDM Offspring

描述（由申请人提供）：患有妊娠期糖尿病（GDM）的母亲的后代更容易发生肥胖、葡萄糖耐受不良、胰岛素抵抗和2型糖尿病，因为宫内暴露于母亲的糖尿病，尽管产后喂养可能会改变风险。“难相处”的性情加上缺乏母乳喂养、早期辅食和含糖食物等产后喂养做法，可能共同使婴儿容易快速生长和后来肥胖，这是未来代谢性疾病的关键风险因素。我们建议对GDM妊娠后妇女、婴儿喂养和2型糖尿病研究（SWIFT;R01HD050625）的GDM母婴高危队列（71%少数）进行二次数据分析。从2008年到2011年，SWIFT招募了1035名GDM母亲，这些母亲在Kaiser Permanente医院生产了一个单胎，活产了35周。性情、饮食摄入（例如，母乳喂养、饮食摄入、含糖饮料）和人体测量对363名出生后第一年的婴儿进行了评估。利用这些现有数据，本研究将首次阐明婴儿气质与健康行为之间的关系，以及它们对GDM后代婴儿生长的影响。本研究的目的是：目的1：表征“困难”气质（即对限制的较差的痛苦，以及较低的安抚性）与婴儿第一年生长的关系；目的2：评估“困难”气质与婴儿快速生长（即母乳喂养较少，在瓶中添加谷物，早期引入果汁/食物，高摄入含糖食物/饮料）之间关联的潜在中介；探索性目标3：目的：确定婴儿气质困难是否与2-4岁超重有关。除了妊娠期糖尿病的压力外，一个困难的婴儿气质可能会给新妈妈带来许多额外的压力源。我们提出的研究提出了关于气质和可改变的风险因素的新假设，这些假设可能为早期生活肥胖预防策略提供信息。

DESCRIPTION (provided by applicant): Offspring of mothers with gestational diabetes mellitus (GDM) are more likely to develop obesity, glucose intolerance, insulin resistance, and type 2 diabetes because of intrauterine exposure to maternal diabetes, although postnatal feeding may modify risk. A 'difficult' temperament coupled with postnatal feeding practices, such as lack of breastfeeding, early complementary and sugary foods may jointly predispose infants to rapid growth and later obesity which are key risk factors for future metabolic disease. We propose a secondary data analysis of a high-risk cohort of GDM mother-infant pairs (71% minority) enrolled in the Study of Women, Infant Feeding and Type 2 Diabetes after GDM Pregnancy (SWIFT;R01HD050625). From 2008-2011, SWIFT enrolled 1,035 GDM mothers who delivered a singleton, live birth e35 weeks at Kaiser Permanente hospitals. Temperament, dietary intake (e.g., breastfeeding, dietary intake, sugar-sweetened beverages), and anthropometry were assessed among 363 infants in the first year of life. Leveraging these existing data, the proposed research will elucidate, for the first time, relationships between infat temperament and health behaviors, and their impact on infant growth in GDM offspring. The study aims are: Aim 1: To characterize the relation of "difficult" temperament (i.e., poorer distress to limitations, and less soothability) to infant growth during the first year of life, Aim2: To evaluate potential mediators of the association between "difficult temperament" and rapid infant growth (i.e., less breast feeding, cereal added to the bottle, early introduction of juice/foods, and high intake of sugar-sweetened foods/beverages), and Exploratory Aim 3: To determine whether difficult infant temperament is associated with overweight at age 2-4 years. A difficult infant temperament may introduce a host of additional stressors to new mothers in addition to the stress of GDM pregnancy. Our proposed research addresses novel hypotheses about temperament and modifiable risk factors that may inform strategies for early life obesity prevention.