Exposure to maternal diabetes in utero and offspring eating behavior: The EPOCH study

Appetite. 2017 Sep 1;116:610-615. doi: 10.1016/j.appet.2017.05.005. Epub 2017 May 3.


The risk of becoming overweight among offspring exposed to gestational diabetes (GDM) in utero is two-fold higher than in the general population. The responsible mechanisms are likely multifactorial, with some evidence that GDM exposure alters brain satiety signaling, which may impact eating behavior. To better understand these effects, we investigated the relationship between GDM exposure, eating behavior, and total energy intake in 268 adolescents from the Exploring Perinatal Outcomes among Children cohort, who were exposed (n = 50) or not exposed (n = 217) to GDM in utero. Eating behavior was measured by the Eating in the Absence of Hunger in Children and Adolescents (EAH-C) questionnaire, which included subscale scores for Negative Affect, External Stimuli, and Fatigue/Boredom. Total energy intake (kcal/day) was derived from the Block Kid's Food Questionnaire. The associations between GDM exposure and the outcomes of total score and each EAH-C subscale were evaluated in separate multivariable models. In addition to the main predictor, GDM, the models included a GDM-by-sex interaction term and were adjusted for important covariates. The associations between EAH-C total and subscale scores and the outcome of total energy intake were also tested in separate multivariable models. Female offspring exposed to GDM in utero (vs unexposed males and females) were more likely to continue eating beyond satiation due to feelings of boredom and fatigue (β = 0.47, 95% CI: 0.11, 0.83), and in general (EAH-C total score; β = 4.20, 95% CI: 0.56, 7.86) compared to unexposed males. All EAH-C subscale and total scores were significantly, positively associated with higher energy intake (p < 0.05 for all, respectively). Our findings highlight the need for further investigation into the possible early life programming of eating behaviors by GDM exposure in utero.

Keywords: Adolescents; Eating in the absence of hunger; Gestational diabetes.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Body Mass Index
  • Child
  • Cohort Studies
  • Diabetes, Gestational / diagnosis*
  • Diet
  • Exercise
  • Feeding Behavior*
  • Female
  • Follow-Up Studies
  • Health Behavior*
  • Humans
  • Hunger
  • Male
  • Obesity / diagnosis*
  • Pregnancy
  • Prenatal Exposure Delayed Effects*
  • Prospective Studies
  • Risk Factors
  • Satiation
  • Socioeconomic Factors
  • Surveys and Questionnaires
  • Young Adult