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

Maternal body mass index, gestational weight gain and the risk of overweight and obesity across childhood: an individual participant data meta-analysis
Maternal body mass index, gestational weight gain and the risk of overweight and obesity across childhood: an individual participant data meta-analysis
Background: maternal obesity and excessive gestational weight gain may have persistent effects on offspring fat development. However, it remains unclear whether these risks 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 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 socio-demographic and life style related characteristics. We observed that a 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 (OR) for overweight/obesity in early-, mid- and late childhood, respectively: 1.66 (95% Confidence Interval (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 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.
1549-1277
1-22
Voerman, Ellis
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Santos, Susana G.
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Golab, Bernadeta Patro
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Amiano, Pilar
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Voerman, Ellis, Santos, Susana G., Golab, Bernadeta Patro, Amiano, Pilar, Ballester, Ferran, Barros, Henrique, Bergström, Anna, Charles, Marie-Aline, Chatzi, Leda, Chevrier, Cecile, Chrousos, George P., Corpeleijn, Eva, Costet, Nathalie, Crozier, Sarah, Devereux, Graham, Eggesbø, Merete, Ekström, Sandra, Fantini, Maria Pia, Farchi, Sara, Forastiere, Francesco, Georgiu, Vagelis, Godfrey, Keith, Gori, Davide, Grote, Veit, Hanke, Wojciech, Hertz-Picciotto, Irva, Heude, Barbara, Hryhorczuk, Daniel O., Huang, Rae-Chi, Inskip, Hazel, Iszatt, Nina, Karvonen, Anne M., Kenny, Louise C., Koletzko, Berthold, Küpers, Leanne K., Lagstrom, Hanna, Lehmann, Irina, Magnus, Per, Majewska, Renata, Makela, Johanna, Manios, Yannis, McAuliffe, Fionnuala M., McDonald, Sheila W., Mehegan, John, Mommers, Monique, Morgen, Camilla S, Mori, Trevor A., Moschonis, George, Murray, Deirdre, Chaoimh, Carol Ni, Nohr, Ellen Aagaard, Nybo Andersen, Anne-Marie, Oken, Emily, Oostvogels, Adriette J J M., Pac, Agnieszka, Papadopoulou, Eleni, Pekkanen, Juha, Pizzi, Costanza, Polanska, Kinga, Porta, Daniela, Stoltenberg, Camilla, Thiering, Elisabeth, Richiardi, Lorenzo, Rifas-shiman, Sheryl L., Ronfani, Luca, Santos, Ana C., Standl, Marie, Thijs, Carel, Torrent, Maties, Tough, Suzanne C., Trnovec, Tomas, Turner, Steve, van Rossem, Lenie, von Berg, Andrea, Vrijheid, Martine, Vrijkotte, Tanja G. M., West, Jane, Wijga, Alet H., Wright, John, Zvinchuk, Oleksandr, Sørensen, Thorkild I. A., Lawlor, Debbie A, Gaillard, Romy and Jaddoe, Vincent W. V. (2019) Maternal body mass index, gestational weight gain and the risk of overweight and obesity across childhood: an individual participant data meta-analysis. PLoS Medicine, 16 (2), 1-22, [e1002744]. (doi:10.1371/journal.pmed.1002744).

Record type: Article

Abstract

Background: maternal obesity and excessive gestational weight gain may have persistent effects on offspring fat development. However, it remains unclear whether these risks 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 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 socio-demographic and life style related characteristics. We observed that a 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 (OR) for overweight/obesity in early-, mid- and late childhood, respectively: 1.66 (95% Confidence Interval (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 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.

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07012019 Manuscript Childhood overweight - Accepted Manuscript
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journal.pmed.1002744 - Version of Record
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Accepted/In Press date: 9 January 2019
e-pub ahead of print date: 11 February 2019

Identifiers

Local EPrints ID: 427579
URI: http://eprints.soton.ac.uk/id/eprint/427579
ISSN: 1549-1277
PURE UUID: 8db1d0bf-bd82-4082-9aa8-f81a1b779d6d
ORCID for Sarah Crozier: ORCID iD orcid.org/0000-0002-9524-1127
ORCID for Keith Godfrey: ORCID iD orcid.org/0000-0002-4643-0618
ORCID for Hazel Inskip: ORCID iD orcid.org/0000-0001-8897-1749

Catalogue record

Date deposited: 23 Jan 2019 17:30
Last modified: 10 Jan 2022 02:44

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Contributors

Author: Ellis Voerman
Author: Susana G. Santos
Author: Bernadeta Patro Golab
Author: Pilar Amiano
Author: Ferran Ballester
Author: Henrique Barros
Author: Anna Bergström
Author: Marie-Aline Charles
Author: Leda Chatzi
Author: Cecile Chevrier
Author: George P. Chrousos
Author: Eva Corpeleijn
Author: Nathalie Costet
Author: Sarah Crozier ORCID iD
Author: Graham Devereux
Author: Merete Eggesbø
Author: Sandra Ekström
Author: Maria Pia Fantini
Author: Sara Farchi
Author: Francesco Forastiere
Author: Vagelis Georgiu
Author: Keith Godfrey ORCID iD
Author: Davide Gori
Author: Veit Grote
Author: Wojciech Hanke
Author: Irva Hertz-Picciotto
Author: Barbara Heude
Author: Daniel O. Hryhorczuk
Author: Rae-Chi Huang
Author: Hazel Inskip ORCID iD
Author: Nina Iszatt
Author: Anne M. Karvonen
Author: Louise C. Kenny
Author: Berthold Koletzko
Author: Leanne K. Küpers
Author: Hanna Lagstrom
Author: Irina Lehmann
Author: Per Magnus
Author: Renata Majewska
Author: Johanna Makela
Author: Yannis Manios
Author: Fionnuala M. McAuliffe
Author: Sheila W. McDonald
Author: John Mehegan
Author: Monique Mommers
Author: Camilla S Morgen
Author: Trevor A. Mori
Author: George Moschonis
Author: Deirdre Murray
Author: Carol Ni Chaoimh
Author: Ellen Aagaard Nohr
Author: Anne-Marie Nybo Andersen
Author: Emily Oken
Author: Adriette J J M. Oostvogels
Author: Agnieszka Pac
Author: Eleni Papadopoulou
Author: Juha Pekkanen
Author: Costanza Pizzi
Author: Kinga Polanska
Author: Daniela Porta
Author: Camilla Stoltenberg
Author: Elisabeth Thiering
Author: Lorenzo Richiardi
Author: Sheryl L. Rifas-shiman
Author: Luca Ronfani
Author: Ana C. Santos
Author: Marie Standl
Author: Carel Thijs
Author: Maties Torrent
Author: Suzanne C. Tough
Author: Tomas Trnovec
Author: Steve Turner
Author: Lenie van Rossem
Author: Andrea von Berg
Author: Martine Vrijheid
Author: Tanja G. M. Vrijkotte
Author: Jane West
Author: Alet H. Wijga
Author: John Wright
Author: Oleksandr Zvinchuk
Author: Thorkild I. A. Sørensen
Author: Debbie A Lawlor
Author: Romy Gaillard
Author: Vincent W. V. Jaddoe

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