A healthy appetite is crucial for optimal infant growth and long-term health. Emerging evidence suggests that maternal diet during prenatal and postnatal periods significantly influences infant appetitive feeding behavior through various hormonal, genetic, and orosensory mechanisms. Flavor exposure in utero, via amniotic fluid, shapes future dietary preferences. Studies show correlations between maternal dietary intake during pregnancy and offspring food intake later in life. Animal studies support these findings, demonstrating that gestational nutritional alterations can program appetite and feeding behavior in offspring, potentially affecting hypothalamic development and gut microbiome composition, which in turn influence appetite regulation. Infant appetitive feeding behavior, encompassing traits like food responsiveness, slowness in eating, and satiety responsiveness, impacts adiposity and weight gain. While the impact of maternal diet on infant appetite is evident, the consistency of effects and the onset and persistence of appetitive abnormalities remain unclear. Women with GDM are often overweight, at risk of type 2 diabetes and hypertension, and have larger babies at increased risk of obesity and metabolic disease. This study aimed to investigate the relationship between maternal dietary patterns in women with GDM, their infants' appetitive feeding behavior, and the connection between the two. The hypotheses were: (1) Infants of women with GDM would exhibit obesity-related appetitive traits; (2) Unhealthy maternal diets would correlate with increased food responsiveness, enjoyment of food, and general appetite in infants; and (3) Healthy maternal diets would correlate with increased satiety responsiveness and slowness in eating.

The literature extensively supports the impact of maternal diet on the development of infant feeding behaviors and long-term health outcomes. Studies have highlighted the importance of early flavor exposure via amniotic fluid and breast milk in shaping food preferences and acceptance. Several studies, including a UK cohort study, found significant correlations between maternal nutrient intake during pregnancy and the offspring's dietary habits years later. Animal research provides compelling evidence that altering the nutritional environment during gestation can program the offspring's appetite regulation, impacting hypothalamic development and influencing neuronal circuitry involved in appetite control. High-fat maternal diets have been linked to alterations in the offspring's gut microbiome, potentially mediating epigenetic modifications of genes that regulate appetite. These findings underscore the critical role of the maternal diet in shaping the offspring's predisposition towards obesity and related metabolic disorders. However, studies have shown inconsistent results regarding the influence of maternal diet on infant appetitive feeding behaviors, highlighting a need for further research to determine the specific mechanisms and the extent to which these influences persist over time.

This nested cohort study used data from the TARGET Trial, a randomized trial comparing different glycemic control targets in women with GDM. Participants included women with GDM who completed a food frequency questionnaire (FFQ) at 36 weeks gestation, had infant sex, gestational age at birth, and pregnancy outcome data, and participated in 6-month postpartum follow-up. Maternal dietary data was collected via a customized 1-month recall FFQ at 36 weeks gestation. This FFQ, adapted from Willett's 163-item semi-quantitative FFQ, was adjusted to reflect New Zealand dietary habits. Data from women with more than ten missing dietary items or implausible energy intakes were excluded. Principal component analysis (PCA) was used on 57 food items to identify maternal dietary patterns. Three distinct patterns were identified: 'Junk,' 'Mixed,' and 'Health-conscious'. Infant appetitive feeding behavior at 6 months was assessed using the Baby Eating Behaviour Questionnaire (BEBQ), a validated measure of general appetite and four specific appetitive traits: enjoyment of food, food responsiveness, slowness in eating, and satiety responsiveness. Covariates considered included maternal age, energy intake, infant gestational age, birth weight, weight-for-length z-scores at 6 months, age at introduction of solids, ethnicity, BMI, smoking status, parity, TARGET Trial treatment group, and infant breastfeeding status. Statistical analysis using SAS 9.4 involved descriptive statistics, correlation analysis, and multivariable regression models adjusting for covariates to assess the relationship between maternal dietary patterns and infant appetitive traits. The study accounted for skewed data using median (interquartile range).

The study included 325 mother-infant dyads. Three distinct maternal dietary patterns were identified through PCA: 'Junk', 'Mixed', and 'Health-conscious'. The 'Health-conscious' dietary pattern was inversely associated with 'enjoyment of food' in sons (β = -0.24, 95% CI -0.36 to -0.11, p = 0.0003) but not daughters (β = -0.02, 95% CI -0.12 to 0.08, p = 0.70). A positive association was observed between the 'Health-conscious' pattern and 'slowness in eating' (β = 0.13, 95% CI 0.02 to 0.24, p = 0.01). No other associations reached statistical significance after adjustment for sex, weight-for-age z-score at 6 months, and NZDep. The majority of infants (92.3%) had high enjoyment of food scores, while fewer than 5% had high food responsiveness. Correlations were found between infant appetitive traits; for example, higher 'food responsiveness' correlated with higher general appetite (r = 0.44, p < 0.0001) and higher 'slowness in eating' (r = 0.21, p < 0.0008). Higher 'enjoyment of food' scores negatively correlated with 'satiety responsiveness' (r = -0.22, p < 0.0006) and 'slowness in eating' (r = -0.22, p < 0.0006). Boys and girls had similar appetitive mean scores, with a negative relationship between satiety responsiveness and food responsiveness/general appetite observed only in girls.

This study, the first to assess the impact of third-trimester diet in women with GDM on infant appetitive traits using the BEBQ, provides novel insights into the relationship between maternal diet and infant feeding behavior. The inverse association between a 'Health-conscious' maternal diet and 'enjoyment of food' in boys suggests a potential protective effect against future obesity risk. This sex-specific finding warrants further exploration. The observed positive association with 'slowness in eating' in both sexes also suggests potential benefits of a health-conscious maternal diet for appetite regulation. These findings align with previous research highlighting the impact of maternal diet on offspring appetite and obesity risk. The sex-specific differences in associations may reflect biological or social factors related to gender-based dietary preferences and patterns. The relatively low percentage of variance explained by the dietary patterns (23.8%) suggests the influence of other factors, emphasizing the need for future research exploring the intricate interplay between maternal diet, infant feeding behavior, and long-term health outcomes.

This study suggests that maternal dietary patterns during late pregnancy may influence appetitive control in infants at high risk of obesity. Specifically, a 'Health-conscious' diet in the third trimester was associated with better appetitive control in 6-month-old infants, particularly boys. Given the increased obesity risk in offspring of women with GDM, dietary advice during pregnancy is a potential area for intervention and public health recommendations. Further research is needed to determine the long-term impact of these early associations on growth and obesity risk.

The study's limitations include the reliance on maternal self-report for both dietary intake and infant feeding behavior, which could introduce recall and social desirability biases. The FFQ used, while validated, is subject to inherent limitations compared to more intensive dietary assessment methods. The PCA used to define dietary patterns has an inherent degree of subjectivity. The cohort may not fully represent the entire population of women with GDM in New Zealand, as responders differed from non-responders in ethnicity and socioeconomic status. Despite adjustments for potential confounding factors, residual confounding might remain.