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PLoS Med. 2019 Feb 11;16(2):e1002744. doi: 10.1371/journal.pmed.1002744. eCollection 2019 Feb.

Maternal body mass index, gestational weight gain, and the risk of overweight and obesity across childhood: An individual participant data meta-analysis.

Author information

1
The Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands.
2
Department of Pediatrics, Erasmus University Medical Center, Rotterdam, the Netherlands.
3
Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland.
4
Public Health Division of Gipuzkoa, San Sebastián, Spain.
5
BioDonostia Research Institute, San Sebastián, Spain.
6
CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
7
Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain.
8
EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
9
Department of Public Health and Forensic Sciences and Medical Education, Unit of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
10
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
11
Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
12
INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), ORCHAD Team, Villejuif, France.
13
Paris Descartes University, Villejuif, France.
14
Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America.
15
Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
16
Department of Genetics and Cell Biology, Maastricht University, Maastricht, the Netherlands.
17
INSERM, UMR1085, Irset-Research Institute for Environmental and Occupational Health, Rennes, France.
18
First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece.
19
Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
20
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom.
21
Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
22
Department of Exposure and Environmental Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
23
The Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
24
Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
25
NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
26
Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.
27
Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland.
28
Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, California, United States of America.
29
Center for Global Health, University of Illinois College of Medicine, Chicago, Illinois, United States of America.
30
Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.
31
Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland.
32
Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland.
33
Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland.
34
Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands.
35
MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom.
36
Population Health Science, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
37
Department of Public Health, University of Turku, Turku, Finland.
38
Department of Environmental Immunology/Core Facility Studies, Helmholtz Centre for Environmental Research-UFZ, Leipzig, Germany.
39
Division of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway.
40
Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland.
41
Turku Centre for Biotechnology, University of Turku and Abo Akademi University, Turku, Finland.
42
Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
43
UCD Perinatal Research Centre, Obstetrics & Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.
44
Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
45
UCD Perinatal Research Centre, School of Public Health and Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
46
Department of Epidemiology, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
47
National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
48
Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark.
49
Medical School, The University of Western Australia, Perth, Western Australia, Australia.
50
Department of Rehabilitation, Nutrition and Sport, La Trobe University, Melbourne, Victoria, Australia.
51
Paediatrics & Child Health, University College Cork, Cork, Ireland.
52
Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland.
53
Research Unit for Gynaecology and Obstetrics, Institute for Clinical Research, University of Southern Denmark, Odense, Denmark.
54
Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America.
55
Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam, the Netherlands.
56
Department of Environmental Exposures and Epidemiology, Domain of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.
57
Department of Public Health, University of Helsinki, Helsinki, Finland.
58
Department of Medical Sciences, University of Turin, Turin, Italy.
59
Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy.
60
Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany.
61
Norwegian Institute of Public Health, Oslo, Norway.
62
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
63
Dr. von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.
64
IB-Salut, Area de Salut de Menorca, Palma, Spain.
65
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
66
Department of Environmental Medicine, Slovak Medical University, Bratislava, Slovak Republic.
67
Child Health, Royal Aberdeen Children's Hospital, Aberdeen, United Kingdom.
68
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
69
Research Institute, Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany.
70
ISGlobal, Barcelona, Spain.
71
Universitat Pompeu Fabra (UPF), Barcelona, Spain.
72
Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, United Kingdom.
73
National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
74
Department of Medical and Social Problems of Family Health, Institute of Pediatrics, Obstetrics and Gynecology, Kyiv, Ukraine.
75
The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
76
Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.

Abstract

BACKGROUND:

Maternal 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 FINDINGS:

We 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.

CONCLUSIONS:

In 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.

Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: KMG has received reimbursement for speaking at conferences sponsored by companies selling nutritional products, and is part of an academic consortium that has received research funding from Abbott Nutrition, Nestec and Danone. HL has participated as an advisory board member, consultant and speaker for Nestlé Nutrition Institute and Nestlé Finland. DAL has received support from several National and International Government and Charity Funders and from Roche Diagnostics and Medtronic for research unrelated to that presented here. All support had been administered via DAL's institution; not directly to her. The other authors have declared that no competing interests exist.

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