Breast Milk and Infant Growth Among Lean, Overweight and Diabetic Mothers

Study Overview
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Brief Summary
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Childhood obesity is a critical global public health concern. Breastfeeding is the ideal choice for infant nutrition. However, rapid and excess weight gain during infancy predicts later, even among breastfed infants. This risk is higher if mothers are obese and/or diabetic. Composition of bioactive components of breast milk may differ based between mothers who are normal weight (NW), overweight, or who have diabetes. Obesity and Type 2 Diabetes are associated with overall increases in inflammation and oxidative stress, but how breast milk composition is affected remains unknown. The investigators overarching goal is to determine how maternal obesity and Type 2 Diabetes impacts human breast milk composition and how differences in composition may impact infant growth and fat development. The investigators are undertaking a study that follows 20 Normal Weight, 20 Obese, 20 Gestational Diabetic, and 20 Type 2 Diabetic mothers and their infants over the first 4 months of life. The investigators will track infant weight and fat gain and monitor maternal glucose control. The investigators will also collect breast milk samples over the first 4 months and measure concentrations of growth and appetite hormones, cytokines, markers of oxidative stress and nutrient composition in milk. The investigators predict that concentrations of growth-regulatory hormones (insulin and leptin) in addition to the inflammatory cytokines and markers of oxidative stress will be lowest in breast milk from NW mothers, higher in breast milk from obese and gestational diabetic mothers, and highest in Type 2 Diabetic mothers' breast milk. The investigators expect these differences will be most pronounced in the first 2 weeks after birth. The investigators also predict that breast milk concentrations of these biomarkers will be associated with infant fat gain. What the investigators find will help understand how early infant nutrition and growth may affect that child's later risk of obesity.

Official Title
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Breast Milk and Infant Growth and Body Composition Among Healthy Mothers, Obese Mothers, and Mothers With Diabetes

Conditions
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Obesity, Type 2 Diabetes, Gestational Diabetes

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Between 28-40 weeks gestation Plan to Exclusively Breastfeed for at least 5 months Between 20 - 35 years old Carrying a singleton pregnancy Parity less than or equal to 5 Pre-pregnancy BMI between 18.5 and 39.9 Exclusion Criteria: No known infant anomalies or birth defects Maternal Type 1 Diabetes Maternal major medical condition (ie: Kidney Disease or Pre-eclampsia) Delivery of the infant before 35 weeks gestation Smoking During pregnancy

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 35 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Normal Weight<br>Normal weight and normoglycemic women: Pre-pregnancy BMI between 18.5 - 24.9 kg/m2. | |
| Overweight/Obese<br>Overweight and normoglycemic women: Pre-pregnancy BMI between > 25 kg/m2. | |
| Gestational Diabetes<br>Women who develop gestational diabetes and return to normal glucose control after delivery. | |
| Type 2 Diabetes<br>Women who are overweight and have Type 2 Diabetes that was diagnosed before pregnancy: Pre-pregnancy BMI > 25 kg/m2. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in infant percent body fat from birth to 4 months | Body composition is measured by skin folds and air displacement plethysmography (PeaPod) | Birth, 2 weeks, 1, 2, 3, and 4 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Human Milk Hormone Composition | The investigators will analyze: insulin, leptin, adiponectin, and ghrelin concentrations in human milk samples collected at these time points | 2 weeks, 1, 2, 3, and 4 months | 
| Change in Human Milk cytokine content | The investigators will analyze: IL-10, IL-6, IL-8, and TNF-alpha concentrations in human milk samples collected at these time points | 2 weeks, 1, 2, 3, and 4 months | 
| Change in Antioxidant capacity of human milk | The investigators will analyze: TBARS, 8-OH-dG, HNE, and F2-isoprostane concentrations and total antioxidant capacity in human milk samples collected at these time points. | 2 weeks, 1, 2, 3, and 4 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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human milk, infant growth, obesity, diabetes, breastfeeding