Pregnancy and post-delivery maternal weight changes and overweight in preschool children

Patterns of Childhood Body Mass Index Percentile Gains as Predictors of Adolescent Body Mass Index, Waist Circumference, and Blood Pressure

OBJECTIVE

To examine whether patterns of body mass index (BMI) percentile gains across childhood predict BMI percentile, overweight and obesity, waist circumference, and elevated or prehypertensive blood pressure at age 15.

METHODS

Trained technicians in the Study of Early Child Care and Youth Development assessed children's weight and height from birth to 15 years and waist circumference and blood pressure at age 15 (n = 1132). Children's BMI percentile trajectories from age 2 to age 13 along with 28 demographic and social covariates were used to predict BMI percentile, waist circumference, overweight, obesity, and elevated or prehypertensive blood pressure. Linear and logistic regressions were used to predict BMI percentile, overweight, obesity, waist circumference, and elevated or prehypertensive blood pressure.

RESULTS

Children were classified into one"?>1 of 4four"?> BMI percentile trajectories: "low stable" (28.4%), "low-to-high" (11.8%), "median stable" (29.0%), and "high rising" (30.7%). Children in trajectory classes characterized by persistent above average BMI percentile or by periods of rapid BMI percentile gains were more likely than their peers to experience poor weight and elevated or prehypertensive outcomes in adolescence. Trajectory class membership explained substantially more variance in adolescent health outcomes than demographic covariates alone. Estimated maternal BMI was a key independent predictor of adolescent outcomes.

CONCLUSIONS

Different patterns of BMI percentile gains, namely those with rapid gains or persistently above average BMI percentile, from ages 2 to 13 predicted weight, waist circumference, and elevated or prehypertensive blood pressure at age 15, above and beyond demographic and social characteristics.

Learning to overeat in infancy: Concurrent and prospective relationships between maternal BMI, feeding practices and child eating response among Hispanic mothers and children

BACKGROUND

Parents play a key role in shaping children's eating behaviours and self-regulation. There is limited data on how maternal weight influences feeding practices in the first year of life.

OBJECTIVE

To examine the relationships between maternal BMI, feeding practices and infant eating behaviours related to self-regulation.

METHODS

Participants were 160 mother-infant dyads. A longitudinal design was used to examine concurrent and prospective associations between maternal 6-month postpartum BMI, mothers' feeding practices at 6 months (Infant Feeding Practices Questionnaire) and children's eating behaviours at 6 months (Baby Eating Behaviour Questionnaire) and 12 months (Child Eating Behaviour Questionnaire).

RESULTS

Higher maternal BMI was associated positively with mothers' use of restrictive feeding practices (β = 0.036, p = 0.033), and inversely with responsivity to infant satiety cues (Spearman partial r = -0.249, p = 0.002) at 6 months. Mother's restrictive feeding practices were associated with infant food responsiveness (β = 0.157, p = 0.009) and emotional overeating (β = 0.118, p = 0.005) at 12 months. Maternal use of responsive feeding practices was associated with lower infant food responsiveness at 6 months (Spearman partial r = -0.173, p = 0.031) and lower emotional overeating at 12 months (Spearman partial r = -0.183, p = 0.022).

CONCLUSIONS

Our findings add to studies suggesting that feeding practices can provide mechanistic pathways in the intergenerational transmission of obesity. Postpartum family-system approaches focusing on maternal health while integrating infant feeding guidance may confer benefits in improving maternal-child health.

Identifying Key Determinants of Childhood Obesity: A Narrative Review of Machine Learning Studies

Machine learning is a class of algorithms able to handle a large number of predictors with potentially nonlinear relationships. By applying machine learning to obesity, researchers can examine how risk factors across multiple settings (e.g., school and home) interact to best predict childhood obesity risk. In this narrative review, we provide an overview of studies that have applied machine learning to predict childhood obesity using a combination of sociodemographic and behavioral risk factors. The objective is to summarize the key determinants of obesity identified in existing machine learning studies and highlight opportunities for future machine learning applications in the field. Of 15 peer-reviewed studies, approximately half examined early childhood (0-24 months of age) determinants. These studies identified child's weight history (e.g., history of overweight/obesity or large increases in weight-related measures between birth and 24 months of age) and parental overweight/obesity (current or prior) as key risk factors, whereas the remaining studies indicated that social factors and physical inactivity were important in middle childhood and late childhood/adolescence. Across age groups, findings suggested that race/ethnic-specific models may be needed to accurately predict obesity from middle childhood onward. Future studies should consider using existing large data sets to take advantage of the benefits of machine learning and should collect a wider range of novel risk factors (e.g., psychosocial and sociocultural determinants of health) to better predict childhood obesity. Ultimately, such research can aid in the development of effective obesity prevention interventions, particularly ones that address the disproportionate burden of obesity experienced by racial/ethnic minorities.

A lifestyle intervention during pregnancy to reduce obesity in early childhood: the study protocol of ADEBAR - a randomized controlled trial

BACKGROUND

The prevalence of obesity in childhood is increasing worldwide and may be affected by genetic factors and the lifestyle (exercise, nutrition behavior) of expectant parents. Lifestyle factors affect adipokines, namely leptin, resistin, and adiponectin as well as cytokines such as tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6), which are involved in the regulation of maternal metabolic homeostasis, glucose metabolism, and the development of insulin resistance, metabolic syndrome, gestational diabetes mellitus, and hypertension. However, studies focusing on the effect of exercise or a combination of parental exercise and nutrition on the above-mentioned markers in newborns (venous cord blood) and especially on the long-term development of infants' weight gain are lacking. The study will investigate the effects of a multimodal intervention (regular exercise, diet) on parental and childhood adipocytokines (leptin, resistin, adiponectin, TNF-α, IL-6, BDNF). The effect of a lifestyle-related change in "fetal environmental conditions" on the long-term weight development of the child up to the age of two will also be assessed.

METHODS/DESIGN

A randomized multi-center controlled trial will be conducted in Germany, comparing supervised aerobic and resistance training 2x/week (13th to 36th weeks of gestation) and nutritional counseling (6th to 36th weeks of gestation) during pregnancy with usual care. Thirty women (pre-pregnancy Body Mass Index ≥25 kg/m2, 6th-10th week of gestation) will be included in each group. Maternal anthropometric and physical measurements as well as blood sampling will occur at the 6th-10th, 13th-14th, 21st-24th, and 36th week of gestation, at delivery as well as 8 weeks and 24 months postpartum. Neonatal measurements and umbilical blood sampling will be performed at birth. Maternal and infants' weight development will be assessed every 6 months till 24 months postpartum. A difference in childhood BMI of 1 kg/m2 at the age of two years between both groups will be assumed. A power size of 80% using a significance level of 0.05 and an effect size of 1.0 is presumed.

DISCUSSION

A better understanding of how lifestyle-related changes in the fetal environment might influence infants' outcome after two years of life could have a profound impact on the prevention and development of infants' obesity.

TRIAL REGISTRATION

The trial is registered at the German Clinical Trial Register (DRKS00007702); Registered on 10th of August 2016; retrospectively registered https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00007702.

Maternal blood pressure mediates the association between maternal obesity and infant weight gain in early postpartum

BACKGROUND

It is unknown to what extent higher maternal blood pressure (BP) in early postpartum impacts the relationship between higher maternal weight status and greater infant weight gain in early postpartum.

OBJECTIVE

To evaluate the mediating role of higher maternal BP at 1 month postpartum on the association between higher maternal weight status at 1 month postpartum and greater infant weight gain over 6 months postpartum.

METHODS

Participants were 169 Hispanic mother-infant pairs. Maternal body mass index (BMI) and BP were assessed at 1 month postpartum. Infant weight was measured at 1 and 6 months postpartum to calculate weight-for-age z scores (WAZ). Multiple linear regression models were used for prediction, and Sobel test was used to determine mediation.

RESULTS

Controlling for maternal pre-pregnancy BMI, age, delivery mode, infant sex, and infant birth weight revealed that both maternal BMI (β = .29) and BP (β = .32) predicted infant WAZ gain (both P ≤ .03). However, the relationship between infant WAZ gain and maternal BMI was no longer significant after further adjustment for maternal BP, which remained significant (P < .05). Maternal BP explained 23.6% (Sobel T = 2.01) of the association between maternal BMI at 1 month and infant WAZ gain over 6 months.

CONCLUSION

Our data suggest that higher maternal weight status at 1 month postpartum is related to greater infant weight gain over 6 months postpartum, and this relationship is mediated by higher maternal BP at 1 month postpartum.

The association between maternal body mass index and child obesity: A systematic review and meta-analysis

BACKGROUND

There is a global obesity crisis, particularly among women and disadvantaged populations. Early-life intervention to prevent childhood obesity is a priority for public health, global health, and clinical practice. Understanding the association between childhood obesity and maternal pre-pregnancy weight status would inform policy and practice by allowing one to estimate the potential for offspring health gain through channelling resources into intervention. This systematic review and meta-analysis aimed to examine the dose-response association between maternal body mass index (BMI) and childhood obesity in the offspring.

METHODS AND FINDINGS

Searches in MEDLINE, Child Development & Adolescent Studies, CINAHL, Embase, and PsycInfo were carried out in August 2017 and updated in March 2019. Supplementary searches included hand-searching reference lists, performing citation searching, and contacting authors. Two researchers carried out independent screening, data extraction, and quality assessment. Observational studies published in English and reporting associations between continuous and/or categorical maternal and child BMI or z-score were included. Categorical outcomes were child obesity (≥95th percentile, primary outcome), overweight/obesity (≥85th percentile), and overweight (85th to 95th percentile). Linear and nonlinear dose-response meta-analyses were conducted using random effects models. Studies that could not be included in meta-analyses were summarised narratively. Seventy-nine of 41,301 studies identified met the inclusion criteria (n = 59 cohorts). Meta-analyses of child obesity included 20 studies (n = 88,872); child overweight/obesity, 22 studies (n = 181,800); and overweight, 10 studies (n = 53,238). Associations were nonlinear and there were significantly increased odds of child obesity with maternal obesity (odds ratio [OR] 3.64, 95% CI 2.68-4.95) and maternal overweight (OR 1.89, 95% CI 1.62-2.19). Significantly increased odds were observed for child overweight/obesity (OR 2.69, 95% CI 2.10-3.46) and for child overweight (OR 1.80, 95% CI 1.25, 2.59) with maternal obesity. A limitation of this research is that the included studies did not always report the data in a format that enabled inclusion in this complex meta-analysis.

CONCLUSIONS

This research has identified a 264% increase in the odds of child obesity when mothers have obesity before conception. This study provides substantial evidence for the need to develop interventions that commence prior to conception, to support women of childbearing age with weight management in order to halt intergenerational obesity.

Associations of Pre-Pregnancy BMI, Gestational Weight Gain and Maternal Parity with the Trajectory of Weight in Early Childhood: A Prospective Cohort Study

Background: The association of maternal parity, pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) with childhood weight status has been well studied; however, little is known about these factors with respect to the rate of weight changes in early childhood. Methods: This study was based on a prospective longitudinal study. The follow-up surveys were conducted at the ages of 1, 3, 6, 8, 12, and 18 months. Child weight was investigated twice at each wave. Data on maternal parity, pre-pregnancy weight and height were collected at baseline. The latent growth curve model was used to examine the effects of interested predictors on the trajectory of weight in early childhood. Results: Finally, 893 eligible mother-child pairs were drawn from the cohort. In adjusted models, multiparas were associated with higher birth weight (β = 0.103) and slower weight change rate of children (β = −0.028). Pre-conception BMI (β = 0.034) and GWG (β = 0.014) played important roles in the initial status of child weight but did not have effects on the rate of weight changes of the child. Conclusions: Multiparous pregnancy is associated with both higher mean birth weight and slower weight-growth velocity in early childhood, while pregravid maternal BMI and GWG are only related to the birth weight.

Trajectories of maternal weight from before pregnancy through postpartum and associations with childhood obesity

Background: Prepregnancy body mass index [BMI (in kg/m²)], gestational weight gain, and postpartum weight retention may have distinct effects on the development of child obesity, but their combined effect is currently unknown.Objective: We described longitudinal trajectories of maternal weight from before pregnancy through the postpartum period and assessed the relations between maternal weight trajectories and offspring obesity in childhood.Design: We analyzed data from 4436 pairs of mothers and their children in the National Longitudinal Survey of Youth 1979 (1981-2014). We used latent-class growth modeling in addition to national recommendations for prepregnancy BMI, gestational weight gain, and postpartum weight retention to create maternal weight trajectory groups. We used modified Poisson regression models to assess the associations between maternal weight trajectory group and offspring obesity at 3 age periods (2-5, 6-11, and 12-19 y).Results: Our analysis using maternal weight trajectories based on either latent-class results or recommendations showed that the risk of child obesity was lowest in the lowest maternal weight trajectory group. The differences in obesity risk were largest after 5 y of age and persisted into adolescence. In the latent-class analysis, the highest-order maternal weight trajectory group consisted almost entirely of women who were obese before pregnancy and was associated with a >2-fold increase in the risk of offspring obesity at ages 6-11 y (adjusted RR: 2.39; 95% CI: 1.97, 2.89) and 12-19 y (adjusted RR: 2.74; 95% CI: 2.13, 3.52). In the analysis with maternal weight trajectory groups based on recommendations, the risk of child obesity was consistently highest for women who were overweight or obese at the beginning of pregnancy.Conclusion: These findings suggest that high maternal weight across the childbearing period increases the risk of obesity in offspring during childhood, but high prepregnancy BMI has a stronger influence than either gestational weight gain or postpartum weight retention.

A scoping review of epidemiologic risk factors for pediatric obesity: Implications for future childhood obesity and dental caries prevention research

RESEARCH QUESTIONS

What are the non-modifiable (socioeconomic, genetic) and modifiable factors (physical activity, dietary behaviors) related to childhood (under age 12) obesity? How can this knowledge be applied to oral health professionals' efforts to prevent or manage dental caries in children?

OBJECTIVES

Studies have identified risk factors for childhood obesity. The purpose of this scoping review was to develop a conceptual model to identify non-modifiable and modifiable risk factors for childhood obesity and to illustrate how these findings are relevant in developing interventions aimed at preventing obesity and dental caries in children.

METHODS

The authors searched PubMed and Embase and limited the study to English-language publications. A total of 2,572 studies were identified. After de-duplication, 2,479 studies remained and were downloaded into a citation-management tool. Two authors screened the titles and abstracts for relevance. Two hundred and sixty studies remained and were retrieved for a full-text review, and 80 studies were excluded, resulting in 180 studies included in the scoping review. An inductive content analytic methods was used to organize all statistically significant obesity risk factors into seven domains, which were classified as non-modifiable or modifiable; then a conceptual model of common risk factors associated with childhood obesity and dental caries was developed.

RESULTS

Non-modifiable obesity risk factors include biological and developmental (e.g., genes, developmental conditions, puberty), sociodemographic and household (e.g., race/ethnicity, socioeconomic status, parent education, unemployment), cultural (e.g., degree of acculturation), and community (e.g., neighborhood composition). Modifiable risk factors included behavioral (e.g., diet, physical activity, weight), psychosocial (e.g., maternal stress, family functioning, parenting practices, child temperament), and medical (e.g., parent smoking, maternal health, child health).

CONCLUSIONS

Identifying common risk factors has important implications for future oral health research aimed at preventing childhood obesity and dental caries. Epidemiologic knowledge gleaned from the literature can be used to develop rigorous interventions and programs aimed at preventing these highly prevalent diseases and improving health outcomes for children.

Clinical management of pregnancy in the obese mother: before conception, during pregnancy, and post partum

The global epidemic of obesity has led to an increasing number of obese women of reproductive age. Obesity is associated with reduced fertility, and pregnancies complicated by maternal obesity are associated with adverse outcomes, including increased risk of gestational diabetes, pre-eclampsia, preterm birth, instrumental and caesarean births, infections, and post-partum haemorrhage. The medical and obstetric management of obese women is focused on identifying, addressing, and preventing some of these associated complications, and is a daunting challenge given the high percentage of patients with obesity and few therapeutic options proven to improve outcomes in this population. The UK's National Institute for Health and Care Excellence guidelines and the American College of Obstetricians and Gynecologists recommend that all pregnant women follow a healthy diet, and consider at least half an hour of moderate physical activity per day during pregnancy. However, although obese women are often directed to seek the advice of a nutritionist and to limit gestational weight gain, guidelines for the management of pregnancy and delivery in this high-risk group are lacking. The post-partum period represents an important opportunity to optimise maternal health before the next pregnancy. As many of the physiological changes of pregnancy associated with maternal obesity are present from early pregnancy onward, reducing maternal obesity before conception is probably the best strategy to decrease the health burden associated with maternal obesity.

Risk Factors for Childhood Obesity in the First 1,000 Days: A Systematic Review

CONTEXT

Mounting evidence suggests that the origins of childhood obesity and related disparities can be found as early as the "first 1,000 days"-the period from conception to age 2 years. The main goal of this study is to systematically review existing evidence for modifiable childhood obesity risk factors present from conception to age 2 years.

EVIDENCE ACQUISITION

PubMed, Embase, and Web of Science were searched for studies published between January 1, 1980, and December 12, 2014, of childhood obesity risk factors present during the first 1,000 days. Prospective, original human subject, English-language research with exposure occurrence during the first 1,000 days and with the outcome of childhood overweight or obesity (BMI ≥85th percentile for age and sex) collected between age 6 months and 18 years were analyzed between December 13, 2014, and March 15, 2015.

EVIDENCE SYNTHESIS

Of 5,952 identified citations, 282 studies met inclusion criteria. Several risk factors during the first 1,000 days were consistently associated with later childhood obesity. These included higher maternal pre-pregnancy BMI, prenatal tobacco exposure, maternal excess gestational weight gain, high infant birth weight, and accelerated infant weight gain. Fewer studies also supported gestational diabetes, child care attendance, low strength of maternal-infant relationship, low SES, curtailed infant sleep, inappropriate bottle use, introduction of solid food intake before age 4 months, and infant antibiotic exposure as risk factors for childhood obesity.

CONCLUSIONS

Modifiable risk factors in the first 1,000 days can inform future research and policy priorities and intervention efforts to prevent childhood obesity.

The Independent and Cumulative Effect of Early Life Risk Factors on Child Growth: A Preliminary Report

BACKGROUND

Early life risk factors may promote faster infant growth leading to childhood obesity. We examined growth patterns (birth to 12 months) and their association with early life risk factors.

METHODS

Participants were drawn from an ongoing birth cohort of 351 mothers. Child weight and length were obtained at birth, 6 weeks, and 3, 6, 9, and 12 months. Independent variables and demographics were tested as risk factors for inclusion in the cumulative risk score if they were significantly associated with change in weight-for-length z-scores (WFLZ; month 12 minus birth) or based on established evidence for an association with child growth. Multiple regression was used to determine the association of change in WFLZ with low maternal education, low month 3 postpartum maternal weight loss, and nonexclusive breastfeeding by month 3 (use of formula) or their cumulative risk. Trajectory groups were identified using semiparametric mixture models and their association with the risk factors and cumulative risk score was tested using logistic regression.

RESULTS

Nonexclusive breastfeeding by month 3 was associated with greater WFLZ increase. We identified three trajectory groups: low-rising (14.5%), mid-stable (59.4%), and high-rising (26.1%). Low-rising versus mid-stable group membership doubled with nonexclusive breastfeeding by month 3 (odds ratio [OR] = 2.24; 95% confidence interval [CI] = 1.05-4.80), but increased the most among children who had three risk factors compared to none (OR = 4.82; 95% CI = 1.14-20.32). No relationships were observed with high-rising growth.

CONCLUSIONS

Early life risk factors influence the development of growth trajectories during the first year in a cumulative fashion.

Changing national guidelines is not enough: the impact of 1990 IOM recommendations on gestational weight gain among US women

Background and Objectives

Gestational weight gain (GWG) is associated with both long- and short-term maternal and child health outcomes, particularly obesity. Targeting maternal nutrition through policies is a potentially powerful pathway to influence these outcomes. Yet prior research has often failed to evaluate national policies and guidelines that address maternal and child health. In 1990, the U.S. Institute of Medicine (IOM) released guidelines recommending different GWG thresholds based on women’s pre-pregnancy body mass index (BMI), with the goal of improving infant birth weight. In this study, we employ quasi-experimental methods to examine whether the release of the IOM guidelines led to changes in GWG among a diverse and nationally representative sample of women.

Methods

Our sample included female participants of the National Longitudinal Survey of Youth who self-reported GWG for pregnancies during 1979–2000 (N = 7,442 pregnancies to 4,173 women). We compared GWG before and after the guidelines were released using difference-in-differences (DID) and regression discontinuity (RD) analyses.

Results

In DID analyses we found no reduction in GWG among overweight/obese women relative to normal/underweight women. Meanwhile, RD analyses demonstrated no changes in GWG by pre-pregnancy BMI for either overweight/obese or normal/underweight women. Results were similar for women regardless of educational attainment, race, or parity.

Conclusions

The findings suggest that national guidelines had no effect on weight gain among pregnant women. These results have implications for the implementation of policies targeting maternal and child health via dietary behaviors.

Maternal Gestational and Postdelivery Weight Gain and Child Weight

BACKGROUND

Maternal gestational weight gain (GWG) is a risk factor for the development of overweight in her child. It is unknown whether GWG programs the child's health or whether GWG indicates a shared familial lifestyle during childhood. To disentangle these influences, we studied the association of GWG and postdelivery maternal weight change simultaneously with child's weight development.

METHODS

We used data from 3367 children participating in a birth cohort that started in 1996 in the Netherlands. Weight and height were self-reported. GWG was categorized as "inadequate," "adequate," and "excessive." Multivariable regression and mixed models were used to study maternal and child weight changes.

RESULTS

Children of mothers with excessive GWG had a higher BMI z score and overweight prevalence (odds ratio [OR] 1.20; 95% confidence interval [CI], 0.99 to 1.46) throughout childhood. Children of mothers with a high (≥1 kg/year) postdelivery weight gain had a 0.14 (95% CI, -0.08 to 0.36) higher change in BMI z score between age 1 and 14 years than children of mothers with a low (<0.5 kg/year) postdelivery weight gain. Children of mothers with excessive GWG in combination with a high postdelivery weight gain had the highest BMI z score and overweight risk at age 14 years (OR 3.53; 95% CI, 1.70 to 7.33).

CONCLUSIONS

Maternal GWG and postdelivery weight gain contribute to child's weight development up to adolescence independently.

Invited Commentary: Multigenerational Social Determinants of Health—Opportunities and Challenges

An emerging area of social epidemiology examines the relationship between grandparental education and grandchild health. In an accompanying article, Huang et al. (Am J Epidemiol. 2015;182(7):568-578) join the small but growing body of research on this topic. It is useful to contextualize Huang et al.'s work within the much larger body of research examining relationships between education and health within a single generation or across 2 generations. These investigators have generally concluded that higher educational attainment is robustly associated with better health. There are many potential mechanisms through which education and other social exposures may affect health outcomes in a single generation or across generations, and estimating direct and indirect effects can be helpful for assessing specific mechanisms. Researchers conducting multigenerational analyses are faced with several challenges, including limited availability of data for some measures (e.g., educational attainment, and sometimes for 1 grandparent only), limited age ranges of participants, disparate social and political contexts in which study participants of different generations have lived, and patterns of social class reproduction. We encourage future researchers to weave together the careful analytical considerations illustrated by Huang et al. with a rich understanding of the social context for each of the generations studied to help overcome these challenges and advance our understanding of multigenerational social determinants of health.

Maternal obesity, gestational weight gain, and offspring adiposity: the exploring perinatal outcomes among children study

OBJECTIVE

To determine whether adequate vs excessive gestational weight gain (GWG) attenuated the association between maternal obesity and offspring outcomes.

STUDY DESIGN

Data from 313 mother-child pairs participating in the Exploring Perinatal Outcomes among Children study were used to test this hypothesis. Maternal prepregnancy body mass index (BMI) and weight measures throughout pregnancy were abstracted from electronic medical records. GWG was categorized according to the 2009 Institute of Medicine criteria as adequate or excessive. Offspring outcomes were obtained at a research visit (average age 10.4 years) and included BMI, waist circumference (WC), subcutaneous adipose tissue (SAT) and visceral adipose tissue, high-density lipoprotein cholesterol, and triglyceride levels.

RESULTS

More overweight/obese mothers exceeded the Institute of Medicine GWG recommendations (68%) compared with normal-weight women (50%) (P < .01). Maternal prepregnancy BMI was associated with worse childhood outcomes, particularly among offspring of mothers with excessive GWG (increased BMI [20.34 vs 17.80 kg/m(2)], WC [69.23 vs 62.83 cm], SAT [149.30 vs 90.47 cm(2)], visceral adipose tissue [24.11 vs 17.55 cm(2)], and homeostatic model assessment [52.52 vs 36.69], all P < .001). The effect of maternal prepregnancy BMI on several childhood outcomes was attenuated for offspring of mothers with adequate vs excessive GWG (P < .05 for the interaction between maternal BMI and GWG status on childhood BMI, WC, SAT, and high-density lipoprotein cholesterol).

CONCLUSION

Our findings lend support for pregnancy interventions aiming at controlling GWG to prevent childhood obesity.