title: Intake of carbohydrates during pregnancy in obese women is associated with fat mass in the newborn offspring.
abstract: BACKGROUND
  Transmission of obesity across generations is of concern. Offspring of obese women have short- and long-term increased morbidities. A high intake of carbohydrate during pregnancy combined with impaired glucose tolerance is postulated to result in high birth weight, which is linked to subsequent metabolic disease.
  
  
  OBJECTIVE
  The objective was to examine the association between carbohydrate intake in obese pregnant women and their offspring's body composition.
  
  
  METHODS
  Secondary analyses were performed in an observational setting of 222 pregnant women with a pregestational BMI (in kg/m(2)) ≥30 participating in a randomized controlled trial. Diet was assessed at gestational weeks 11-14 and 36-37 by using a semiquantitative food-frequency questionnaire. Body composition in the offspring was assessed at birth by dual-energy X-ray absorptiometry. Relative fat mass (%) was the primary outcome. Absolute measures (total fat, abdominal fat, and lean body mass) were secondary outcomes.
  
  
  RESULTS
  Mean ± SD weight and absolute and relative fat mass in the offspring at birth were 3769 ± 542 g, 436 ± 214 g, and 11% ± 4%, respectively. Maternal intake of digestible carbohydrates was associated with the offspring's relative fat mass in late (P-trend = 0.006) but not early (P-trend = 0.15) pregnancy. A comparison of mothers in the highest (median: 238 g/d) compared with the lowest (median: 188 g/d) quartile of digestible carbohydrate intake showed a mean adjusted higher value in the offspring's relative fat mass of 2.1% (95% CI: 0.6%, 3.7%), which corresponded in absolute terms to a 103-g (95% CI: 27, 179-g) higher fat mass. Abdominal fat mass was also higher. In a strata of women with well-controlled glucose (2-h glucose values ≤6.6 mmol/L), no association between carbohydrate intake and offspring fat mass was observed, but the associations became significant and increased in strength with higher intolerance (strata with 2-h glucose values between 6.7-7.7 and ≥7.8 mmol/L).
  
  
  CONCLUSIONS
  In obese women, even those without gestational diabetes but with impaired glucose tolerance, a lower carbohydrate intake at moderate levels in late gestation is associated with a lower fat mass in their offspring at birth. The TOP study was registered at clinicaltrials.gov as NCT01345149.
authors.affiliation: Departments of Obstetrics and Gynaecology, krenault@dadlnet.dk.
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Renault
authors.affiliation: Paediatrics, and.
authors.forename: Emma M
authors.initials: EM
authors.lastname: Carlsen
authors.affiliation: Endocrinology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark;
authors.forename: Kirsten
authors.initials: K
authors.lastname: Nørgaard
authors.affiliation: Departments of Obstetrics and Gynaecology.
authors.forename: Lisbeth
authors.initials: L
authors.lastname: Nilas
authors.affiliation: Paediatrics, and.
authors.forename: Ole
authors.initials: O
authors.lastname: Pryds
authors.affiliation: The Research Unit Women's and Children's Health, the Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark;
authors.forename: Niels J
authors.initials: NJ
authors.lastname: Secher
authors.affiliation: Paediatrics, and.
authors.forename: Dina
authors.initials: D
authors.lastname: Cortes
authors.affiliation: Endocrinology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark;
authors.forename: Jens-Erik Beck
authors.initials: JE
authors.lastname: Jensen
authors.affiliation: Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; and.
authors.forename: Sjurdur F
authors.initials: SF
authors.lastname: Olsen
authors.affiliation: Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland.
authors.forename: Thorhallur I
authors.initials: TI
authors.lastname: Halldorsson
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D055815:Young Adult; D050156:Adipogenesis; D050154:Adiposity; D001724:Birth Weight; D015992:Body Mass Index; D003718:Denmark / Q000453:epidemiology; D050528:Diet, Carbohydrate-Restricted; D038441:Diet, Mediterranean; D004040:Dietary Carbohydrates / Q000009:adverse effects; D047109:Fetal Development; D018149:Glucose Intolerance / Q000150:complications / Q000178:diet therapy / Q000503:physiopathology; D039382:Maternal Nutritional Physiological Phenomena; D009765:Obesity / Q000150:complications / Q000178:diet therapy / Q000503:physiopathology; D063766:Pediatric Obesity / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011248:Pregnancy Complications / Q000178:diet therapy / Q000503:physiopathology; D012307:Risk Factors; D057566:Self Report; D000094422:Secondary Data Analysis
chemical_list: D004040:Dietary Carbohydrates
keywords: carbohydrate; fat mass; maternal diet; obesity; offspring; pregnancy