title: The impact of neonatal breast-feeding on growth trajectories of youth exposed and unexposed to diabetes in utero: the EPOCH Study.
abstract: OBJECTIVE
  To evaluate the influence of breast-feeding on the body mass index (BMI) growth trajectory from birth through 13 years of age among offspring of diabetic pregnancies (ODP) and offspring of non-diabetic pregnancies (ONDP) participating in the Exploring Perinatal Outcomes Among Children Study.
  
  
  METHODS
  There were 94 ODP and 399 ONDP who had multiple BMI measures obtained from birth throughout childhood. A measure of breast milk-months was derived from maternal self-report to categorize breast-feeding status as adequate (≥6 breast milk-months) or low (<6 breast milk-months). Mixed linear-effects models were constructed to assess the impact of breast-feeding on the BMI growth curves during infancy (birth to 27 months) and childhood (27 months to 13 years).
  
  
  RESULTS
  ODP who were adequately breast-fed had a slower BMI growth trajectory during childhood (P=0.047) and slower period-specific growth velocity with significant differences between 4 and 6 years of age (P=0.03) and 6 to 9 years of age (P=0.01) compared with ODP with low breast-feeding. A similar pattern was seen in the ONDP, with adequate breast-feeding associated with lower average BMI in infancy (P=0.03) and childhood (P=0.0002) and a slower growth trajectory in childhood (P=0.0002). Slower period-specific growth velocity was seen among the ONDP associated with adequate breast-feeding with significant differences between 12-26 months (P=0.02), 4-6 years (P=0.03), 6-9 years (P=0.0001) and 9-13 years of age (P<0.0001).
  
  
  CONCLUSIONS
  Our study provides novel evidence that breast-feeding is associated with long-term effects on childhood BMI growth that extend beyond infancy into early and late childhood. Importantly, these effects are also present in the high-risk offspring, exposed to overnutrition during pregnancy. Breast-feeding in the early postnatal period may represent a critical opportunity to reduce the risk of childhood obesity.
authors.affiliation: Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA. Tessa.Crume@ucdenver.edu
authors.forename: T L
authors.initials: TL
authors.lastname: Crume
authors.forename: L G
authors.initials: LG
authors.lastname: Ogden
authors.forename: E J
authors.initials: EJ
authors.lastname: Mayer-Davis
authors.forename: R F
authors.initials: RF
authors.lastname: Hamman
authors.forename: J M
authors.initials: JM
authors.lastname: Norris
authors.forename: K J
authors.initials: KJ
authors.lastname: Bischoff
authors.forename: R
authors.initials: R
authors.lastname: McDuffie
authors.forename: D
authors.initials: D
authors.lastname: Dabelea
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D001942:Breast Feeding / Q000706:statistics & numerical data; D002648:Child; D016241:Child of Impaired Parents / Q000706:statistics & numerical data*; D002675:Child, Preschool; D015331:Cohort Studies; D003120:Colorado / Q000453:epidemiology; D016640:Diabetes, Gestational; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009765:Obesity / Q000453:epidemiology* / Q000517:prevention & control*; D011247:Pregnancy; D011254:Pregnancy in Diabetics; D012189:Retrospective Studies