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

Ellis Voerman, Susana Santos, Bernadeta Patro Golab, Pilar Amiano, Ferran Ballester, Henrique Barros, Anna Bergstrom, Marie-Aline Charles, Leda Chatzi, Cecile Chevrier, George P. Chrousos, Eva Corpeleijn, Nathalie Costet, Sarah Crozier, Graham Devereux, Merete Eggesbo, Sandra Ekstrom, Maria Pia Fantini, Sara Farchi, Francesco Forastiere & 64 others 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. Kupers, Hanna Lagstrom, Irina Lehmann, Per Magnus, Renata Majewska, Johanna Makela, Yannis Manios, Fionnuala M. McAuliffe, Sheila W. McDonald, John Mehegan, Monique Mommers, Camilla S. Morgen, Trevor A. Mori, George Moschonis, Deirdre Murray, Carol Ni Chaoimh, Ellen A. Nohr, Anne-Marie Nybo Andersen, Emily Oken, Adriette 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. Sorensen, Debbie A. Lawlor, Romy Gaillard, Vincent W. V. Jaddoe

Research output: Contribution to journalArticle

9 Citations (Scopus)

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 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.

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.

Original languageEnglish
Article number1002744
Number of pages22
JournalPLoS Medicine
Volume16
Issue number2
DOIs
Publication statusPublished - Feb 2019

Cite this

Voerman, Ellis ; Santos, Susana ; Golab, Bernadeta Patro ; Amiano, Pilar ; Ballester, Ferran ; Barros, Henrique ; Bergstrom, Anna ; Charles, Marie-Aline ; Chatzi, Leda ; Chevrier, Cecile ; Chrousos, George P. ; Corpeleijn, Eva ; Costet, Nathalie ; Crozier, Sarah ; Devereux, Graham ; Eggesbo, Merete ; Ekstrom, Sandra ; Fantini, Maria Pia ; Farchi, Sara ; Forastiere, Francesco ; Georgiu, Vagelis ; Godfrey, Keith M. ; Gori, Davide ; Grote, Veit ; Hanke, Wojciech ; Hertz-Picciotto, Irva ; Heude, Barbara ; Hryhorczuk, Daniel ; Huang, Rae-Chi ; Inskip, Hazel ; Iszatt, Nina ; Karvonen, Anne M. ; Kenny, Louise C. ; Koletzko, Berthold ; Kupers, 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 A. ; Andersen, Anne-Marie Nybo ; Oken, Emily ; Oostvogels, Adriette J. J. M. ; Pac, Agnieszka ; Papadopoulou, Eleni ; Pekkanen, Juha ; Pizzi, Costanza ; Polanska, Kinga ; Porta, Daniela ; Richiardi, Lorenzo ; Rifas-Shiman, Sheryl L. ; Ronfani, Luca ; Santos, Ana C. ; Standl, Marie ; Stoltenberg, Camilla ; Thiering, Elisabeth ; 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 ; Wright, John ; Zvinchuk, Oleksandr ; Sorensen, Thorkild I. A. ; Lawlor, Debbie A. ; Gaillard, Romy ; Jaddoe, Vincent W. V. / Maternal body mass index, gestational weight gain, and the risk of overweight and obesity across childhood : An individual participant data meta-analysis. In: PLoS Medicine. 2019 ; Vol. 16, No. 2.
@article{d1541141d52a408786cd0515be698393,
title = "Maternal body mass index, gestational weight gain, and the risk of overweight and obesity across childhood: An individual participant data meta-analysis",
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 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.",
keywords = "OFFSPRING OBESITY, PREGNANCY, CHILDREN, HEALTH, INTERVENTION, BIRTH, WOMEN",
author = "Ellis Voerman and Susana Santos and Golab, {Bernadeta Patro} and Pilar Amiano and Ferran Ballester and Henrique Barros and Anna Bergstrom and Marie-Aline Charles and Leda Chatzi and Cecile Chevrier and Chrousos, {George P.} and Eva Corpeleijn and Nathalie Costet and Sarah Crozier and Graham Devereux and Merete Eggesbo and Sandra Ekstrom and Fantini, {Maria Pia} and Sara Farchi and Francesco Forastiere and Vagelis Georgiu and Godfrey, {Keith M.} and Davide Gori and Veit Grote and Wojciech Hanke and Irva Hertz-Picciotto and Barbara Heude and Daniel Hryhorczuk and Rae-Chi Huang and Hazel Inskip and Nina Iszatt and Karvonen, {Anne M.} and Kenny, {Louise C.} and Berthold Koletzko and Kupers, {Leanne K.} and Hanna Lagstrom and Irina Lehmann and Per Magnus and Renata Majewska and Johanna Makela and Yannis Manios and McAuliffe, {Fionnuala M.} and McDonald, {Sheila W.} and John Mehegan and Monique Mommers and Morgen, {Camilla S.} and Mori, {Trevor A.} and George Moschonis and Deirdre Murray and Chaoimh, {Carol Ni} and Nohr, {Ellen A.} and Andersen, {Anne-Marie Nybo} and Emily Oken and Oostvogels, {Adriette J. J. M.} and Agnieszka Pac and Eleni Papadopoulou and Juha Pekkanen and Costanza Pizzi and Kinga Polanska and Daniela Porta and Lorenzo Richiardi and Rifas-Shiman, {Sheryl L.} and Luca Ronfani and Santos, {Ana C.} and Marie Standl and Camilla Stoltenberg and Elisabeth Thiering and Carel Thijs and Maties Torrent and Tough, {Suzanne C.} and Tomas Trnovec and Steve Turner and {Van Rossem}, Lenie and {Von Berg}, Andrea and Martine Vrijheid and Vrijkotte, {Tanja G. M.} and Jane West and Alet Wijga and John Wright and Oleksandr Zvinchuk and Sorensen, {Thorkild I. A.} and Lawlor, {Debbie A.} and Romy Gaillard and Jaddoe, {Vincent W. V.}",
year = "2019",
month = "2",
doi = "10.1371/journal.pmed.1002744",
language = "English",
volume = "16",
journal = "PLoS Medicine",
issn = "1549-1277",
publisher = "Public Library of Science (PLoS)",
number = "2",

}

Voerman, E, Santos, S, Golab, BP, Amiano, P, Ballester, F, Barros, H, Bergstrom, A, Charles, M-A, Chatzi, L, Chevrier, C, Chrousos, GP, Corpeleijn, E, Costet, N, Crozier, S, Devereux, G, Eggesbo, M, Ekstrom, S, Fantini, MP, Farchi, S, Forastiere, F, Georgiu, V, Godfrey, KM, Gori, D, Grote, V, Hanke, W, Hertz-Picciotto, I, Heude, B, Hryhorczuk, D, Huang, R-C, Inskip, H, Iszatt, N, Karvonen, AM, Kenny, LC, Koletzko, B, Kupers, LK, Lagstrom, H, Lehmann, I, Magnus, P, Majewska, R, Makela, J, Manios, Y, McAuliffe, FM, McDonald, SW, Mehegan, J, Mommers, M, Morgen, CS, Mori, TA, Moschonis, G, Murray, D, Chaoimh, CN, Nohr, EA, Andersen, A-MN, Oken, E, Oostvogels, AJJM, Pac, A, Papadopoulou, E, Pekkanen, J, Pizzi, C, Polanska, K, Porta, D, Richiardi, L, Rifas-Shiman, SL, Ronfani, L, Santos, AC, Standl, M, Stoltenberg, C, Thiering, E, Thijs, C, Torrent, M, Tough, SC, Trnovec, T, Turner, S, Van Rossem, L, Von Berg, A, Vrijheid, M, Vrijkotte, TGM, West, J, Wijga, A, Wright, J, Zvinchuk, O, Sorensen, TIA, Lawlor, DA, Gaillard, R & Jaddoe, VWV 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, vol. 16, no. 2, 1002744. https://doi.org/10.1371/journal.pmed.1002744

Maternal body mass index, gestational weight gain, and the risk of overweight and obesity across childhood : An individual participant data meta-analysis. / Voerman, Ellis; Santos, Susana; Golab, Bernadeta Patro; Amiano, Pilar; Ballester, Ferran; Barros, Henrique; Bergstrom, Anna; Charles, Marie-Aline; Chatzi, Leda; Chevrier, Cecile; Chrousos, George P.; Corpeleijn, Eva; Costet, Nathalie; Crozier, Sarah; Devereux, Graham; Eggesbo, Merete; Ekstrom, Sandra; Fantini, Maria Pia; Farchi, Sara; Forastiere, Francesco; Georgiu, Vagelis; Godfrey, Keith M.; Gori, Davide; Grote, Veit; Hanke, Wojciech; Hertz-Picciotto, Irva; Heude, Barbara; Hryhorczuk, Daniel; Huang, Rae-Chi; Inskip, Hazel; Iszatt, Nina; Karvonen, Anne M.; Kenny, Louise C.; Koletzko, Berthold; Kupers, 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 A.; Andersen, Anne-Marie Nybo; Oken, Emily; Oostvogels, Adriette J. J. M.; Pac, Agnieszka; Papadopoulou, Eleni; Pekkanen, Juha; Pizzi, Costanza; Polanska, Kinga; Porta, Daniela; Richiardi, Lorenzo; Rifas-Shiman, Sheryl L.; Ronfani, Luca; Santos, Ana C.; Standl, Marie; Stoltenberg, Camilla; Thiering, Elisabeth; 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; Wright, John; Zvinchuk, Oleksandr; Sorensen, Thorkild I. A.; Lawlor, Debbie A.; Gaillard, Romy; Jaddoe, Vincent W. V.

In: PLoS Medicine, Vol. 16, No. 2, 1002744, 02.2019.

Research output: Contribution to journalArticle

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.

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 - OFFSPRING OBESITY

KW - PREGNANCY

KW - CHILDREN

KW - HEALTH

KW - INTERVENTION

KW - BIRTH

KW - WOMEN

U2 - 10.1371/journal.pmed.1002744

DO - 10.1371/journal.pmed.1002744

M3 - Article

VL - 16

JO - PLoS Medicine

JF - PLoS Medicine

SN - 1549-1277

IS - 2

M1 - 1002744

ER -