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Increased fetal adiposity: A very sensitive marker of abnormal

in utero development
Patrick M Catalano, MD,a,b Alicia Thomas, RD,a Larraine Huston-Presley, MS,a and
Saeid B. Amini, PhD, MBA, JDa
Cleveland, Ohio

OBJECTIVE: Because offspring of women with gestational diabetes mellitus have an increased risk of obesity
and diabetes mellitus as young adults, our purpose was to characterize body composition at birth in infants of
women with gestational diabetes mellitus and normal glucose tolerance.
STUDY DESIGN: One hundred ninety-ve infants of women with gestational diabetes mellitus and 220 infants
of women with normal glucose tolerance had anthropometric measurements and total body electrical
conductivity body composition evaluations at birth. Parental demographic, anthropometric, medical and
family history data, and diagnostic glucose values were used to develop a stepwise regression model that
related to fetal growth and body composition.
RESULTS: There was no signicant difference in birth weight (gestational diabetes mellitus [3398 550 g]
vs normal glucose tolerance [3337 549 g], P = .26) or fat-free mass (gestational diabetes mellitus
[2962 405 g] vs normal glucose tolerance [2975 408 g], P = .74) between groups. However, infants of
women with gestational diabetes mellitus had signicantly greater skinfold measures (P = .0001) and fat mass
(gestational diabetes mellitus [436 206 g] vs normal glucose tolerance [362 198 g], P = .0002) compared
with infants of women with normal glucose tolerance. In the gestational diabetes mellitus group, although
gestational age had the strongest correlation with birth weight and fat-free mass, fasting glucose level had
the strongest correlation with neonatal adiposity.
CONCLUSION: Infants of women with gestational diabetes mellitus, even when they are average weight for
gestational age, have increased body fat compared with infants of women with normal glucose tolerance.
Maternal fasting glucose level was the strongest predictor of fat mass in infants of women with gestational
diabetes mellitus. This increase in body fat may be a signicant risk factor for obesity in early childhood
and possibly in later life. (Am J Obstet Gynecol 2003;189:1698-704.)

Key words: Pregnancy, gestational diabetes mellitus, body composition, fetal growth

Fetal overgrowth is common during gestation in women diabetes mellitus (GDM), which includes women with
with glucose intolerance. The Pedersen1 hypothesis states optimal glycemic control. There is further evidence for
that fetal overgrowth or macrosomia is a consequence of obesity and diabetes mellitus in children of women who
increased maternal glucose, which stimulates fetal insulin were glucose intolerant during pregnancy compared with
production and possibly other growth factors. Increased their siblings when these women had normal glucose
fetal beta-cell mass in infants of diabetic mothers has been tolerance (NGT).3
identified as early as the second trimester of pregnancy,2 The classification of macrosomia is controversial. It has
and increased maternal amino acid and free fatty acids been defined as a birth weight of >4000 g, regardless of
have been related to fetal overgrowth. Macrosomia com- gestational age. Macrosomia has also been described as
plicates as many as 50% of pregnancies with gestational birth weight being >90th percentile for gestational age or
large for gestational age. Factors such as ethnicity, altitude
From the Department of Reproductive Biologya and the Schwartz Center above sea level, sex, and parity must be considered in the
for Nutrition and Metabolism,b Case Western Reserve University at assessment of fetal growth. Hence, the classification of
MetroHealth Medical Center. macrosomia remains problematic.
Supported by National Institutes of Health grants No. HD-22965,
PERC-11089, General Clinical Research Center MO1-RR-80, and the Our purpose was to conduct a prospective evaluation of
Weight Watchers Foundation. neonatal body composition and anthropometric measure-
Received for publication January 8, 2003; revised March 24, 2003; ments in infants of women with NGT and GDM. GDM is
accepted June 20, 2003.
Reprint requests: Patrick M. Catalano, MD, Dept. of Reproductive defined as carbohydrate intolerance of varying degrees of
Biology, Case Western Reserve University, MetroHealth Medical Center, severity, with first recognition during pregnancy.4 We
Cleveland, OH 44109. E-mail: pcatalano@metrohealth.org elected to assess the body composition of infants on the
2003, Mosby, Inc. All rights reserved.
0002-9378/2003 $30.00 + 0 basis of a review by Sparks,5 whereby he hypothesized that
doi:10.1016/S0002-9378(03)00828-7 genetic factors have a stronger relationship with fat-free

Volume 189, Number 6 Catalano et al 1699
Am J Obstet Gynecol

mass (FFM), whereas in utero environment may correlate Indicators, Sussex, UK) for skinfold measurements, a tape
better with fetal fat mass. There has been a 33% increase measure for circumference, and an anthropometer for
in the incidence of type 2 diabetes mellitus over the last limb lengths. Normative birth weight for gestational age
decade in the United States, particularly in young adults was based on published standards from this institution.10
who are obese.6 Because the offspring of women with Details of the methods for skinfold measurements, bone
GDM have an increased risk of obesity and type 2 lengths, and circumferences of trunk and extremities have
diabetes,3,7 we hypothesized that, consistent with the fetal been described previously.11
origin of adult disease theory, infants of women with GDM TOBEC estimates of body composition were obtained
have increased fat mass and not FFM compared with on the pediatric model HP-2 (EM-SCAN, Inc, Springfield,
infants of women with NGT. Ill) at birth. A description of the TOBEC instrument,
theory, and validation studies are in a review by Fiorotto
Material and methods et al.12 Briefly, the instrument consists of a cylindric mea-
The protocol was approved by the hospital Institutional surement chamber that contains a solenoid coil that
Review Board. Written informed consent was obtained creates an electromagnetic field that is generated by an
from each subject before evaluation in the General oscillating electric current. Any conductive object placed
Clinical Research Center. Subjects were recruited on the within the coil will disturb the electromagnetic field and
basis of availability to participate in this prospective result in a dissipation of a quantity of the fields energy.
protocol that evaluated fetal growth. Women with NGT TOBEC estimates of neonatal body composition are based
were recruited from the general population, and women on the premise that the FFM contains electrolytes and
with GDM were recruited from our Pregnancy Diabetes represents a conductive component of the body, in
Clinic from 1990 through 2000. All women in these clinics contrast to fat mass, which is relatively anhydrous.
were eligible to participate and were recruited before Therefore, the FFM disturbs the electromagnetic field in
delivery. The obstetric record was reviewed, and each a precise manner. To perform TOBEC measurements, the
mother was interviewed. Exclusion criteria included birth infant was swaddled and placed on the carriage of the
weight of < 2000 g, multifetal gestations, and neonates instrument. Each infant was measured when the carriage
with anomalies. was pushed into the cylinder a set distance. A computer-
All subjects had a screening 1-hour 50-g glucose generated estimate of FFM was calculated from the
challenge test at 26 to 28 weeks of gestation. A glucose disturbance of the electromagnetic field. Each infant
level of $135 mg/dL was considered positive. All subjects was measured 10 times, and the mean estimate of FFM
with positive screening results had a 3-hour 100-g oral was used as estimated FFM. Fat mass was estimated by
glucose tolerance test. The subjects with NGT had either the subtraction of the FFM from the body weight.
a 1-hour 50-g glucose challenge of < 135 mg/dL or, if Anthropometric and TOBEC measurements were per-
positive, a normal 100-g 3-hour oral glucose tolerance test. formed by one of three examiners. The coefficient of
The diagnosis of GDM was made according to the variation among the examiners was 3% for the anthro-
National Diabetes Data Group criteria.8 All women with pometrics and 7% for the skinfolds. The coefficient of
GDM had dietary instruction by a registered dietician. variation for repetitive TOBEC measures is < 2%.
The diet consisted of 50% complex carbohydrates, 30% Statistical analysis were performed with the use of two-
fat, and 20% protein. Caloric intake was calculated to sample t tests, the Mann-Whitney U test, v2 analysis, anal-
ensure weight gain according to the American Institute of ysis of variance, analysis of covariance that was adjusted
Medicine criteria.9 All subjects with GDM performed for confounding covariables, and stepwise multiple re-
home glucose monitoring. Target fasting and preprandial gression analysis on SAS (Statistix Analysis System, Cary,
glucose values were < 100 mg/dL and 2-hour postpran- NC). In the stepwise multiple regression analysis, smoking
dial values were < 120 mg/dL. All women with GDM were was coded with 0 (nonsmoker) and 1 (smoker), the rest of
encouraged to increase physical activity by walking 30 the variables were continuous. Data are expressed as
minutes each day after meals. Insulin was instituted when mean SD, and a probability value of < .05 was consid-
subjects had persistent glucose concentrations greater ered significant.
than target levels.
Eighty percent of the anthropometric measurements Results
and total body electrical conductivity (TOBEC) estimates One hundred ninety-five women with GDM and 220
of body composition were completed within 24 hours of women with NGT were recruited. Demographics are
birth; 93% of the measurements were completed within 48 shown in Table I. Of the 195 women with GDM, 67
hours, and the remaining 7% of the measurements were women (34%) required insulin to maintain fasting and
completed within 72 hours. Weight was obtained with preprandial and postprandial glucose values within the
a calibrated scale (Scale-Tronix, Wheaton, Ill), a measur- target range. One hundred twenty-eight women with
ing board for length, Harpenden calipers (British GDM (66%) were able to maintain glucose values within
1700 Catalano et al December 2003
Am J Obstet Gynecol

Table I. Parental demographics

Demographic GDM (n = 195) NGT (n = 220) P value

Age (y) 29.0 6.1 28.0 5.8 .12
Height (cm) 162.4 6.3 164.5 7.9 .003
Pregravid weight (kg) 81.0 23.2 65.5 15.3 .0001
Weight at last antenatal visit (kg) 94.9 22.8 80.5 15.3 .0001
Weight gain (kg) 13.9 9.4 14.7 5.9 .29
Height (cm) 177.8 8.6 178.9 8.2 .18
Weight (kg) 87.8 18.0 82.8 14.2 .003
1 h 50 g glucose screen (mg/dL) 170 32 112 28 .0001
Maternal smoking status (%)
Yes 29 15 .0004
No 71 85
Family history of diabetes mellitus (%)
Yes 74 47 .0001
No 26 53
Obstetric problems(%)*
Yes 28 20 .08
No 72 80
Medical problems(%)y
Yes 20 16 .22
No 80 84
Maternal race (%)
White 58 75
African American 27 17 .002
Hispanic/other 15 8
0 121 137 .96
$1 74 83
Education level years (%)
0-12 63 40 .0001
13-16 32 39
>16 5 21
Route of delivery (%)
Cesarean 37 25 .01
Vaginal 63 75

Data are presented as mean SD.

*History of first trimester spotting, endometriosis, history of neonatal death, uterine anomaly, herpes virus, chlamydia, infertility,
abnormal Papanicolaou smears, and ovarian cysts.
yHistory of bronchitis, asthma, colitis, seizures, hypertension, obesity, migraine headaches, anemia, and mitral valve prolapse.

the normal range using diet and exercise. Women with The TOBEC estimates of body composition are shown
GDM were older, shorter, and smoked more frequently on Table III. The infants of women with GDM had
and had greater pregravid weight compared with the NGT significantly greater body fat and percentage of body fat
group. Paternal weight was greater in the partners of the but no significant difference in average FFM in compar-
GDM compared with the NGT group. Thirty-seven per- ison with the NGT group. Additionally, the distribution of
cent of the subjects with GDM and 25% of the subjects fat was not significant in the circumferences of the
with NGT had cesarean deliveries. abdominal/thigh and chest/thigh ratios between the
Neonatal anthropometrics are shown on Table II. The groups. Furthermore, there were no significant differ-
average gestational age at delivery was earlier in infants of ences in the average skinfold abdominal + flank +
women with GDM by 4 days. There was no significant subscapular/triceps + thigh ratio or abdominal + flank +
difference in length or birth weight. The infants of the subscapular/thigh ratio (data not shown). After adjust-
women with GDM had significantly greater ponderal ment for gestational age, maternal pregravid weight,
indexes (weight/length3 3 100) and skinfold measures at weight at last antenatal visit, race, smoking status, and
all five sites compared with the NGT group. Although maternal and paternal height, there was no significant
there was no significant difference in the proportion of difference in birth weight (P = .15) or FFM (P = .60);
infants with weight >4000 g between groups, there were however, a significant difference persisted in the percent-
significantly more infants whose weights were >90th age of body fat (P = .0005) between GDM and NGT. After
percentile for gestational age in the GDM group an adjustment for the aforementioned factors plus
compared with the NGT group (27% vs 14%, P = .004). a family history of diabetes mellitus and maternal weight
Volume 189, Number 6 Catalano et al 1701
Am J Obstet Gynecol

Table II. Neonatal anthropometrics

Measure GDM (n = 195) NGT (n = 220) P value

Gestational age at delivery (wk) 38.4 1.3 39.0 1.4 .0001

Gestiational age dating criteria (%)
Ultrasound < 20 wk 73 71
Ultrasound >20 wk and Dubowitz dates 22 20 .57
Dubowitz dates 5 9
Sex (%)
Male 51 54 .57
Female 49 46
Weight (g) 3398 550 3337 549 .26
Length (cm) 49.9 2.1 50.0 2.2 .68
Extremity length (cm)
Upper arm 8.2 0.6 8.4 0.6 .002
Lower arm 7.3 0.6 7.4 0.5 .03
Upper leg 9.7 0.9 9.9 0.9 .09
Lower leg 8.3 0.7 8.5 0.7 .02
Circumferences (cm)
Head 34.7 1.4 34.5 1.5 .18
Chest 31.8 2.0 31.8 2.1 .88
Umbilical 31.3 2.3 31.0 2.2 .16
Upper arm 10.6 1.3 10.4 1.0 .18
Lower arm 9.7 1.0 9.6 0.9 .16
Upper leg 15.2 1.6 15.0 1.6 .16
Lower leg 11.1 1.1 11.0 1.0 .25
Ponderal index (weight/length3) 3 100 2.72 0.28 2.66 0.26 .02
Skinfolds (mm)
Triceps 4.7 1.1 4.2 1.0 .0001
Subscapular 5.4 1.4 4.6 1.2 .0001
Flank 4.2 1.2 3.8 1.0 .0001
Thigh 6.0 1.4 5.4 1.5 .0001
Abdominal wall 3.5 0.9 3.0 0.8 .0001
Weight for gestational age (%)
< 10% 5 6 .007
10%-90% 68 79
>90% 27 14
Weight (%)
>4000 g 12 9 .37
< 4000 g 88 91

Data are presented as mean SD.

gain, there still remained a significant difference Table III. Neonatal body composition
(P = .04) in fat mass between groups.
GDM (n = 195) NGT (n = 220) P value
Because more of the infants of women with GDM were
macrosomic (ie, >90th percentile; 27% vs 14%) compared FFM (g) 2962 405 2975 408 .74
with the neonates of women with NGT , we next evaluated Fat mass (g) 436 206 362 198 .0002
only neonates whose weights were average for gestational
Body fat (%) 12.4 4.6 10.4 4.6 .0001

age (ie, between the 10th and 90th percentiles). There Data are presented as mean SD.
were 132 infants of women with GDM and 175 infants of
women with NGT for analysis. The subjects with GDM
were significantly shorter and had greater pregravid P = .002), but there was no significant difference in the
weight and weight at last antenatal visit as compared with mean birth weight (3202 357 g vs 3249 372 g,
the NGT group. The subjects with GDM also had a greater P = .27) between groups. Infants of women with GDM
incidence of positive smoking history, family history of had significantly greater skinfold measures at all five sites
diabetes mellitus, and less post-high school education in comparison with the infants of women with NGT
compared with the NGT group. The infants of the women (P = .007  .0001). TOBEC estimates of body composi-
with GDM were delivered more often by cesarean delivery tion showed that the infants of the women with GDM had
(36% vs 25%, P = .03) compared with the NGT group. significantly less FFM (2832 286 g vs 2919 287 g,
The average gestational age at delivery was again signifi- P = .008) but had significantly greater fat mass
cantly earlier in infants of women with GDM (38.5 1.4 (371 163 g vs 329 150 g, P = .02) percent body fat
weeks of gestation vs 39.0 1.4 weeks of gestation, (11.4% 4.6% vs 9.9% 4.0%, P = .002) in comparison
1702 Catalano et al December 2003
Am J Obstet Gynecol

Table IV. Multiple stepwise regression analysis for Table V. Multiple stepwise regression analysis for
factors that affected fetal growth and body factors that affected fetal growth and body
composition in 220 women with NGT composition in 195 women with GDM

Factor r2 Dr2 P value Factor r2 Dr2 P value

Weight Weight
Gestational age 0.22 Gestational age 0.07 .0003
Maternal height 0.25 0.03 .007 Fasting glucose 0.17 0.10 .0001
Maternal weight gain 0.28 0.03 .01 Smoking status () 0.21 0.04 .003
Glucose screen 0.30 0.02 .008 FFM
Smoking status () 0.31 0.01 .05 Gestational age 0.07 .0003
FFM Smoking status () 0.14 0.07 .0006
Gestational age 0.20 .0001 Fasting glucose 0.19 0.05 .0005
Maternal height 0.23 0.03 .002 Maternal height 0.22 0.03 .02
Maternal weight gain 0.24 0.01 .05 Fat mass
Fat mass Fasting glucose 0.11 .0001
Gestational age 0.16 .0001 Gestational age 0.17 0.06 .0007
Weight at first antenatal visit 0.21 0.05 .004 Body fat (%)
Maternal weight gain 0.24 0.03 .006 Fasting glucose 0.09 .0001
Glucose screen 0.26 0.02 .01 Gestational age 0.13 0.04 .007
Body fat (%)
Gestational age 0.14 .0001
Glucose screen 0.18 0.04 .01
Maternal weight gain 0.20 0.02 .001
Pregravid weight 0.23 0.03 .01 TOBEC estimates of FFM (3005 397 g vs 2939 409 g,
P = .28), but there were significantly greater fat mass
(492 215 g vs 407 196 g, P = .006) and percent body
fat (13.6% 4.6% vs 11.7% 4.5%, P = .007) in the
with the infants of women with NGT. There was no A2 GDM group compared with the A1 GDM group. After
significant difference in the distribution of body fat the adjustment for gestational age, maternal pregravid
between groups. After an adjustment was made for weight, parity, and smoking status, there were significant
maternal height and pregravid weight, gestational age, differences in birth weight (P = .0006) and FFM (P = .03).
smoking status, race, and paternal weight, there was no Because smoking affects FFM and not fat mass, when we
significant difference in birth weight (P = .42) or FFM adjusted for gestational age, maternal pregravid weight,
(P = .59). Adjustment for the aforementioned factors plus and parity, the A2 GDM group persisted in having greater
weight at the last antenatal visit and a family history of fat mass (P = .002) and percent body fat (P = .003) as
diabetes mellitus in fat mass (P = .02) and percent body compared with the A1 GDM group.
fat (P = .02) continued to be significant between groups We performed a multiple stepwise regression analysis to
(detailed data available on request). assess the factors and relative strength of each variable in
We next compared the body composition estimates regard to birth weight and body composition in the NGT
between the infants of the women with GDM who were group (Table IV) and GDM group (Table V). The purpose
treated with diet alone (group A1, n = 128 infants) and of this analysis was to identify factors that are available
infants who were treated with diet plus insulin (group A2, in clinical practice and potentially amenable to interven-
n = 67 infants) on the average. The A2 GDM group had tion to decrease the risk of adiposity. The independent
greater pregravid weight (87.9 25.5 kg vs 77.4 21.1 variables for the NGT group included maternal age,
kg, P = .0002). The A2 GDM group also had greater parity height, pregravid weight, weight at last visit, weight gain,
(49% > 1.0 vs 32% > 1.0, P = .02) and cesarean delivery parity, paternal height and weight, gestational age, neo-
(52% vs 29%, P = .001) compared with the A1 GDM natal gender, presence of family history of diabetes
group. The A2 GDM group was delivered earlier mellitus, race, smoking status, and glucose screen. In
(37.9 1.1 weeks of gestation vs 38.7 1.4 weeks of the GDM group, we included all the variables for the NGT
gestation, P = .0001) than the A1 GDM group. There was group with the exception of the glucose screen, but
no significant difference in birth weight (3497 556 g vs included the fasting, 1-, 2-, and 3-hour glucose values from
3346 542 g, P = .07) between groups. The skinfold the diagnostic oral glucose tolerance test. In the NGT
measures were significantly greater in the A2 GDM group: group, gestational age had the strongest correlation with
subscapular (5.9 1.6 mm vs 5.1 1.2 mm, P = .0001), birth weight and body composition. Maternal height was
triceps (5.0 1.1 mm vs 4.5 1.0 mm, P = .003), flank a significant variable with respect to birth weight and FFM,
(4.5 1.2 mm vs 4.0 1.1 mm, P = .01), thigh (6.3 1.5 whereas maternal pregravid weight, weight gain, and
mm vs 5.8 1.3 mm, P = .02), and abdomen (4.0 1.4 glucose screen were included in the regression models of
mm vs 3.3 0.9 mm, P = .0001) compared with the NGT fat mass and percent body fat. In the GDM group,
group. There were no significant differences in the gestational age had the strongest correlation with birth
Volume 189, Number 6 Catalano et al 1703
Am J Obstet Gynecol

weight and FFM, although fasting glucose had the the risk of macrosomia markedly, optimal treatment has
strongest correlation with fat mass and percent body fat. yet to be defined. Furthermore, maternal glucose concen-
trations, less than those used in the diagnosis of GDM,
Comment have also been related to increased fetal growth.20 Various
The most significant finding of our study was that of treatment strategies, which include intensive treatment
a significant increase in adiposity of average for gestational protocols to normalize maternal glucose concentration,
aged infants of women with GDM. Previous studies by are used currently in the treatment of GDM. However,
Pettitt et al3 and Silverman et al7 have shown that infants of such protocols may result in as many as 66% of women
women with GDM have an increased risk of adolescent requiring insulin, and the overly aggressive treatment of
obesity and glucose intolerance. However, detailed body maternal glycemia may actually increase the risk of small
composition data at the time of birth was not available. for gestational age neonates.21,22 Thirty-four percent of
Earlier studies ascribed the increases in birth weight of the patients with GDM (n = 67) were treated with insulin
infants of diabetic women to either fat mass and/or FFM. (A2 GDM group) in addition to diet and exercise. Thus,
The carcass analysis studies of Fee and Weil13 in stillbirths even in GDM patients who were treated with insulin, the
and cases of neonatal death described normal body water neonates were significantly heavier and had increased
in FFM but significant increases in body fat in comparison adiposity in comparison with the infants of the A1 GDM
with control subjects. In 40 infants of women with GDM, group. We speculate that the A2 GDM group had greater
Whitelaw14 reported that neonatal fat mass, as estimated pregravid insulin resistance as compared with the A1
from skinfolds, was significantly greater in infants of GDM group. This is based on the A2 GDM group having
women with diabetes mellitus compared with a nondia- significantly greater pregravid weight and parity com-
betic reference population. Additionally, Enzi et al15 pared with the A1 GDM group. These two factors have
evaluated body composition using skinfolds in 17 infants been associated with increased maternal insulin resis-
of women with GDM and 17 nondiabetic control subjects. tance and neonatal adiposity.23 Hence, the criteria for the
The mean SE percent body fat in the infants of the diagnosis of GDM earlier in gestation may be warranted.
GDM was 17% 1.7% compared with 12.2% 0.5% in The issue of whether the optimization of the control of
the control subjects. However, body weight was also greater fasting as compared with either preprandial or post-
in the GDM group (3508 200 g) compared with the prandial glucose concentrations is more important for the
control group (3103 100 g). In contrast, Naeye16 control of fetal overgrowth continues to be debated, as
reported that there was an increase in FFM, in contrast does the importance of glucose control in early, compared
with fat mass, in overgrown stillborn fetuses or neonatal with late, gestation.24 Of interest, in our study, fasting
deaths for women with GDM. These infants also had glucose levels at the time of the oral glucose tolerance test
evidence of both hyperplasia and hypertrophy in cellular was the factor with the strongest correlation with fetal
tissue of various organs. All these studies were conducted fat accretion. These data support a study by Uvena-
on a small number of infants, and the cause of the fetal/ Celebrezze et al25 that reported that fasting glucose had
neonatal death was often unknown. the strongest correlation with fetal fat mass in comparison
Additional body composition studies were conducted with premeal or postmeal glucose values, based on
recently by Nasiat et al.17 Although the investigators glucose self-monitoring seven times per day.
reported an increase in subscapular fat in the infants of In summary, infants of women with mild glucose
the women with diabetes mellitus (both pregestational intolerance (ie, GDM) have increased body fat compared
and gestational), the birth weight of the infants of the with infants of women with NGT; this is independent of
women with diabetes mellitus was significantly greater birth weight and may be regarded as very early onset
than the birth weight of the nondiabetic control subjects. obesity. We propose that the use of specific outcome
Furthermore, fat mass was estimated as the sum of four measurements such as fetal adiposity may be a more
skinfolds. In a study by McFarland et al,18 although the sensitive and specific outcome measure at birth. The
authors found greater fat mass using an anthropometric increase in body fat at birth may be the harbinger of an
formula in infants of women with diabetes mellitus, the increased risk of obesity and other metabolic compli-
number of study subjects was small and limited to cations in adolescence for these infants. Although the dif-
macrosomic infants. The results of our study extend these ference in fat mass between the two groups was only 74 g
results on the basis of method and number and analysis of (Table III), this represents a 20% difference between the
study subjects. Thus, the current goal of achieving appro- NGT and GDM infants. Should this 20% difference in fat
priate weight for gestational age may not be adequate mass persist into adolescence, it will become a significant
given these results. problem. Therefore, we are in the process of following
The summary of the Fourth International Workshop- this cohort to evaluate long-term outcome that is relative
Conference on Gestational Diabetes Mellitus19 noted to adolescent obesity, glucose tolerance, and the insulin
that, although treatment of hyperglycemia can decrease resistance syndrome.
1704 Catalano et al December 2003
Am J Obstet Gynecol

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