TY - JOUR
T1 - Maternal body mass index, gestational weight gain, and the risk of overweight and obesity across childhood
T2 - An individual participant data meta-analysis
AU - Voerman, Ellis
AU - Santos, Susana
AU - Golab, Bernadeta Patro
AU - Amiano, Pilar
AU - Ballester, Ferran
AU - Barros, Henrique
AU - Bergstrom, Anna
AU - Charles, Marie-Aline
AU - Chatzi, Leda
AU - Chevrier, Cecile
AU - Chrousos, George P.
AU - Corpeleijn, Eva
AU - Costet, Nathalie
AU - Crozier, Sarah
AU - Devereux, Graham
AU - Eggesbo, Merete
AU - Ekstrom, Sandra
AU - Fantini, Maria Pia
AU - Farchi, Sara
AU - Forastiere, Francesco
AU - Georgiu, Vagelis
AU - Godfrey, Keith M.
AU - Gori, Davide
AU - Grote, Veit
AU - Hanke, Wojciech
AU - Hertz-Picciotto, Irva
AU - Heude, Barbara
AU - Hryhorczuk, Daniel
AU - Huang, Rae-Chi
AU - Inskip, Hazel
AU - Iszatt, Nina
AU - Karvonen, Anne M.
AU - Kenny, Louise C.
AU - Koletzko, Berthold
AU - Kupers, Leanne K.
AU - Lagstrom, Hanna
AU - Lehmann, Irina
AU - Magnus, Per
AU - Majewska, Renata
AU - Makela, Johanna
AU - Manios, Yannis
AU - McAuliffe, Fionnuala M.
AU - McDonald, Sheila W.
AU - Mehegan, John
AU - Mommers, Monique
AU - Morgen, Camilla S.
AU - Mori, Trevor A.
AU - Moschonis, George
AU - Murray, Deirdre
AU - Chaoimh, Carol Ni
AU - Nohr, Ellen A.
AU - Andersen, Anne-Marie Nybo
AU - Oken, Emily
AU - Oostvogels, Adriette J. J. M.
AU - Pac, Agnieszka
AU - Papadopoulou, Eleni
AU - Pekkanen, Juha
AU - Pizzi, Costanza
AU - Polanska, Kinga
AU - Porta, Daniela
AU - Richiardi, Lorenzo
AU - Rifas-Shiman, Sheryl L.
AU - Ronfani, Luca
AU - Santos, Ana C.
AU - Standl, Marie
AU - Stoltenberg, Camilla
AU - Thiering, Elisabeth
AU - Thijs, Carel
AU - Torrent, Maties
AU - Tough, Suzanne C.
AU - Trnovec, Tomas
AU - Turner, Steve
AU - Van Rossem, Lenie
AU - Von Berg, Andrea
AU - Vrijheid, Martine
AU - Vrijkotte, Tanja G. M.
AU - West, Jane
AU - Wijga, Alet
AU - Wright, John
AU - Zvinchuk, Oleksandr
AU - Sorensen, Thorkild I. A.
AU - Lawlor, Debbie A.
AU - Gaillard, Romy
AU - Jaddoe, Vincent W. V.
N1 - Funding Information:
BPG received a research training fellowship grant from the Nestle Nutrition Institute. The work of VG and BK is financially supported in part by the Commission of the European Communities, Projects Early Nutrition (FP7-289346), DYNAHEALTH (H2020-633595) and LIFECYCLE (H2020-SC1-2016-RTD), the European Research Council Advanced Grant META-GROWTH (ERC-2012-AdG 322605). ACS holds a FCT Investigator contract IF/01060/2015. JWe is funded by a UK Medical Research Council (MRC) Population Health Scientist Postdoctoral Award (MR/K021656/1). DAL works in a unit that receives UK MRC funding (MC_UU_12013/5) and is an NIHR senior investigator (NF-SI-0611-10196). RG received funding from the Dutch Heart Foundation (grant number 2017T013) and the Dutch Diabetes Foundation (grant number 2017.81.002). VWVJ received grants from the Netherlands Organization for Health Research and Development (VIDI 016.136.361) and the European Research Council (Consolidator Grant, ERC-2014-CoG-648916). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Cohort-specific sources of funding are listed in S2 Text.
Publisher Copyright:
© 2019 Voerman et al.
PY - 2019/2
Y1 - 2019/2
N2 - 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 lifestylerelated 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.
AB - 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 lifestylerelated 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.
KW - BIRTH
KW - CHILDREN
KW - HEALTH
KW - INTERVENTION
KW - OFFSPRING OBESITY
KW - PREGNANCY
KW - WOMEN
U2 - 10.1371/journal.pmed.1002744
DO - 10.1371/journal.pmed.1002744
M3 - Article
C2 - 30742624
SN - 1549-1277
VL - 16
JO - PLOS Medicine
JF - PLOS Medicine
IS - 2
M1 - 1002744
ER -