Risks of maternal prepregnancy overweight/obesity, excessive gestational weight gain, and bottle-feeding in infancy rapid weight gain: evidence from a cohort study in China

Mediating role of birth at a baby-friendly hospital in the association between parental socioeconomic status and infant exclusive breastfeeding at six months old

BACKGROUND

Current evidence suggests that the exclusive breastfeeding (EBF) rate at six months postpartum in China falls considerably below the targets recommended by the World Health Organization (WHO). Socioeconomic disparities in EBF have been observed in developing countries, with significant heterogeneity across studies. Despite the implementation of the Baby-Friendly Hospital Initiative (BFHI) in China since the 1990s to promote breastfeeding, there has been a lack of assessment concerning infants from different socioeconomic backgrounds. This study sought to investigate the association between socioeconomic status (SES) and EBF and explore the potential impact of giving birth at a Baby-Friendly Hospital (BFH) on this association.

METHODS

We analyzed data from 98,469 mother-child dyads selected from the Maternal and Child Health Management Information System. We used log-binomial models to examine the relationships between SES and EBF, SES and giving birth at a BFH, as well as BFH births and EBF. Additionally, we explored a counterfactual mediation approach to assess the mediating role of BFH births in the SES-EBF association.

FINDINGS

We identified a significant association between SES and EBF (RRMedium vs. Low = 1.47, 95% CI 1.39-1.55; RRHigh vs. Low = 1.40, 95% CI 1.32-1.49). Mothers with higher SES were more likely to give birth at BFHs (RRMedium vs. Low = 1.85, 95% CI 1.81-1.88; RRHigh vs. Low=2.29, 95% CI 2.25-2.33). The significance of the SES-EBF association was attenuated when the type of hospital for childbirth was considered, revealing the significant mediating effect of BFH births in the SES-EBF association.

CONCLUSION

Socioeconomic disparities are linked to infant EBF rates, with giving birth at a BFH mediating this association, especially for cases with low SES in rural areas.

Magnitude of bottle-feeding practice and associated factors among mothers of 0-24 months' children in Asella town, Oromia region, Ethiopia

BACKGROUND

Since bottle feeding has an impact on the effectiveness of breastfeeding and appropriate supplemental feeding, the World health organization recommends being avoided for infant and early child feeding. Thus, this study aimed to assess the level of the bottle-feeding practice and its associated factors among mothers of 0-24 month's children in Asella town, Oromia region, Ethiopia.

METHODS

Community-based cross-sectional study design was conducted from March 8-April 8, 2022, among a sample of 692 mothers of children aged 0-24 months. A multi-stage sampling technique was used to select the study subjects. Data were collected using a pretested and structured questionnaire by face-to-face interview technique questionnaire. The outcome variable bottle-feeding practice (BFP) was assessed using WHO and UNICEF UK healthy baby initiative BF assessment tools. Binary logistic regression analysis was used to identify the association between explanatory and outcome variables. Adjusted Odds ratio (AOR) with a 95% confidence interval was used to measure the strength of the association and a p-value < 0.05 was used to declare statistical significance.

RESULTS

A total of 692 mothers with mean age and standard deviation (SD) of 31.86 (± 4.87) participated in the study. The prevalence of bottle-feeding practice was 246(35.5% with 95% CI: (31.8, 39.5). Mothers who were government-employed (AOR: 1.64, 95% CI: 1.02, 2.64), mothers who delivered at home (AOR: 3.74, 95% CI: 2.58-5.42), mothers who did not attend postnatal care (AOR: 3.76, 95% CI: 2.60,5.44) and mother who had negative attitude (AOR: 1.94, 95%CI: 1.34,2.8) were significantly associated with bottle feeding practices.

CONCLUSION

The BFP were higher in the study area when compared with national reports of practices. The occupational status of the mothers, place of delivery, attending postnatal care, and attitude of the mothers were factors that increased bottle-feeding practice in the study area. Strengthening dietary behavioral modification for mothers who have children 0-24 months of the child to practice appropriate feeding is recommended.

Timing of infant formula introduction in relation to BMI and overweight at ages 1 and 3 years: the Born in Guangzhou Cohort Study (BIGCS)

Mounting evidence suggests that the first few months of life are critical for the development of obesity. The relationships between the timing of solid food introduction and the risk of childhood obesity have been examined previously; however, evidence for the association of timing of infant formula introduction remains scarce. This study aimed to examine whether the timing of infant formula introduction is associated with growth z-scores and overweight at ages 1 and 3 years. This study included 5733 full-term (≥ 37 gestational weeks) and normal birth weight (≥ 2500 and < 4000 g) children in the Born in Guangzhou Cohort Study, a prospective cohort study with data collected at 6 weeks, 6, 12 and 36 months. Compared with infant formula introduction at 0-3 months, introduction at 4-6 months was associated with the lower BMI, weight-for-age and weight-for-length z-scores at 1 and 3 years old. Also, introduction at 4-6 months was associated with the lower odds of at-risk of overweight at age 1 (adjusted OR 0·72, 95 % CI 0·55, 0·94) and 3 years (adjusted OR 0·50, 95 % CI 0·30, 0·85). Introduction at 4-6 months also decreased the odds of overweight at age 1 year (adjusted OR 0·42, 95 % CI 0·21, 0·84) but not at age 3 years. Based on our findings, compared with introduction within the first 3 months, introduction at 4-6 months has a reduction on later high BMI risk and at-risk of overweight. However, these results need to be replicated in other well-designed studies before more firm recommendations can be made.

The care of infants with rapid weight gain: Should we be doing more?

Rapid weight gain (RWG) during infancy is a known risk factor for later childhood obesity. It can be measured using a range of definitions across various time periods in the first 2 years of life. In recent years, some early childhood obesity prevention trials have included a focus on preventing RWG during infancy, with modest success. Overall, RWG during infancy remains common, yet little work has examined whether infants with this growth pattern should receive additional care when it is identified in health-care settings. In this viewpoint, we contend that RWG during infancy should be routinely screened for in health-care settings, and when identified, viewed as an opportunity for health-care professionals to instigate non-stigmatising discussions with families about RWG and general healthy practices for their infants. If families wish to engage, we suggest that six topics from early life obesity prevention studies (breastfeeding, formula feeding, complementary feeding, sleep, responsive parenting, and education around growth charts and monitoring) could form the foundations of conversations to help them establish and maintain healthy habits to support their infant's health and well-being and potentially lower the risk of later obesity. However, further work is needed to develop definitive guidelines in this area, and to address other gaps in the literature, such as the current lack of a standardised definition for RWG during infancy and a clear understanding of the time points over which it should be measured.

Is Infant and Young Child-feeding (IYCF) a potential double-duty strategy to prevent the double burden of malnutrition among children at the critical age? Evidence of association from urban slums in Pune, Maharashtra, India

BACKGROUND

This study characterized undernutrition among children (0-24 months) by age groups specified for Infant and Young Child-feeding (IYCF) and determined the association between child malnutrition and IYCF.

METHODS

This cross-sectional survey recruited mother-children dyads (N = 1443). WHO standards were used to assess nutritional status and IYCF indicators. Multivariate analyses were performed to assess the association between IYCF and nutritional indicators.

RESULTS

Stunting, underweight, wasting, overweight, and obesity were prevalent in 33.1%, 26%, 20.2%, 4.6%, and 2.9% of the children, respectively. Age-wise distribution of undernutrition identified severity of stunting and underweight at 10-24 months (median < -1.6 SD; < -1.2 SD; 25th percentile at -2.6 & -2.2 SD respectively) and wasting highest at 0-6 months (25th percentile close to -2SD). Boys manifested higher stunting (lower value -5.2 SD) and were more wasted (lower value -4.7 SD). IYCF prevalence recorded early initiation at 45.2%, exclusive breastfeeding at 23.1%, and prelacteal and bottle-feeding at 37.5 and 22.5% respectively. Child minimum diet diversity (MDD) ≥4 was not achieved by 84%. Minimum meal frequency and minimum acceptable diet were achieved by 75% and 14% respectively. Bottle-feeding increased the odds of wasting [AOR: 1.501 (95% CI: 1.062-2.121)], severe stunting [AOR: 1.595 (95% CI: 1.079-2.358)] and underweight [AOR: 1.519 (95% CI 1.102-2.094)]. Wasting according to BAZ scores was associated with delayed initiation of breastfeeding [AOR: 1.387 (95% CI: 1.018-1.889)] and bottle feeding [AOR: 1.538 (95% CI: 1.087-2.175)]. Delayed introduction of complementary feeding increased the odds of severe stunting [AOR: 2.189 (95% CI: 1.090-4.399)]. Formula feeding increased the odds of underweight [AOR: 1.738 (95% CI: 1.046-2.888)] and obesity [AOR: 4.664 (95% CI: 1.351-16.10)]. Prelacteal feeding increased the odds of severe forms of stunting and underweight by 56% and 79% respectively, and overweight by 96%.

CONCLUSION

Setting and age-specific interventions to improve age-appropriate child-feeding practices are vital to address the double burden of malnutrition in the critical age group.

Associations between KCNQ1 and ITIH4 gene polymorphisms and infant weight gain in early life

BACKGROUND

An earlier meta-analysis of genome-wide association studies in Asian populations detected five novel body mass index-associated single-nucleotide polymorphisms (SNPs), including potassium voltage-gated channel subfamily Q member 1 (KCNQ1) (rs2237892), ALDH2/MYL2 (rs671, rs12229654), ITIH4 (rs2535633), and NT5C2 (rs11191580). Whether these SNPs take effect in early life, for example, affect infant rapid weight gain (RWG), is unclear.

METHODS

We obtained genomic DNA from 460 term infants with normal birth weight. RWG was defined as the change of weight-for-age standardized Z-score, calculated according to the Children Growth Standard released by the World Health Organization, from birth to 3 months of age >0.67. Using genetic models, associations between the candidate SNPs and infant RWG were examined, along with the interaction between the SNPs and the potential risk factors.

RESULTS

RWG was presented in 225 of 460 infants. SNP rs2535633 and rs2237892 were associated with the risk of RWG. Both additive and multiplicative interaction effects were found between infant delivery mode and rs2237892. The negative association between the rs2237892 T allele and infant RWG was only observed in vaginally delivered infants.

CONCLUSIONS

Obesity-related loci rs2535633 and rs2237892 are associated with infant RWG in the first 3 months of infancy. The relationship between rs2237892 and infant RGW might be moderated by cesarean delivery.

IMPACT

Genetic predisposition is an essential aspect to understand infant weight gain. Obesity-related SNPs, rs2535633 and rs2237892, are associated with RWG in very early years of life. The negative association between rs2237892 T allele and RWG is only observed in infants delivered vaginally instead of cesarean section.

Associations between Gene-Gene Interaction and Overweight/Obesity of 12-Month-Old Chinese Infants

Background

Childhood overweight and obesity (OW/OB) is a worldwide public health problem, and its genetic risks remain unclear.

Objectives

To investigate risks of OW/OB associated with genetic variances in SEC16B rs543874 and rs10913469, BDNF rs11030104 and rs6265, NT5C2 rs11191580, PTBP2 rs11165675, ADCY9 rs2531995, FAM120A rs7869969, KCNQ1 rs2237892, and C4orf33 rs2968990 in Chinese infants at 12-month old.

Methods

We conducted a case-control study with 734 infants included at delivery and followed up to 12-month old. The classification and regression tree analysis were used to generate the structure of the gene-gene interactions, while the unconditional multivariate logistic regression models were applied to analyze the single SNP, gene-gene interactions, and cumulative effects of the genotypes on OW/OB, adjusted for potential confounders.

Results

There were 219 (29.84%) OW/OB infants. Rs543874 G allele and rs11030104 AA genotype increased the risk of OW/OB in 12-month-old infants (P < 0.05). Those carrying both rs11030104 AA genotype and rs10913469 C allele had 4.3 times greater OW/OB than those carrying rs11030104 G allele, rs11191580 C allele, rs11165675 A allele, and rs543874 AA genotype. Meanwhile, the risk of OW/OB increased with the number of the risk genotypes individuals harbored.

Conclusions

Rs543874, rs11030104, and rs11191580 were associated with OW/OB in 12-month-old Chinese infants, and the three SNPs together with rs10913469 and rs11165675 had a combined effect on OW/OB.

Association between rapid weight gain and overweight in children aged 0 to 5 years in Latin America

Abstract Objectives: to assess the prevalence of rapid weight gain (RWG) in children born with normal weight and its association with overweight (OW) in four Latin America countries. Methods: cross-sectional study in children aged 0 to 5 from the Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher in Brazil and the Encuesta Nacional de Demografía y Salud in Bolivia, Colombia and Peru,using a birth weight ≥2,500g. The outcome variable was OW, the exposure was RWG and breastfeeding (BF) was the adjustment variable. Prevalence, odds ratio and 95% confidence intervalwere estimated using multivariate logistic regression model. Results: there was a greater prevalence of RWG and BF at less than 6 months in Brazil, and a greater prevalence of OW in Brazil and Bolivia. The chances of OW when RWG was present and adjusted for BF were 6.1 times (CI95% = 3.8-9.7) in Brazil, 4.4 times (CI95% = 3.6-5.3) in Bolivia, 6.7 times (CI95% = 5.5-8.2) in Colombia, and 12.2 times in Peru (CI95% = 9.4-15.7) with a p < 0.001 for all countries. Conclusions: RWG in children with normal birth weight was associated with a greater chance of being OW in the four observed Latin America countries.

Early childhood body mass index trajectory and overweight/obesity risk differed by maternal weight status

OBJECTIVES

To evaluate the associations of maternal prepregnancy body mass index (pp-BMI) and gestational weight gain (GWG) with the childhood BMI z-score (BMI-z) trajectories from birth to 2 years old and the risk of overweight/obesity (OWO) at 2 years of age.

SUBJECTS/METHODS

Mother-child dyads (23,617) were involved in the analysis. They were followed up from early pregnancy to 2 years postpartum with their healthcare data recorded in the Wuhan Maternal and Child Health Management Information System (WMCHMIS). The OWO in children was defined as BMI-z > 1. Linear mixed models (LMM) and unconditional logistic regression were used to evaluate the independent and joint associations of pp-BMI and GWG with the BMI-z trajectory of children per their anthropometric measurements at 0, 1, 3, 6, 9, 12, 18, and 24 months old and the risk of OWO at 2 years of age.

RESULTS

Maternal overweight/obesity and excessive GWG independently and jointly increased the risks of their offspring falling into high BMI-z trajectories of birth to 2 years (p < 0.001). In addition, the children whose mothers were overweight/obese before pregnancy and gained excessive weight during pregnancy independently and jointly increased the OWO risk in children at age 2, with adjusted odds ratios (adjOR) of 1.36 (95% CI, 1.22-1.53), 1.28 (95% CI, 1.18-1.39), and 1.76 (95% CI: 1.52-2.03), respectively.

CONCLUSIONS

Maternal prepregnancy overweight/obesity and excessive GWG can independently and jointly increase the risks of their children falling into high BMI-z trajectories from birth to 2 years of age and becoming overweight/obese at age 2. Maternal overweight/obesity and excessive gestational weight should be the prime targets for early obese prevention efforts.

Transmission of a Novel Imprinting Center Deletion Associated With Prader-Willi Syndrome Through Three Generations of a Chinese Family: Case Presentation, Differential Diagnosis, and a Lesson Worth Thinking About

Prader-Willi syndrome (PWS) is a complex genetic syndrome caused by the loss of function of genes in 15q11-q13 that are subject to regulation by genomic imprinting and expressed from the paternal allele only. The main clinical features of PWS patients are hypotonia during the neonatal and infantile stages, accompanied by delayed neuropsychomotor development, hyperphagia, obesity, hypogonadism, short stature, small hands and feet, mental disabilities, and behavioral problems. However, PWS has a clinical overlap with other disorders, especially those with other gene variations or chromosomal imbalances but sharing part of the similar clinical manifestations with PWS, which are sometimes referred to as Prader-Willi syndrome-like (PWS-like) disorders. Furthermore, it is worth mentioning that significant obesity as a consequence of hyperphagia in PWS usually develops between the ages of 1 and 6 years, which makes early diagnosis difficult. Thus, PWS is often not clinically recognized in infants and, on the other hand, may be wrongly suspected in obese and intellectually disabled patients. Therefore, an accurate investigation is necessary to differentiate classical PWS from PWS-like phenotypes, which is imperative for further treatment. For PWS, it is usually sporadic, and very rare family history and affected siblings have been described. Here, we report the clinical and molecular findings in a three-generation family with a novel 550-kb microdeletion affecting the chromosome 15 imprinting center (IC). Overall, the present study finds that the symptoms of our patient are somewhat different from those of typical PWS cases diagnosed and given treatment in our hospital. The familial occurrence and clinical features were challenging to our diagnostic strategy. The microdeletion included a region within the complex small nuclear ribonucleoprotein polypeptide protein N (SNRPN) gene locus encompassing the PWS IC and was identified by using a variety of techniques. Haplotype studies suggest that the IC microdeletion was vertically transmitted from an unaffected paternal grandmother to an unaffected father and then caused PWS in two sibling grandchildren when the IC microdeletion was inherited paternally. Based on the results of our study, preimplantation genetic diagnosis (PGD) was applied successfully to exclude imprinting deficiency in preimplantation embryos before transfer into the mother's uterus. Our study may be especially instructive regarding accurate diagnosis, differential diagnosis, genetic counseling, and PGD for familial PWS patients.

Association of infant feeding patterns with body fat mass and obesity in the first 2 years of life: a longitudinal twin birth cohort study

Childhood obesity is a major public health problem with no effective intervention. We explored the influence of feeding patterns on infants' growth indices within the first 2 years in a twin birth cohort. Dietary intake at 12 months was recorded with a food frequency questionnaire, and dietary patterns were identified by principal component analysis. Milk feeding methods in first 6 months were categorised as breastfeeding or exclusive formula feeding. Correlations between feeding patterns and infants' growth indices were examined via generalised estimating equations. Two dietary patterns were identified and neither of which was related to growth indices. Breastfed infants had a higher body fat mass (BFM) percentage at 12 months, a higher body mass index (BMI) increment from birth to 6 months and a lower BMI increment from 6 to 12 months. Breastfed infants were likely positively correlated with BFM at 12 months; as complementary food was added, the effect of breastfeeding on growth gradually decreased.

What Links Maternal Prepregnancy BMI to Early Childhood BMI: A Serial Mediation Analysis

OBJECTIVE

The aim of this study was to explore the potential impact of maternal gestational weight gain (GWG), infant birth weight, and postnatal weight change (ΔWAZ) on the relationship between maternal prepregnancy BMI (ppBMI) and childhood BMI.

METHODS

This retrospective cohort study analyzed a data set from Wuhan, China. The mediation effect of targeted mediators on the association between maternal BMI and childhood BMI at the age of 2 years was analyzed.

RESULTS

In the mediation model comprising maternal GWG, infant birth weight, and the first-6-month ΔWAZ as mediators of the association between ppBMI and children's BMI, the per unit increase in ppBMI resulted in a 0.01-kg/m² increase in children's BMI, through all three mediators. For the model comprising infant birth weight and the first-6-month ΔWAZ as mediators but maternal GWG as a moderator, the indirect effects of the first-6-month ΔWAZ on the relationship between ppBMI and childhood BMI was 0.0018 higher when maternal GWG increased from average values to 1 SD above the average values.

CONCLUSIONS

Maternal GWG, infant birth weight, and the first-6-month ΔWAZ mediated the effects of maternal ppBMI on children's BMI. Interventions targeting these factors can mitigate the risk of childhood obesity.

Nutrition- and feeding practice-related risk factors for rapid weight gain during the first year of life: a population-based birth cohort study

Background

Rapid weight gain (RWG) during infancy increases the risk of excess weight later in life. Nutrition- and feeding practices associated with RWG need to be further examined. The present study aimed to examine nutrition- and feeding practice-related risk factors for RWG during the first year of life.

Methods

A population-based longitudinal birth cohort study of 1780 infants, classified as having RWG or non-RWG during 0–3-4, 0–6 and 6–12 months. RWG was defined as a change > 0.67 in weight standard deviation scores. Associations between nutrition- and feeding practice-related factors and RWG were examined with logistic regression models.

Results

Of the participating infants, 47% had RWG during 0–3-4 months, 46% during 0–6 months and 8% during 6–12 months. In the fully adjusted models, bottle-feeding at birth and at 3–4 months and nighttime meals containing formula milk were positively associated with RWG during 0–3-4 months (p < 0.05 for all). Breastfeeding at 3–4 months and nighttime meals containing breast milk were negatively associated with RWG during this period (p < 0.001). Bottle-feeding at birth, 3–4 and 6 months and nighttime meals containing formula milk at 3–4 months were positively associated with RWG during 0–6 months (p < 0.01 for all). Breastfeeding at 3–4 and 6 months was negatively associated with RWG (p < 0.01). During 6–12 months, only bottle-feeding at 3–4 months was positively associated with RWG (p < 0.05).

Conclusions

RWG was more common during the first 6 months of life and bottle-feeding and formula milk given at night were risk factors for RWG during this period.

Supplementary information

Supplementary information accompanies this paper at 10.1186/s12887-020-02391-4.

Rapid Weight Gain, Infant Feeding Practices, and Subsequent Body Mass Index Trajectories: The CALINA Study

We aimed to study growth patterns according to rapid weight gain (RWG) and infant feeding practices during the first 120 days and whether infant feeding practices mediated the association between RWG in the first semester of life and subsequent body mass index (BMI) z-score in children from age 1 to 6. (1) Methods: 862 children from the Growth and Feeding during Lactation and Early Childhood in Children of Aragon study (CALINA in Spanish) were examined. Repeated-measures ANOVA analyses were conducted to assess growth trajectories according to RWG and type of feeding practice. The product of coefficients mediation method was used to assess the potential contribution of infant feeding practices to the association between RWG and BMI z-score. Mediation models were conducted using IBM SPSS-PROCESS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp. (2) Results: BMI and weight z-score trajectories were significantly higher in the RWG group and the formula-fed group. No significant differences were found regarding height. Infant feeding practices did not mediate the association between RWG and BMI z-score but were associated with BMI at 6 years. (3) Conclusions: Infant feeding practices and RWG determine different growth trajectories of BMI and weight during childhood. Although infant feeding practices did not mediate the association between early RWG and BMI later in life, formula feeding is independently related to higher BMI growth patterns later in childhood.

Study Design and Baseline Profiles of Participants in the Tianjin Birth Cohort (TJBC) in China

Background

To investigate the causal link between early-life exposures and long-term health consequences, we established the Tianjin Birth Cohort (TJBC), a large-scale prospective cohort in northern China.

Methods

TJBC aims to enroll 10,000 families with follow-ups from pregnancy until children’s six year-old. Pregnant women and their spouses were recruited through a three-tier antenatal healthcare system at early pregnancy, with follow-ups at mid-pregnancy, late pregnancy, delivery, 42 days after delivery, 6 months after delivery, and each year until 6 years old. Antenatal/neonatal examination, biological samples and questionnaires were collected.

Results

From August 2017 to January 2019, a total of 3,924 pregnant women have already been enrolled, and 1,697 women have given birth. We observed the prevalence of gestational diabetes mellitus as 18.1%, anemia as 20.4%, and thyroid hypofunction as 2.0%. In singleton live births, 5.6% were preterm birth (PTB), 3.7% were low birth weight, and 7.3% were macrosomia. Based on current data, we also identified maternal/paternal factors which increased the risk of PTB, including paternal age (OR 1.07; 95% CI, 1.01–1.14 for each year increase), vaginal bleeding during pregnancy (OR 2.82; 95% CI, 1.54–5.17) and maternal early-pregnancy BMI (OR 1.08; 95% CI, 1.01–1.15 for each kg/m² increase).

Conclusion

TJBC has the strength of collecting comprehensive maternal, paternal, and childhood information. With a diverse range of biological samples, we are also engaging with emerging new technologies for multi-omics research. The study would provide new insight into the causal link between macro/micro-environmental exposures of early life and short/long-term health consequences.

Associations of Gestational Weight Gain Rate During Different Trimesters with Early-Childhood Body Mass Index and Risk of Obesity

OBJECTIVE

This study aimed to estimate the associations of gestational weight gain rate (GWGR) during different trimesters with offspring growth and overweight/obesity risk.

METHODS

The study included 4,807 mother-infant pairs enrolled in Wuhan, China. GWGR in each trimester was used as a continuous and a categorical variable to estimate the associations with offspring BMI z score (ZBMI) and overweight/obesity risk between 0 and 2 years.

RESULTS

Greater GWGR (per 0.2 kg/wk) in the first, second, and third trimester was positively associated with offspring ZBMI across birth to 2 years old (β 0.06 [95% CI: 0.04-0.09], β 0.13 [95% CI: 0.09-0.16], and β 0.04 [95% CI: 0.02-0.07], respectively). Excessive GWGR in the first trimester (≥ 0.30 kg/wk) was associated with an odds ratio (OR) of 1.58 (95% CI: 1.18-2.13) and 1.37 (95% CI: 1.11-1.71) for macrosomia and 2-year overweight/obesity, respectively. Excessive GWGR in the second trimester was associated with an OR of 2.09 (95% CI: 1.42-3.08), 1.21 (95% CI: 1.02-1.43), and 1.48 (95% CI: 1.15-1.90) for macrosomia, 1-year, and 2-year overweight/obesity, respectively. Excessive GWGR in the third trimester was associated with an OR of 1.91 (95% CI: 1.27-2.86) and 1.32 (95% CI: 1.02-1.72) for macrosomia and 2-year overweight/obesity, respectively.

CONCLUSIONS

Excessive GWGR in each trimester was positively associated with offspring ZBMI and early-childhood overweight/obesity risk.