Date Published: February 11, 2019
Publisher: Public Library of Science
Author(s): Ellis Voerman, Susana Santos, Bernadeta Patro Golab, Pilar Amiano, Ferran Ballester, Henrique Barros, Anna Bergström, Marie-Aline Charles, Leda Chatzi, Cécile Chevrier, George P. Chrousos, Eva Corpeleijn, Nathalie Costet, Sarah Crozier, Graham Devereux, Merete Eggesbø, Sandra Ekström, Maria Pia Fantini, Sara Farchi, Francesco Forastiere, Vagelis Georgiu, Keith M. Godfrey, Davide Gori, Veit Grote, Wojciech Hanke, Irva Hertz-Picciotto, Barbara Heude, Daniel Hryhorczuk, Rae-Chi Huang, Hazel Inskip, Nina Iszatt, Anne M. Karvonen, Louise C. Kenny, Berthold Koletzko, Leanne K. Küpers, Hanna Lagström, Irina Lehmann, Per Magnus, Renata Majewska, Johanna Mäkelä, Yannis Manios, Fionnuala M. McAuliffe, Sheila W. McDonald, John Mehegan, Monique Mommers, Camilla S. Morgen, Trevor A. Mori, George Moschonis, Deirdre Murray, Carol Ní Chaoimh, Ellen A. Nohr, Anne-Marie Nybo Andersen, Emily Oken, Adriëtte J. J. M. Oostvogels, Agnieszka Pac, Eleni Papadopoulou, Juha Pekkanen, Costanza Pizzi, Kinga Polanska, Daniela Porta, Lorenzo Richiardi, Sheryl L. Rifas-Shiman, Luca Ronfani, Ana C. Santos, Marie Standl, Camilla Stoltenberg, Elisabeth Thiering, Carel Thijs, Maties Torrent, Suzanne C. Tough, Tomas Trnovec, Steve Turner, Lenie van Rossem, Andrea von Berg, Martine Vrijheid, Tanja G. M. Vrijkotte, Jane West, Alet Wijga, John Wright, Oleksandr Zvinchuk, Thorkild I. A. Sørensen, Debbie A. Lawlor, Romy Gaillard, Vincent W. V. Jaddoe, Ronald C. W. Ma
Abstract: BackgroundMaternal obesity and excessive gestational weight gain may have persistent effects on offspring fat development. However, it remains unclear whether these effects differ by severity of obesity, and whether these effects are restricted to the extremes of maternal body mass index (BMI) and gestational weight gain. We aimed to assess the separate and combined associations of maternal BMI and gestational weight gain with the risk of overweight/obesity throughout childhood, and their population impact.Methods and findingsWe conducted an individual participant data meta-analysis of data from 162,129 mothers and their children from 37 pregnancy and birth cohort studies from Europe, North America, and Australia. We assessed the individual and combined associations of maternal pre-pregnancy BMI and gestational weight gain, both in clinical categories and across their full ranges, with the risks of overweight/obesity in early (2.0–5.0 years), mid (5.0–10.0 years) and late childhood (10.0–18.0 years), using multilevel binary logistic regression models with a random intercept at cohort level adjusted for maternal sociodemographic and lifestyle-related characteristics. We observed that higher maternal pre-pregnancy BMI and gestational weight gain both in clinical categories and across their full ranges were associated with higher risks of childhood overweight/obesity, with the strongest effects in late childhood (odds ratios [ORs] for overweight/obesity in early, mid, and late childhood, respectively: OR 1.66 [95% CI: 1.56, 1.78], OR 1.91 [95% CI: 1.85, 1.98], and OR 2.28 [95% CI: 2.08, 2.50] for maternal overweight; OR 2.43 [95% CI: 2.24, 2.64], OR 3.12 [95% CI: 2.98, 3.27], and OR 4.47 [95% CI: 3.99, 5.23] for maternal obesity; and OR 1.39 [95% CI: 1.30, 1.49], OR 1.55 [95% CI: 1.49, 1.60], and OR 1.72 [95% CI: 1.56, 1.91] for excessive gestational weight gain). The proportions of childhood overweight/obesity prevalence attributable to maternal overweight, maternal obesity, and excessive gestational weight gain ranged from 10.2% to 21.6%. Relative to the effect of maternal BMI, excessive gestational weight gain only slightly increased the risk of childhood overweight/obesity within each clinical BMI category (p-values for interactions of maternal BMI with gestational weight gain: p = 0.038, p < 0.001, and p = 0.637 in early, mid, and late childhood, respectively). Limitations of this study include the self-report of maternal BMI and gestational weight gain for some of the cohorts, and the potential of residual confounding. Also, as this study only included participants from Europe, North America, and Australia, results need to be interpreted with caution with respect to other populations.ConclusionsIn this study, higher maternal pre-pregnancy BMI and gestational weight gain were associated with an increased risk of childhood overweight/obesity, with the strongest effects at later ages. The additional effect of gestational weight gain in women who are overweight or obese before pregnancy is small. Given the large population impact, future intervention trials aiming to reduce the prevalence of childhood overweight and obesity should focus on maternal weight status before pregnancy, in addition to weight gain during pregnancy.
Partial Text: Maternal pre-pregnancy obesity and excessive gestational weight gain are major public health problems. Maternal obesity is an important risk factor of gestational hypertensive and diabetic disorders, fetal death, pre-term birth, and macrosomia [1,2]. An accumulating body of evidence suggests that maternal obesity also has persistent effects on long-term health in offspring . A meta-analysis of published studies showed a 3-fold increased risk of overweight in children of mothers with pre-pregnancy obesity, as compared to those of mothers with a normal pre-pregnancy weight . It remains unclear whether these risks differ by severity of obesity, and whether these effects are restricted to the extremes of maternal BMI or are present across the full range. In addition to maternal pre-pregnancy obesity, excessive gestational weight gain also seems to be associated with increased risks of childhood overweight and obesity . Previous meta-analyses of published studies showed a 30%–40% increased risk of childhood overweight in children of mothers with excessive gestational weight gain [5–7]. From a prevention perspective, insight into the combined effects of maternal BMI and gestational weight gain on offspring obesity risk and their population impact in different geographical regions is needed.
In this IPD meta-analysis, we observed that higher maternal pre-pregnancy BMI and gestational weight gain were across their full ranges associated with higher risks of offspring overweight/obesity throughout childhood. The effects tended to be stronger at older ages. However, the effect of gestational weight gain in addition to that of pre-pregnancy BMI was small. At the population level, 21.7% to 41.7% of childhood overweight/obesity prevalence was estimated to be attributable to maternal overweight and obesity together, whereas 11.4% to 19.2% was estimated to be attributable to excessive gestational weight gain.