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Deveci AC, Keown-Stoneman CDG, Maguire JL, O'Connor DL, Anderson LN, Dennis CL, Birken CS. Maternal BMI in the preconception period, and association with child zBMI growth rates. Pediatr Obes 2023; 18:e12999. [PMID: 36573480 DOI: 10.1111/ijpo.12999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Elevated body mass index (BMI) and rapid growth in early childhood are important predictors of obesity risk. The association between maternal preconception BMI and child growth rates is unclear. OBJECTIVES To assess the association between measured maternal preconception BMI and child age- and sex- standardized WHO BMI z-score (zBMI) growth rates and mean zBMI, in children aged 0-10 years old. METHODS A longitudinal cohort study was conducted with children (n = 499) enrolled in The Applied Research Group for Kids (TARGet Kids!) primary care practice-based research cohort. Maternal BMI was measured during the preconception period, defined as the 2 years prior to pregnancy. Repeated measures of child weight and height were obtained between 0 and 10 years of age. Linear mixed models were used to evaluate the association between maternal BMI and child zBMI growth rates and mean zBMI. RESULTS Maternal preconception BMI was associated with child zBMI growth rate during some growth periods, with the strongest association from age 0 to 4 months; a 5 kg/m2 higher maternal BMI was associated with 0.031 zBMI SD unit/mo higher growth rate (p = 0.004), and 0.186 SD unit higher mean child zBMI (p = 0.0002). CONCLUSIONS Maternal preconception BMI was associated with growth rate and mean zBMI in early childhood. The preconception period may be an important target for health interventions to promote healthy child growth rate and weight outcomes.
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Affiliation(s)
- Arin C Deveci
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Charles D G Keown-Stoneman
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jonathon L Maguire
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Pediatrics, St. Michael's Hospital, Toronto, Canada
| | - Deborah L O'Connor
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Translational Medicine, SickKids Research Institute, Toronto, Canada.,Department of Paediatrics, Mount Sinai Health, Toronto, Canada
| | - Laura N Anderson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Cindy-Lee Dennis
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Catherine S Birken
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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2
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Fouda S, Vennikandam MM, Pappachan JM, Fernandez CJ. Pregnancy and Metabolic-associated Fatty Liver Disease: A Clinical Update. J Clin Transl Hepatol 2022; 10:947-954. [PMID: 36304500 PMCID: PMC9547252 DOI: 10.14218/jcth.2022.00052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/15/2022] [Accepted: 04/26/2022] [Indexed: 12/04/2022] Open
Abstract
The intricate relationship between metabolic-associated fatty liver disease (MAFLD) and maternal complications has rapidly become a significant health threat in pregnant women. The presence of MAFLD in pregnancy increases the maternal risk of metabolic complications and comorbidities for both mother and baby. The preexistence or development of MAFLD in pregnancy is a complex multifactorial disorder that can lead to further complications for mother and baby. Therefore, as pregnant women are severely underrepresented in clinical research, there is a great need for a fair inclusion of this group in clinical trials. This review aims to explore the effects of MAFLD during pregnancy in the context of maternal complications and outcomes and explore the effects of pregnancy on the development and progression of MAFLD within the context of maternal obesity, altered metabolic profiles, gestational diabetes and altered hormonal profiles. We also addressed potential implications for the presence of MAFLD during pregnancy and its management in the clinical setting.
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Affiliation(s)
- Sherouk Fouda
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Madhu Mathew Vennikandam
- Department of Gastroenterology and Hepatology, Sparrow Hospital, Michigan State University College of Human Medicine, Lansing, MI, USA
| | - Joseph M. Pappachan
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston, UK
- Faculty of Science, Manchester Metropolitan University, Manchester, UK
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Correspondence to: Joseph M Pappachan, Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Royal Preston Hospital, Sharoe Green Lane, Preston PR2 9HT, UK. ORCID: https://orcid.org/0000-0003-0886-5255. Tel/Fax: +44-1-7725-22092, E-Mail:
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3
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Valentini F, Rocchi G, Vespasiani-Gentilucci U, Guarino MPL, Altomare A, Carotti S. The Origins of NAFLD: The Potential Implication of Intrauterine Life and Early Postnatal Period. Cells 2022; 11:cells11030562. [PMID: 35159371 PMCID: PMC8834011 DOI: 10.3390/cells11030562] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 01/30/2022] [Accepted: 02/02/2022] [Indexed: 02/04/2023] Open
Abstract
Fetal life and the first few months after birth represent a plastic age, defined as a “window of opportunity”, as the organism is particularly susceptible to environmental pressures and has to adapt to environmental conditions. Several perturbations in pregnancy, such as excessive weight gain, obesity, gestational diabetes mellitus and an inadequate or high-fat diet, have been associated with long-term metabolic consequences in offspring, even without affecting birth weight. Moreover, great interest has also been focused on the relationship between the gut microbiome of early infants and health status in later life. Consistently, in various epidemiological studies, a condition of dysbiosis has been associated with an increased inflammatory response and metabolic alterations in the host, with important consequences on the intestinal and systemic health of the unborn child. This review aims to summarize the current knowledge on the origins of NAFLD, with particular attention to the potential implications of intrauterine life and the early postnatal period. Due to the well-known association between gut microbiota and the risk of NAFLD, a specific focus will be devoted to factors affecting early microbiota formation/composition.
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Affiliation(s)
- Francesco Valentini
- Pediatric Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, “Sapienza” University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy;
| | - Giulia Rocchi
- Unit of Food Science and Human Nutrition, Campus Biomedico University of Rome, Via Alvaro del Portillo 21, 00128 Rome, Italy;
| | - Umberto Vespasiani-Gentilucci
- Unit of Internal Medicine and Hepatology, Fondazione Policlinico Campus Biomedico of Rome, Via Alvaro del Portillo 21, 00128 Rome, Italy;
| | - Michele Pier Luca Guarino
- Gastroenterology Unit, Fondazione Policlinico Campus Biomedico of Rome, Via Alvaro del Portillo 21, 00128 Rome, Italy;
| | - Annamaria Altomare
- Gastroenterology Unit, Fondazione Policlinico Campus Biomedico of Rome, Via Alvaro del Portillo 21, 00128 Rome, Italy;
- Correspondence:
| | - Simone Carotti
- Unit of Microscopic and Ultrastructural Anatomy, Campus Biomedico University of Rome, Via Alvaro del Portillo 21, 00128 Rome, Italy;
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Zamora AN, Marchlewicz E, Téllez-Rojo MM, Burant CF, Cantoral A, Song PXK, Mercado A, Dolinoy DC, Peterson KE. Trimester two gestational exposure to bisphenol A and adherence to mediterranean diet are associated with adolescent offspring oxidative stress and metabolic syndrome risk in a sex-specific manner. Front Nutr 2022; 9:961082. [PMID: 36276834 PMCID: PMC9579372 DOI: 10.3389/fnut.2022.961082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/09/2022] [Indexed: 01/25/2023] Open
Abstract
Background Exposure to prenatal bisphenol A (BPA) and Mediterranean Diet Score (MDS) has been linked to metabolic risk in child offspring. It remains unclear if independent and interactive effects persist in adolescence. Methods We examined prenatal BPA and MDS on adolescent offspring metabolic syndrome risk score (MRS) and 8-isoprostane (8-iso), a biomarker of oxidative stress. Data from maternal-adolescent dyads from a Mexico City cohort were utilized, including trimester-specific prenatal BPA from spot urine and MDS from food frequency questionnaires. Offspring socio-demographic data and biomarkers to estimate MRS and 8-iso were obtained during peri-adolescence. Results Adjusted linear regression models examined associations between trimester-specific BPA, MDS, and BPA*MDS on outcomes. Sex-stratified analyses revealed a significant association between MDS with increased 8-iso (β = 0.064, p < 0.05), and a marginal association between trimester two BPA with increased 8-iso (β = 0.237), while MDS modified the marginal association between BPA and 8-iso in females (β = 0.046). A negative, marginal association was observed between trimester two BPA and MRS (β = - 0.728), while BPA * MDS was marginally, positively associated with MRS (β = 0.152) in males. Conclusions Study findings indicate that trimester two prenatal BPA and maternal adherence to a Mediterranean diet may have sexually dimorphic effects on adolescent offspring oxidative stress and metabolic syndrome risk.
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Affiliation(s)
- Astrid N Zamora
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Elizabeth Marchlewicz
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Martha M Téllez-Rojo
- Center for Research on Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Charles F Burant
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States.,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, United States
| | | | - Peter X K Song
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Adriana Mercado
- Center for Research on Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Dana C Dolinoy
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States.,Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Karen E Peterson
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States.,Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
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El Jamaly H, Eslick GD, Weltman M. Systematic review with meta-analysis: Non-alcoholic fatty liver disease and the association with pregnancy outcomes. Clin Mol Hepatol 2022; 28:52-66. [PMID: 34530527 PMCID: PMC8755467 DOI: 10.3350/cmh.2021.0205] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND/AIMS Maternal and fetal outcomes in pregnant patients with Non-alcoholic fatty liver disease (NAFLD) have been largely unexplored. To determine the level of evidence associated with maternal and fetal outcomes in pregnant women with NAFLD. METHODS We conducted a comprehensive literature search. The studies included pregnant patients with a previous, current or subsequent diagnosis of NAFLD. We used a random-effects model using odds ratios (OR) with 95% confidence intervals (CI). RESULTS Twenty-two studies, with 13,641 female NAFLD patients were reviewed. The results highlight that NAFLD patients had a statistically significant increased likelihood of baseline diabetes mellitus (OR, 6.00; 95% CI, 2.21-16.31; P<0.001; n=7), baseline Hypertension (OR, 3.75; 95% CI, 2.13-6.59; P<0.001; n=4), gestational hypertension (OR, 1.83; 95% CI, 1.03-3.26; P=0.041; n=2), and pre-eclampsia (OR, 2.43; 95% CI, 1.46-4.04; P=0.001; n=3). The odds for a past and current history of gestational diabetes mellitus were OR, 3.78; 95% CI, 2.21-6.44; P<0.001; n=5 and OR, 3.23; 95% CI, 1.97- 5.31; P<0.001; n=6, respectively. As for fetal outcomes, pregnant NAFLD patients were significantly more likely to have a premature birth (OR, 2.02; 95% CI, 1.44-2.85; P<0.001; n=4), large for gestational age birth (OR, 2.01; 95% CI, 1.72-2.37; P<0.001; n=2) or a history of prior miscarriage or abortion (OR, 1.15; 95% CI, 1.02-1.30; P=0.02; n=2). Egger's regression revealed no evidence of publication bias (P>0.05). CONCLUSION This meta-analysis provides pooled evidence that NAFLD is associated with a substantial increase in maternal diabetic and hypertensive complications and multiple adverse fetal outcomes. This data is important for clinicians managing these patients before, during and after pregnancy.
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Affiliation(s)
- Hydar El Jamaly
- Department of Gastroenterology and Hepatology, Nepean Hospital, Penrith, Australia
- Nepean Clinical School, The University of Sydney, Penrith, Australia
| | - Guy D Eslick
- The Centre for Digestive Health and Neurogastroenterology, Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia
| | - Martin Weltman
- Department of Gastroenterology and Hepatology, Nepean Hospital, Penrith, Australia
- Nepean Clinical School, The University of Sydney, Penrith, Australia
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Association between parental and offspring BMI: results from EPACI Portugal 2012. Public Health Nutr 2021; 24:2798-2807. [PMID: 33843556 PMCID: PMC9884752 DOI: 10.1017/s1368980021001543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the longitudinal association between parental BMI and offspring's BMI, in EPACI Portugal 2012. DESIGN Longitudinal study with retrospective collection of children's anthropometry data since birth. Children's anthropometric data were gathered from individual child health bulletins, and parents' anthropometrics were self-reported. Children's and parents' BMI were classified according to WHO cut-offs. Linear mixed models with random intercept and slope for age were applied to quantify the association between parental BMI and children BMI Z-score (zBMI). SETTING EPACI Portugal 2012. PARTICIPANTS Representative sample from the Portuguese population (n 2230) aged from 12 to 36 months. RESULTS 58·9 % of the fathers and 35·6 % of the mothers were overweight (OW) or obese. Prevalence of infants who were, at least, at risk of OW increased from 17·0 % to 30·3 % since birth to 12 months. About half of the mothers with pre-pregnancy OW and obesity (OB) gained gestational weight above the recommendations. The children from mothers with gestational weight gain (GWG) below the recommendations showed a -0·15 SD lower zBMI (95 % CI -0·23, -0·06) in early life, comparing with mothers within GWG recommendations. Children of obese mothers were more likely to present a higher zBMI (0·24 SD, 95 % CI 0·13, 0·35) throughout the first months of life. CONCLUSIONS A high prevalence of OW and OB was observed in Portuguese young adults and toddlers. Mothers' pre-pregnancy BMI and insufficient GWG had a direct effect on offspring BMI. Early effective interventions are needed in order to prevent the transgenerational transmission of OB.
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Association between maternal prepregnancy body mass index with offspring cardiometabolic risk factors: analysis of three Brazilian birth cohorts. J Dev Orig Health Dis 2021; 13:161-167. [PMID: 33941308 DOI: 10.1017/s2040174421000179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Evidence suggests that maternal prepregnancy body mass index (BMI) is associated with offspring cardiometabolic risk factors. This study was aimed at assessing the association of maternal prepregnancy BMI with offspring cardiometabolic risk factors in adolescence and adulthood. We also evaluated whether offspring BMI was a mediator in this association. The study included mother-offspring pairs from three Pelotas birth cohorts. Offspring cardiometabolic risk factors were collected in the last follow-up of each cohort [mean age (in years) 30.2, 22.6, 10.9]. Blood pressure was measured using an automatic device, cholesterol by using an enzymatic colorimetric method, and glucose from fingertip blood, using a portable glucose meter. In a pooled analysis of the cohorts, multiple linear regression was used to control for confounding. Mediation analysis was conducted using G-computation formula. In the adjusted model, mean systolic blood pressure of offspring from overweight and obese mothers was on average 1.25 (95% CI: 0.45; 2.05) and 2.13 (95% CI: 0.66; 3.59) mmHg higher than that of offspring from normal-weight mothers; for diastolic blood pressure, the means were 0.80 (95% CI: 0.26; 1.34) and 2.60 (95% CI: 1.62; 3.59) mmHg higher, respectively. Non-HDL cholesterol was positively associated with maternal BMI, whereas blood glucose was not associated. Mediation analyses showed that offspring BMI explained completely the association of maternal prepregnancy BMI with offspring systolic and diastolic blood pressure, and non-HDL cholesterol. Our findings suggest that maternal prepregnancy BMI is positively associated with offspring blood pressure, and blood lipids, and this association is explained by offspring BMI.
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8
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Influence of maternal pre-pregnancy nutritional status on offspring anthropometric measurements and body composition in three Brazilian Birth Cohorts. Public Health Nutr 2020; 24:882-894. [PMID: 33261702 DOI: 10.1017/s1368980020004887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We aimed at evaluating the association of maternal pre-pregnancy nutritional status with offspring anthropometry and body composition. We also evaluated whether these associations were modified by gender, diet and physical activity and mediated by birth weight. DESIGN Birth cohort study. SETTING Waist circumference was measured with an inextensible tape, and fat and lean mass were measured using dual-energy X-ray absorptiometry. Multiple linear regression was used to adjust for possible confounders and allele score of BMI. We carried out mediation analysis using G-formula. PARTICIPANTS In 1982, 1993 and 2004, all maternity hospitals in Pelotas (South Brazil) were visited daily and all live births whose families lived in the urban area of the city were evaluated. These subjects have been followed up at different ages. RESULTS Offspring of obese mothers had on average higher BMI, waist circumference and fat mass index than those of normal weight mothers, and these differences were higher among daughters. The magnitudes of the association were similar in the cohorts, except for height, where the association pattern was not clear. In the 1982 cohort, further adjustment for a BMI allele score had no material influence on the magnitude of the associations. Mediation analyses showed that birth weight captured part of this association. CONCLUSIONS Our findings suggest that maternal pre-pregnancy nutritional status is positively associated with offspring BMI and adiposity in offspring. And this association is higher among daughters whose mother was overweight or obese and, birth weight explains part of this association.
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Liang Z, Liu H, Wang L, Song Q, Sun D, Li W, Leng J, Gao R, Hu G, Qi L. Maternal Gestational Diabetes Mellitus Modifies the Relationship Between Genetically Determined Body Mass Index During Pregnancy and Childhood Obesity. Mayo Clin Proc 2020; 95:1877-1887. [PMID: 32861332 PMCID: PMC7672776 DOI: 10.1016/j.mayocp.2020.04.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/29/2020] [Accepted: 04/10/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To analyze the interactions between maternal gestational diabetes mellitus (GDM) and genetically determined maternal body mass index (BMI) during pregnancy on offspring childhood obesity. RESEARCH DESIGN AND METHODS A total of 1114 Chinese mother-child pairs (560 GDM and 554 non-GDM) were included between August 2009 and July 2011. Maternal genetic risk score (GRS) of BMI during pregnancy was derived on the basis of 12 single nucleotide polymorphisms identified from a genome-wide association study. Offspring's BMI, BMI-for-age z score, weight, weight-for-age z score, waist circumference, sum of skinfolds, and body fat percentage during childhood were measured or calculated. RESULTS Maternal GRS of BMI during pregnancy significantly interacted with maternal GDM status on childhood risks of overweight and obesity (all P for interaction <.05). After multivariable adjustment, per unit of GRS was associated with a 24% (P<.001) and a 28% (P<.001) increased risk of overweight and obesity among children of GDM mothers, whereas no significant associations were observed among children of mothers without GDM. In addition, per unit GRS of BMI during pregnancy was significantly associated with 0.16 kg/m2 higher BMI (P=.002), 0.09 higher BMI-for-age z score (P=.002), 0.24 kg higher weight (P=.04), 0.06 higher weight-for-age z score (P=.02), 0.28 cm higher waist circumference (P=.03), 0.94 mm higher sum of skinfolds (P=.004), and 0.37% higher body fat percentage (P=.03) among children of GDM mothers. There were no significant associations between maternal GRS of BMI during pregnancy and offspring's obesity-related outcomes among children of mothers without GDM. CONCLUSION Our findings for the first time indicate that maternal GDM status may modify the relation between genetically determined maternal BMI during pregnancy and offspring's obesity risk during childhood.
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Affiliation(s)
- Zhaoxia Liang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA; Department of Obstetrical, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Huikun Liu
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Leishen Wang
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Qiying Song
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA; Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Dianjianyi Sun
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Weiqin Li
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Junhong Leng
- Tianjin Women's and Children's Health Center, Tianjin, China
| | - Ru Gao
- Pennington Biomedical Research Center, Baton Rouge, LA
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, LA
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
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Cantoral A, Montoya A, Luna-Villa L, Roldán-Valadez EA, Hernández-Ávila M, Kershenobich D, Perng W, Peterson KE, Hu H, Rivera JA, Téllez-Rojo MM. Overweight and obesity status from the prenatal period to adolescence and its association with non-alcoholic fatty liver disease in young adults: cohort study. BJOG 2020; 127:1200-1209. [PMID: 32145139 DOI: 10.1111/1471-0528.16199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To examine the associations of maternal and child overweight status across multiple time-points with liver fat content in the offspring during young adulthood. DESIGN Cohort study. SETTING ELEMENT Cohort in Mexico City. POPULATION Pregnant women with singleton births (n = 97). METHODS We quantified hepatic triglyceride content (liver fat content) by proton magnetic resonance spectroscopy (1H MRS) and conventional T2-weighted MRIs (3T scanner) in 97 young adults from the ELEMENT birth cohort in Mexico City. Historical records of the cohort were used as a source of pregnancy, and childhood and adolescence anthropometric information, overweight and obesity (OWOB) were defined. Adjusted structural equation models were run to identify the association between OWOB in different life stages with liver fat content (log-transformed) in young adulthood. MAIN OUTCOME Maternal OWOB at the time of delivery was directly and indirectly associated with the liver fat content in the offspring at young adulthood. RESULTS Seventeen percent of the participants were classified as having NAFLD. We found a strong association of OWOB between all periods assessed. Maternal OWOB at time of delivery (β = 1.97, 95% CI 1.28-3.05), and OWOB status in the offspring at young adulthood (β = 3.17, 95% CI 2.10-4.77) were directly associated with the liver fat content in the offspring. Also, maternal OWOB was indirectly associated with liver fat content through offspring OWOB status. CONCLUSION We found that maternal OWOB status is related to fatty liver content in the offspring as young adults, even after taking into account OWOB status and lifestyle factors in the offspring. TWEETABLE ABSTRACT There was an association between pre-pregnancy overweight and the development of NAFLD in adult offspring.
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Affiliation(s)
- A Cantoral
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - A Montoya
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - L Luna-Villa
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - E A Roldán-Valadez
- Hospital General de México 'Dr. Eduardo Liceaga', Mexico City, Mexico.,Department of Radiology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | - D Kershenobich
- Instituto Nacional de Ciencias Médicas y Nutrición 'Salvador Zubirán', Mexico City, Mexico
| | - W Perng
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - K E Peterson
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.,Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA.,Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - H Hu
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA.,Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - J A Rivera
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico
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Liang Z, Liu H, Wang L, Chen Y, Zhou T, Heianza Y, Li W, Leng J, Wang J, Gao R, Hu G, Qi L. Maternal MTNR1B genotype, maternal gestational weight gain, and childhood obesity. Am J Clin Nutr 2020; 111:360-368. [PMID: 31826236 PMCID: PMC6997086 DOI: 10.1093/ajcn/nqz296] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 11/05/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Maternal metabolic abnormalities have been related to offspring obesity especially during childhood. OBJECTIVES We analyzed whether the gestational diabetes mellitus (GDM)-associated melatonin receptor 1B (MTNR1B) genotype of mothers modified the relation between maternal gestational weight gain and childhood obesity. METHODS A total of 1114 Chinese mother-child pairs (mothers with or without prior GDM) were included. Mothers' MTNR1B rs10830962 genotype and gestational weight gain were assessed. Indicators of childhood obesity included BMI-for-age z-score, weight-for-age z-score, waist circumference, and body fat. Childhood overweight and obesity were also analyzed. RESULTS We found that the maternal MTNR1B genotype significantly interacted with gestational weight gain on indicators of offspring's obesity (all P for interaction < 0.05). After multivariable adjustment, BMI-for-age z-scores associated with 1-kg gestational weight gain were 0.009 (SE 0.018), 0.026 (SE 0.010), and 0.061 (SE 0.010) in children with the maternal MTNR1B genotype CC, CG, and GG, respectively (P-interaction = 0.012). Similar interactions were observed for weight-for-age z-score, waist circumference, and body fat (P-interaction = 0.001, 0.003, and 0.012, respectively). The associations remained consistently significant in women with and without GDM. We also found significant interactions between the maternal MTNR1B genotype and gestational weight gain on the offspring's childhood overweight and obesity (P-interaction = 0.005 and 0.026, respectively). CONCLUSIONS The maternal MTNR1B genotype might interact with gestational weight gain on offspring's obesity risk during childhood.
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Affiliation(s)
- Zhaoxia Liang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, PR China
| | - Huikun Liu
- Tianjin Women's and Children's Health Center, Tianjin, PR China
| | - Leishen Wang
- Tianjin Women's and Children's Health Center, Tianjin, PR China
| | - Yuhang Chen
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- Department of Public Health Laboratory Sciences, West China School of Public Health, Sichuan University, Chengdu, Sichuan Province, PR China
| | - Tao Zhou
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Weiqin Li
- Tianjin Women's and Children's Health Center, Tianjin, PR China
| | - Junhong Leng
- Tianjin Women's and Children's Health Center, Tianjin, PR China
| | - Jing Wang
- Tianjin Women's and Children's Health Center, Tianjin, PR China
| | - Ru Gao
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Villalobos-Labra R, Westermeier F, Pizarro C, Sáez PJ, Toledo F, Pardo F, Kusanovic JP, Mardones F, Poblete JA, Sobrevia L, Farías M. Neonates from women with pregestational maternal obesity show reduced umbilical vein endothelial response to insulin. Placenta 2019; 86:35-44. [PMID: 31345420 DOI: 10.1016/j.placenta.2019.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/09/2019] [Accepted: 07/15/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Pregestational maternal obesity (PGMO) associates with foetoplacental vascular endothelial dysfunction and higher risk for insulin resistance in the neonate. We characterised the PGMO consequences on the insulin response of the human foetoplacental vasculature. METHODS Umbilical veins were from pregnancies where the mother was with PGMO (body mass index 30-42.3 kg/m2, n = 33) or normal pregestational weight (PGMN) (body mass index 19.5-24.4 kg/m2, n = 21) with total gestational weight gain within the physiological range. Umbilical vein ring segments were mounted in a myograph for isometric force measurements. Primary cultures of human umbilical vein endothelial cells were used in passage 3. Vessel rings and cells were exposed to 1 nmol/L insulin (20 min) in the absence or presence of 100 μmol/L NG-nitro-l-arginine methyl ester (inhibitor of nitric oxide synthase, NOS). RESULTS Vessel rings from PGMO showed reduced nitric oxide synthase-activity dependent dilation to insulin or calcitonin-gene related peptide compared with PGMN. PGMO associated with higher inhibitor phosphorylation of the insulin receptor substrate 1 (IRS-1) and lower activator phosphorylation of protein kinase B/Akt (Akt). Cells from PGMO also showed lower nitric oxide level and reduced activator serine1177 but increased inhibitor threonine495 phosphorylation of endothelial nitric oxide synthase (eNOS) and saturable transport of l-arginine. HUVECs from PGMO were not responsive to insulin. CONCLUSION The lack of response to insulin by the foetoplacental endothelium may result from reduced IRS-1/Akt/eNOS signalling in PGMO. These findings may result in higher risk of insulin resistance in neonates to PGMO pregnancies.
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Affiliation(s)
- Roberto Villalobos-Labra
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, 8330024, Chile
| | - Francisco Westermeier
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, 8330024, Chile; FH JOANNEUM Gesellschaft MbH University of Applied Sciences, Institute of Biomedical Science, Eggenberger Allee 13, 8020, Graz, Austria
| | - Carolina Pizarro
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, 8330024, Chile
| | - Pablo J Sáez
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, 8330024, Chile; Institut Curie, Paris Sciences & Lettres Research University, CNRS, UMR 144, F-75005, Paris, France
| | - Fernando Toledo
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, 8330024, Chile; Department of Basic Sciences, Faculty of Sciences, Universidad del Bío-Bío, Chillán, 3780000, Chile
| | - Fabián Pardo
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, 8330024, Chile; Metabolic Diseases Research Laboratory, Interdisciplinary Center of Territorial Health Research (CIISTe), San Felipe Campus, School of Medicine, Faculty of Medicine, Universidad de Valparaíso, 2172972, San Felipe, Chile
| | - Juan P Kusanovic
- Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, 8330024, Chile
| | - Francisco Mardones
- Department of Public Health, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, 8330024, Chile
| | - José A Poblete
- Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, 8330024, Chile
| | - Luis Sobrevia
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, 8330024, Chile; Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, Seville, E-41012, Spain; University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, QLD 4029, Queensland, Australia.
| | - Marcelo Farías
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, 8330024, Chile.
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Heslehurst N, Vieira R, Akhter Z, Bailey H, Slack E, Ngongalah L, Pemu A, Rankin J. The association between maternal body mass index and child obesity: A systematic review and meta-analysis. PLoS Med 2019; 16:e1002817. [PMID: 31185012 PMCID: PMC6559702 DOI: 10.1371/journal.pmed.1002817] [Citation(s) in RCA: 210] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/01/2019] [Indexed: 01/09/2023] Open
Abstract
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.
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Affiliation(s)
- Nicola Heslehurst
- Institute of Health & Society, Newcastle University, Newcastle upon
Tyne, United Kingdom
- * E-mail:
| | - Rute Vieira
- Institute of Health & Society, Newcastle University, Newcastle upon
Tyne, United Kingdom
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen,
United Kingdom
| | - Zainab Akhter
- Institute of Health & Society, Newcastle University, Newcastle upon
Tyne, United Kingdom
| | - Hayley Bailey
- Institute of Health & Society, Newcastle University, Newcastle upon
Tyne, United Kingdom
| | - Emma Slack
- Institute of Health & Society, Newcastle University, Newcastle upon
Tyne, United Kingdom
| | - Lem Ngongalah
- Institute of Health & Society, Newcastle University, Newcastle upon
Tyne, United Kingdom
| | - Augustina Pemu
- Institute of Health & Society, Newcastle University, Newcastle upon
Tyne, United Kingdom
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle upon
Tyne, United Kingdom
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Li C, Zeng L, Wang D, Dang S, Chen T, Watson V, Yan H. Effect of maternal pre-pregnancy BMI and weekly gestational weight gain on the development of infants. Nutr J 2019; 18:6. [PMID: 30674315 PMCID: PMC6345052 DOI: 10.1186/s12937-019-0432-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 01/14/2019] [Indexed: 11/19/2022] Open
Abstract
Objective The aim of the present study is to identify the average effect across different time points and to specify the time effects of maternal pre-pregnancy BMI and weekly gestational weight gain on the mental development and physical growth of infants. Methods The present cohort study used a repeated measures study design that began in 2004 with follow up at 3, 6, 12, 18, and 24 months of age. The participants were a subset from a controlled, cluster-randomized, double-blind trial. Bayley Scales of Infant Development (BSID) were used to estimate the mental development of infants. A generalized estimating equation linear model was used to estimate the effects of maternal BMI and weight gain. Results The average effect of maternal BMI and weight gain on the weight for age Z scores (WAZ), length for age Z scores (LAZ) and mental development index (MDI) across the different time points of infants was significant. In addition, the maternal BMI and weight gain were positively and significantly associated with the WAZ and LAZ in infants of different ages. However, the effect of weekly gestational weight gain was significant only during the earlier period of life (3 months, Coefficient: 11.15, 95%CI: 4.89–17.41). Conclusions Our results indicate positive effects of pre-pregnancy and prenatal nutrition on the physical growth of infants. Weekly gestational weight gain of the pregnant women had a positive effect on the mental development of the infants, but this effect appears to decline over time. Electronic supplementary material The online version of this article (10.1186/s12937-019-0432-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chao Li
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Shaonong Dang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Tao Chen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Victoria Watson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Hong Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China. .,Nutrition and Food Safety Engineering Research Center of Shaanxi Province, Xi'an, China. .,Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Xi'an, China. .,School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76 West Yanta Road, PO Box 46, Xi'an, Xi'an, 710061, Shaanxi, China.
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Schoppa I, Lyass A, Heard-Costa N, de Ferranti SD, Fox C, Gillman MW, D'Agostino R, Levy D, Mendelson MM. Association of Maternal Prepregnancy Weight with Offspring Adiposity Throughout Adulthood over 37 Years of Follow-up. Obesity (Silver Spring) 2019; 27:137-144. [PMID: 30474203 PMCID: PMC6309198 DOI: 10.1002/oby.22326] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/07/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study aimed to determine the relation of maternal prepregnancy weight with offspring BMI across adulthood from almost 40 years of follow-up. METHODS BMI was measured in Framingham Heart Study Offspring cohort participants between 1971 and 2008. The association of maternal prepregnancy weight category (ascertained via direct measure and questionnaire) with serial offspring BMI, overweight, obesity, and change in BMI over time was tested, adjusted for age, sex, and a BMI genetic risk score; secondary models additionally adjusted for physical activity, dietary factors, smoking, education, and familial relatedness. RESULTS Among 863 participants at initial assessment (83 exposed and 780 controls), mean (SD) age was 33 (10) years, 53% were female, and mean BMI was 24.5 (4.1) kg/m2 . Exposed offspring BMI was higher at every examination cycle, ranging from 1.5 (0.5) to 3.0 (0.5) kg/m2 (P < 0.001), with larger differences at later assessments. The rate of increase in offspring BMI over time was higher in exposed offspring before the age of 50 years (β [SE] = 0.07 [0.02] kg/m2 per year; P = 0.004) but not after the age of 50 years (-0.05 [0.04] kg/m2 per year; P = 0.2). CONCLUSIONS Maternal prepregnancy weight is associated with greater offspring BMI throughout adulthood, with more rapid weight acceleration in early and midadulthood.
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Affiliation(s)
- Isabelle Schoppa
- Framingham Heart Study, Framingham, Massachusetts, USA
- Population Studies Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Framingham, Massachusetts, USA
| | - Asya Lyass
- Framingham Heart Study, Framingham, Massachusetts, USA
- Department of Mathematics and Statistics, Boston University, Boston, Massachusetts, USA
| | - Nancy Heard-Costa
- Framingham Heart Study, Framingham, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Sarah D de Ferranti
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Caroline Fox
- Framingham Heart Study, Framingham, Massachusetts, USA
- Population Studies Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Framingham, Massachusetts, USA
- Merck Research Laboratories, Merck & Co., Boston, Massachusetts, USA
| | - Matthew W Gillman
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts, USA
- Office of the Director, National Institutes of Health, Bethesda, Maryland, USA
| | - Ralph D'Agostino
- Framingham Heart Study, Framingham, Massachusetts, USA
- Department of Mathematics and Statistics, Boston University, Boston, Massachusetts, USA
| | - Daniel Levy
- Framingham Heart Study, Framingham, Massachusetts, USA
- Population Studies Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Framingham, Massachusetts, USA
| | - Michael M Mendelson
- Framingham Heart Study, Framingham, Massachusetts, USA
- Population Studies Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Framingham, Massachusetts, USA
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Karami Z, Nekuei N, Kazemi A, Paknahad Z. Psychosocial Factors Related to Dietary Habits in Women Undergoing Preconception Care. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2018; 23:311-315. [PMID: 30034493 PMCID: PMC6034532 DOI: 10.4103/ijnmr.ijnmr_22_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: Correct health behaviors such as dietary habits before pregnancy ensure desired pregnancy outcomes. The aim of this study was to determine the relationship between psychosocial factors and dietary habits using social cognitive theory (SCT) in women undergoing preconception care (PCC). Materials and Methods: This cross-sectional study was conducted among 120 women from October to December 2015 in health centres in Isfahan, Iran. Using a researcher-made questionnaire, the researcher conducted stratified random sampling and convenience sampling for selecting health centres and participants, respectively. For data analysis, the researcher applied the Pearson, Spearman's, and linear regression test in SPSS software. Results: The results showed that perceived support from healthcare personnel and outcome expectations are not associated with any of the components of dietary habits. Access to healthy food was inversely correlated with incorrect dietary habits (β = −0.19, p = 0.039) and had a direct correlation with daily consumption of fruits (β = 0.27, p = 0.006). Perceived support from the spouse had a direct correlation with desired dietary habits (β = 0.27, p = 0.006). Self-efficacy was inversely correlated with incorrect dietary habits (β = −0.22, p = 0.011) and had a direct relationship with desired dietary habits (β = 0.25, p = 0.004). Conclusions: To improve the nutritional status of women prior to pregnancy, interventions must be focused on increasing women's access to healthy food and their self-efficacy in maintaining a healthy diet.
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Affiliation(s)
- Zahra Karami
- Students Research Centre, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nafisehsadat Nekuei
- Nursing and Midwifery Care Research Center, Midwifery and Reproductive Health Department, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ashraf Kazemi
- Nursing and Midwifery Care Research Center, Midwifery and Reproductive Health Department, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zamzam Paknahad
- Department of Clinical Nutrition, Faculty of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Hanem LGE, Stridsklev S, Júlíusson PB, Salvesen Ø, Roelants M, Carlsen SM, Ødegård R, Vanky E. Metformin Use in PCOS Pregnancies Increases the Risk of Offspring Overweight at 4 Years of Age: Follow-Up of Two RCTs. J Clin Endocrinol Metab 2018; 103:1612-1621. [PMID: 29490031 DOI: 10.1210/jc.2017-02419] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/26/2018] [Indexed: 12/30/2022]
Abstract
CONTEXT Metformin is used in pregnancy in women with gestational diabetes mellitus, polycystic ovary syndrome (PCOS), and obesity. Metformin passes the placenta. OBJECTIVE To explore the effects of metformin use in PCOS pregnancies on offspring growth to 4 years of age. DESIGN Follow-up study of two randomized, double-blind, placebo-controlled trials. SETTING Secondary care centers. Eleven public hospitals in Norway. PARTICIPANTS One hundred eighty-two children of mothers with PCOS who participated in two randomized controlled trials. INTERVENTION Metformin 1700 or 2000 mg/d or placebo from first trimester to delivery in the original studies. No intervention in the current study. MAIN OUTCOME MEASURES Height, weight, body mass index (BMI), and overweight/obesity at 4 years of age and head circumference at 1 year of age, converted to z scores. RESULTS The difference in height z score means between the groups at 4 years of age was nonsignificant (0.07 [95% confidence interval (CI): -0.22 to 0.36]; P = 0.651). At 4 years of age, the metformin group had higher weight z score than the placebo group [difference in means: 0.38 (0.07 to 0.69); P = 0.017] and higher BMI z score [difference in means: 0.45 (0.11 to 0.78); P = 0.010]. There were more overweight/obese children in the metformin group [26 (32%)] than in the placebo group [14 (18%)] at 4 years of age [odds ratio: 2.17 (1.04 to 4.61); P = 0.038]. The difference in mean head circumference z score at 1 year of age was 0.27 (-0.04 to 0.58; P = 0.093). CONCLUSION Metformin-exposed children had higher BMI and increased prevalence of overweight/obesity at 4 years of age.
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Affiliation(s)
- Liv Guro Engen Hanem
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Solhild Stridsklev
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Pétur B Júlíusson
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Øyvind Salvesen
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mathieu Roelants
- Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium
| | - Sven M Carlsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Rønnaug Ødegård
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Children's Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Eszter Vanky
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Chagarlamudi H, Kim J, Newton E. Associations of Prepregnancy Morbid Obesity and Prenatal Depression with Gestational Weight Gain. South Med J 2018; 111:23-29. [DOI: 10.14423/smj.0000000000000756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Partap U, Young EH, Allotey P, Sandhu MS, Reidpath DD. Anthropometric and cardiometabolic risk factors in parents and child obesity in Segamat, Malaysia. Int J Epidemiol 2017; 46:1523-1532. [PMID: 29106558 PMCID: PMC5837730 DOI: 10.1093/ije/dyx114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/25/2017] [Accepted: 06/09/2017] [Indexed: 02/06/2023] Open
Abstract
Background There is little evidence regarding risk factors for child obesity in Asian populations, including the role of parental anthropometric and cardiometabolic risk factors. We examined the relation between parental risk factors and child obesity in a Malaysian population. Methods We used data from health and demographic surveillance conducted by the South East Asia Community Observatory in Segamat, Malaysia. Analyses included 9207 individuals (4806 children, 2570 mothers and 1831 fathers). Child obesity was defined based on the World Health Organization 2007 reference. We assessed the relation between parental anthropometric (overweight, obesity and central obesity) and cardiometabolic (systolic hypertension, diastolic hypertension and hyperglycaemia) risk factors and child obesity, using mixed effects Poisson regression models with robust standard errors. Results We found a high burden of overweight and obesity among children in this population (30% overweight or obese). Children of one or more obese parents had a 2-fold greater risk of being obese compared with children of non-obese parents. Sequential adjustment for parental and child characteristics did not materially affect estimates (fully adjusted relative risk for obesity in both parents: 2.39, 95% confidence interval: 1.82, 3.10, P < 0.001; P for trend < 0.001). These associations were not modified by parental or child sex. We found no consistent evidence for associations between parental cardiometabolic risk factors and child obesity. Conclusions Parental obesity was strongly associated with child obesity in this population. Further exploration of the behavioural and environmental drivers of these associations may help inform strategies addressing child obesity in Asia.
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Affiliation(s)
- Uttara Partap
- Department of Medicine, University of Cambridge, UK
- Wellcome Trust Sanger Institute, Hinxton, UK
| | - Elizabeth H Young
- Department of Medicine, University of Cambridge, UK
- Wellcome Trust Sanger Institute, Hinxton, UK
| | - Pascale Allotey
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
- South East Asia Community Observatory, Segamat, Malaysia
| | - Manjinder S Sandhu
- Department of Medicine, University of Cambridge, UK
- Wellcome Trust Sanger Institute, Hinxton, UK
| | - Daniel D Reidpath
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
- South East Asia Community Observatory, Segamat, Malaysia
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20
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Alisi A, Vajro P. Pre-natal and post-natal environment monitoring to prevent non-alcoholic fatty liver disease development. J Hepatol 2017; 67:451-453. [PMID: 28619256 DOI: 10.1016/j.jhep.2017.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 04/24/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Anna Alisi
- Liver Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Pietro Vajro
- Dept. Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Unit of Pediatrics, University of Salerno, Baronissi (Sa), Italy
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21
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Association of parental body mass index before pregnancy on infant growth and body composition: Evidence from a pregnancy cohort study in Malaysia. Obes Res Clin Pract 2016; 10 Suppl 1:S35-S47. [DOI: 10.1016/j.orcp.2015.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 07/01/2015] [Accepted: 08/07/2015] [Indexed: 11/19/2022]
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22
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Gillespie SL, Christian LM. Body Mass Index as a Measure of Obesity: Racial Differences in Predictive Value for Health Parameters During Pregnancy. J Womens Health (Larchmt) 2016; 25:1210-1218. [PMID: 27487272 DOI: 10.1089/jwh.2016.5761] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND As a measure of obesity, body mass index (BMI; kg/m2) is an imperfect predictor of health outcomes, particularly among African Americans. However, BMI is used to guide prenatal care. We examined racial differences in the predictive value of maternal BMI for physiologic correlates of obesity, serum interleukin (IL)-6 and C-reactive protein (CRP), as well as cesarean section and infant birth weight. METHODS One hundred five pregnant women (40 European American, 65 African American) were assessed during the second trimester. BMI was defined as per prepregnancy weight. Electrochemiluminescence and enzyme-linked immunosorbent assays were used to quantify IL-6 and CRP, respectively. Birth outcomes were determined by medical record review. RESULTS Women of both races classified as obese had higher serum IL-6 and CRP than their normal-weight counterparts (ps ≤ 0.01). However, among women with overweight, elevations in IL-6 (p < 0.01) and CRP (p = 0.06) were observed among European Americans, but not African Americans (ps ≥ 0.61). Maternal obesity was a significantly better predictor of cesarean section among European Americans versus African Americans (p = 0.03) and BMI was associated with infant birth weight among European Americans (p < 0.01), but not African Americans (p = 0.94). Effects remained after controlling for gestational age at delivery, gestational diabetes, and gestational weight gain as appropriate. CONCLUSIONS BMI may be a less valid predictor of correlates of overweight/obesity among African Americans versus European Americans during pregnancy. This should be considered in epidemiological studies of maternal-child health. In addition, studies examining the comparative validity of alternative/complementary measures to define obesity in pregnancy are warranted to inform clinical care.
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Affiliation(s)
| | - Lisa M Christian
- 2 Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center , Columbus, Ohio.,3 Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center , Columbus, Ohio.,4 The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center , Columbus, Ohio.,5 Department of Psychology, The Ohio State University , Columbus, Ohio
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23
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Claesson IM, Sydsjö G, Olhager E, Oldin C, Josefsson A. Effects of a Gestational Weight Gain Restriction Program for Obese Pregnant Women: Children's Weight Development during the First Five Years of Life. Child Obes 2016; 12:162-70. [PMID: 27007580 DOI: 10.1089/chi.2015.0177] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Maternal prepregnancy obesity (BMI ≥30 kg/m(2)) and excessive gestational weight gain (GWG) have shown a strong positive association with a higher BMI and risk of obesity in the offspring. The aim of this study is to estimate the effect of a GWG restriction program for obese pregnant women on the children's BMI at 5 years of age and weight-for-length/height (WL/H) development from 2 months of age until 5 years of age. METHODS This was a follow-up study of 302 children (137 children in an intervention group and 165 children in a control group) whose mothers participated in a weight gain restriction program during pregnancy. RESULTS BMI at five years of age did not differ between girls and boys in the intervention and control group. The degree of maternal GWG, <7 kg or ≥7 kg, did not affect the offspring's WL/H. Compared with Swedish reference data, just over half of the children in both the intervention and control group had a BMI within the average range, whereas slightly more than one-third of the children had a higher BMI. CONCLUSION Despite a comprehensive gestational intervention program for obese women containing individual weekly visits and opportunity to participate in aqua aerobic classes, there were no differences between BMI or weight development among the offspring at 5 years of age in the intervention and control group.
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Affiliation(s)
- Ing-Marie Claesson
- 1 Department of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Linköping University , Linköping, Sweden
| | - Gunilla Sydsjö
- 1 Department of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Linköping University , Linköping, Sweden
| | - Elisabeth Olhager
- 2 Department of Clinical Sciences, Department of Paediatrics, Lund University , Lund, Sweden
| | - Carin Oldin
- 3 Child Health Services , Public Health and Health Care, Region Jönköping County, Jönköping, Sweden
| | - Ann Josefsson
- 1 Department of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Linköping University , Linköping, Sweden
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24
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Pedersen JM, Budtz-Jørgensen E, Mortensen EL, Bruunsgaard H, Osler M, Sørensen TIA, Rod NH, Lund R. Late midlife C-reactive protein and interleukin-6 in middle aged danish men in relation to body size history within and across generations. Obesity (Silver Spring) 2016; 24:461-8. [PMID: 26718895 DOI: 10.1002/oby.21311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 06/24/2015] [Accepted: 07/30/2015] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The aim was to estimate the effects of ponderal index at birth and body mass index (BMI) in early adulthood on C-reactive protein (CRP) and interleukin-6 (IL-6) and to quantify the effects through subsequent measures of body size. In a subanalysis, the contributions of maternal BMI to the inflammatory status of offspring were investigated. METHODS The study was based on 2,986 Danish males from the Copenhagen Aging and Midlife Biobank. Path analysis was employed to estimate direct and indirect effects. RESULTS A 10% higher maternal BMI was associated with 7% higher CRP and 3% higher IL-6 among offspring. A 10% higher ponderal index at birth was associated with 4% lower CRP in late midlife; this effect was only partially mediated by later growth. A 10% higher BMI in early adulthood was associated with 8% higher CRP and 4% higher IL-6 in late midlife. The findings suggest that weight gain in adulthood is associated with low-grade inflammation in late midlife. CONCLUSIONS Ponderal index at birth is associated with CRP in later life independently of adult BMI. The findings additionally suggest that preventing weight gain in early adulthood would be beneficial for inflammatory status in later life.
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Affiliation(s)
- Jolene Masters Pedersen
- Section of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Esben Budtz-Jørgensen
- Section of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
- Section of Environmental Health, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Helle Bruunsgaard
- Department of Clinical Immunology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
- Centre of Inflammation and Metabolism, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Merete Osler
- Research Center for Prevention and Health, Glostrup Hospital, Capital Region, Copenhagen, Denmark
| | - Thorkild I A Sørensen
- University of Copenhagen, and Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospitals, Capital Region, Copenhagen, Denmark
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- MRC Integrative Epidemiology Unit, Bristol University, Bristol, UK
| | - Naja Hulvej Rod
- Section of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Stress Research Center, Copenhagen, Denmark
| | - Rikke Lund
- Section of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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25
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Thompson MD, Cismowski MJ, Trask AJ, Lallier SW, Graf AE, Rogers LK, Lucchesi PA, Brigstock DR. Enhanced Steatosis and Fibrosis in Liver of Adult Offspring Exposed to Maternal High-Fat Diet. Gene Expr 2016; 17:47-59. [PMID: 27342733 PMCID: PMC5611859 DOI: 10.3727/105221616x692135] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Early life exposures can increase the risk of developing chronic diseases including nonalcoholic fatty liver disease. Maternal high-fat diet increases susceptibility to development of steatosis in the offspring. We determined the effect of maternal high-fat diet exposure in utero and during lactation on offspring liver histopathology, particularly fibrosis. Female C57Bl/6J mice were fed a control or high-fat diet (HFD) for 8 weeks and bred with lean males. Nursing dams were continued on the same diet with offspring sacrificed during the perinatal period or maintained on either control or high-fat diet for 12 weeks. Increased hepatocyte proliferation and stellate cell activation were observed in the liver of HFD-exposed pups. Offspring exposed to perinatal high-fat diet and high-fat diet postweaning showed extensive hepatosteatosis compared to offspring on high-fat diet after perinatal control diet. Offspring exposed to perinatal high-fat diet and then placed on control diet for 12 weeks developed steatosis and pericellular fibrosis. Importantly, we found that exposure to perinatal high-fat diet unexpectedly promotes more rapid disease progression of nonalcoholic fatty liver disease, with a sustained fibrotic phenotype, only in adult offspring fed a postweaning control diet.
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Affiliation(s)
- Michael D. Thompson
- *Division of Endocrinology, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Mary J. Cismowski
- †Center for Cardiovascular and Pulmonary Research, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Aaron J. Trask
- †Center for Cardiovascular and Pulmonary Research, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Scott W. Lallier
- ‡Center for Perinatal Research, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Amanda E. Graf
- ‡Center for Perinatal Research, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Lynette K. Rogers
- ‡Center for Perinatal Research, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Pamela A. Lucchesi
- †Center for Cardiovascular and Pulmonary Research, Nationwide Children’s Hospital, Columbus, OH, USA
- §Department of Basic Sciences, The Commonwealth Medical College, Scranton, PA, USA
| | - David R. Brigstock
- ¶Center for Clinical and Translational Research, Nationwide Children’s Hospital, Columbus, OH, USA
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de Campora G, Larciprete G, Delogu AM, Meldolesi C, Giromini L. A longitudinal study on emotional dysregulation and obesity risk: From pregnancy to 3 years of age of the baby. Appetite 2015; 96:95-101. [PMID: 26375359 DOI: 10.1016/j.appet.2015.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 08/10/2015] [Accepted: 09/10/2015] [Indexed: 11/15/2022]
Abstract
Some recent findings indicate that maternal sensitivity and emotional regulation may play a key role in predicting the risk for obesity of the child in early ages. The current article describes a longitudinal study encompassing more than 50 women, across a time-span that currently goes from pregnancy (n = 65) to three years of age of the baby (n = 53). In a previous report on our ongoing research project, we showed that emotional regulation during pregnancy and pre-pregnancy BMI significantly predicted the quality of the early, dyadic feeding interactions, at 7 months of age of the baby. The current study confirmed and extended those findings, by showing that maternal emotional dysregulation (r = .355, p = .009) and pre-pregnancy BMI (r = .389, p = .004) predicted the BMI of the child at three years of age too, with a medium to large effect size. However, neither maternal emotional regulation nor pre-pregnancy BMI significantly predicted infant attachment at one year of age.
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Affiliation(s)
- Gaia de Campora
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli 1, Rome, Italy.
| | - Giovanni Larciprete
- Department of Obstetrics and Gynecology, Fatebenefratelli Hospital, Piazza Fatebenefratelli 2, Rome, Italy
| | - Anna Maria Delogu
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli 1, Rome, Italy
| | - Cristina Meldolesi
- Department of Obstetrics and Gynecology, San Pietro Hospital, Via Cassia 600, Rome, Italy
| | - Luciano Giromini
- Department of Psychology, University of Turin, Via Po 14, Turin, Italy
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27
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Haby K, Glantz A, Hanas R, Premberg Å. Mighty Mums – An antenatal health care intervention can reduce gestational weight gain in women with obesity. Midwifery 2015; 31:685-92. [DOI: 10.1016/j.midw.2015.03.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 03/22/2015] [Accepted: 03/29/2015] [Indexed: 01/25/2023]
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28
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Widen EM, Whyatt RM, Hoepner LA, Mueller NT, Ramirez-Carvey J, Oberfield SE, Hassoun A, Perera FP, Gallagher D, Rundle AG. Gestational weight gain and obesity, adiposity and body size in African-American and Dominican children in the Bronx and Northern Manhattan. MATERNAL AND CHILD NUTRITION 2015; 12:918-28. [PMID: 25753294 DOI: 10.1111/mcn.12174] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Gestational weight gain (GWG) is potentially modifiable and is associated with infant size and body composition; however, long-term effects on childhood obesity have not been reported among multi-ethnic urban populations. We examined the association between GWG and child anthropometric measures and body composition at 7 years [waist circumference (WC), body mass index z-score (BMIZ), obesity (BMIZ ≥95%ile) and bioelectrical impedance analysis estimates of percentage body fat (%fat)] in African-American and Dominican dyads (n = 323) in the Columbia Center for Children's Environmental Health prospective birth cohort study from 1998 to 2013. Linear and logistic regression evaluated associations between excessive GWG [>Institute of Medicine (IOM) 2009 guidelines] and outcomes, adjusting for pre-pregnancy BMI and covariates. Pre-pregnancy BMI (mean ± standard deviation, all such values) and total GWG were 25.8 ± 6.2 kg m(-2) (45% overweight/obese) and 16.4 ± 7.9 kg (64% > IOM guidelines), respectively. Excessive GWG was associated with higher BMIZ {0.44 [95% confidence interval (CI): 0.2, 0.7], P < 0.001}, WC [β: 2.9 cm (95% CI: 1.1, 4.6), P = 0.002], %fat at 7 years [β: 2.2% (95% CI: 1.0, 3.5), P = 0.001)] and obesity [odds ratio: 2.93 (95% CI: 1.5, 5.8), P = 0.002]. Pre-pregnancy BMI was positively associated with child size, adiposity and obesity (all P < 0.05). Excessive GWG was highly prevalent and was associated with child obesity, greater percentage body fat and abdominal adiposity. Strategies to support healthy GWG are warranted to promote healthy growth and prevent childhood obesity.
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Affiliation(s)
- Elizabeth M Widen
- New York Obesity Nutrition Research Center, Columbia University Medical Center, New York, New York, USA. .,Institute of Human Nutrition and Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA. .,Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, New York, USA.
| | - Robin M Whyatt
- Department of Environmental Health Sciences and the Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Lori A Hoepner
- Department of Environmental Health Sciences and the Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Noel T Mueller
- Institute of Human Nutrition and Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, New York, USA
| | - Judyth Ramirez-Carvey
- Department of Environmental Health Sciences and the Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Sharon E Oberfield
- Division of Pediatric Endocrinology, Columbia University Medical Center, New York, New York, USA
| | - Abeer Hassoun
- Division of Pediatric Endocrinology, Columbia University Medical Center, New York, New York, USA
| | - Frederica P Perera
- Department of Environmental Health Sciences and the Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Dympna Gallagher
- New York Obesity Nutrition Research Center, Columbia University Medical Center, New York, New York, USA.,Institute of Human Nutrition and Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
| | - Andrew G Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, New York, USA
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29
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Lau EY, Liu J, Archer E, McDonald SM, Liu J. Maternal weight gain in pregnancy and risk of obesity among offspring: a systematic review. J Obes 2014; 2014:524939. [PMID: 25371815 PMCID: PMC4202338 DOI: 10.1155/2014/524939] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/11/2014] [Accepted: 09/14/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To systematically review the evidence from prospective and retrospective cohort studies on the association between gestational weight gain (GWG) and offspring's body weight. METHODS Electronic databases PubMed, Web of Science, CINAHL, and Academic Search Premiere were searched from inception through March 18, 2013. Included studies (n = 23) were English articles that examined the independent associations of GWG with body mass index (BMI) and/or overweight status in the offspring aged 2 to 18.9 years. Two authors independently extracted the data and assessed methodological quality of the included studies. RESULTS Evidence from cohort studies supports that total GWG and exceeding the Institute of Medicine maternal weight gain recommendation were associated with higher BMI z-score and elevated risk of overweight or obesity in offspring. The evidence of high rate of GWG during early- and mid-pregnancy is suggestive. Additionally, the evidence on inadequate GWG and net GWG in relation to body weight outcomes in offspring is insufficient to draw conclusions. CONCLUSIONS These findings suggest that GWG is a potential risk factor for childhood obesity. However, findings should be interpreted with caution due to measurement issues of GWG and potential confounding effects of shared familial characteristics (i.e., genetics and maternal and child's lifestyle factors).
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Affiliation(s)
- Erica Y. Lau
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Junxiu Liu
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Room 459 Discovery Building, Columbia, SC 29208, USA
| | - Edward Archer
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Samantha M. McDonald
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Jihong Liu
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Room 459 Discovery Building, Columbia, SC 29208, USA
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30
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Perng W, Gillman MW, Mantzoros CS, Oken E. A prospective study of maternal prenatal weight and offspring cardiometabolic health in midchildhood. Ann Epidemiol 2014; 24:793-800.e1. [PMID: 25263237 DOI: 10.1016/j.annepidem.2014.08.002] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/22/2014] [Accepted: 08/25/2014] [Indexed: 01/28/2023]
Abstract
PURPOSE To examine the relations of maternal prepregnancy body mass index (ppBMI) and gestational weight gain (GWG) with offspring cardiometabolic health. DESIGN We studied 1090 mother-child pairs in Project Viva, a Boston-area prebirth cohort. We measured overall (dual x-ray absorptiometry total fat; body mass index z-score) and central adiposity (dual x-ray absorptiometry trunk fat), and systolic blood pressure in offspring at 6 to 10 years. Fasting bloods (n = 687) were assayed for insulin and glucose (for calculation of homeostatic model assessment of insulin resistance), triglycerides, leptin, adiponectin, high sensitivity C-reactive protein, and interleukin 6. Using multivariable linear regression, we examined differences in offspring outcomes per 1 SD maternal ppBMI and GWG. RESULTS After adjustment for confounders, each 5 kg/m² higher ppBMI corresponded with 0.92 kg (95% confidence interval, 0.70-1.14) higher total fat, 0.27 BMI z-score (0.21-0.32), and 0.39 kg (0.29-0.49) trunk fat. ppBMI was also positively associated with homeostatic model assessment of insulin resistance, leptin, high sensitivity C-reactive protein, interleukin 6, and systolic blood pressure; and lower adiponectin. Each 5 kg of GWG predicted greater adiposity (0.33 kg [0.11-0.54] total fat; 0.14 kg [0.04-0.23] trunk fat) and higher leptin (6% [0%-13%]) in offspring after accounting for confounders and ppBMI. CONCLUSIONS Children born to heavier mothers have more overall and central fat and greater cardiometabolic risk. Offspring of women with higher GWG had greater adiposity and higher leptin.
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Affiliation(s)
- Wei Perng
- Obesity Prevention Program, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA.
| | - Matthew W Gillman
- Obesity Prevention Program, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA; Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Christos S Mantzoros
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Emily Oken
- Obesity Prevention Program, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA; Department of Nutrition, Harvard School of Public Health, Boston, MA
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31
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Thorn SR, Baquero KC, Newsom SA, El Kasmi KC, Bergman BC, Shulman GI, Grove KL, Friedman JE. Early life exposure to maternal insulin resistance has persistent effects on hepatic NAFLD in juvenile nonhuman primates. Diabetes 2014; 63:2702-13. [PMID: 24705404 PMCID: PMC4113070 DOI: 10.2337/db14-0276] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The origins of nonalcoholic fatty liver disease (NAFLD) may lie in early intrauterine exposures. Here we examined the maternal response to chronic maternal high-fat (HF) diet and the impact of postweaning healthy diet on mechanisms for NAFLD development in juvenile nonhuman primate (NHP) offspring at 1 year of age. Pregnant females on HF diet were segregated as insulin resistant (IR; HF+IR) or insulin sensitive (IS; HF+IS) compared with control (CON)-fed mothers. HF+IR mothers have increased body mass, higher triglycerides, and increased placental cytokines. At weaning, offspring were placed on a CON or HF diet. Only offspring from HF+IR mothers had increased liver triglycerides and upregulated pathways for hepatic de novo lipid synthesis and inflammation that was irreversible upon switching to a healthy diet. These juvenile livers also showed a combination of classical and alternatively activated hepatic macrophages and natural killer T cells, in the absence of obesity or insulin resistance. Our findings suggest that maternal insulin resistance, including elevated triglycerides, insulin, and weight gain, initiates dysregulation of the juvenile hepatic immune system and development of de novo lipogenic pathways that persist in vitro and may be an irreversible "first hit" in the pathogenesis of NAFLD in NHP.
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Affiliation(s)
- Stephanie R Thorn
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Karalee C Baquero
- Diabetes, Obesity, and Metabolism, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR
| | - Sean A Newsom
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Karim C El Kasmi
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Bryan C Bergman
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Gerald I Shulman
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Kevin L Grove
- Diabetes, Obesity, and Metabolism, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR
| | - Jacob E Friedman
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
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32
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Brumbaugh DE, Friedman JE. Developmental origins of nonalcoholic fatty liver disease. Pediatr Res 2014; 75:140-7. [PMID: 24192698 PMCID: PMC4081536 DOI: 10.1038/pr.2013.193] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 08/06/2013] [Indexed: 02/07/2023]
Abstract
Obese pregnant women may transmit their metabolic phenotype to offspring, leading to a cycle of obesity and diabetes over generations. Early childhood obesity predicts nonalcoholic fatty liver disease (NAFLD), the most common chronic human liver disease. The fetus may be vulnerable to steatosis because immature fetal adipose depots are not available to buffer the excess transplacental lipid delivery in maternal obesity. In animal models, in utero high-fat diet exposure results in an increase in the accumulation of liver triglycerides in offspring and increased hepatic oxidative stress and apoptosis, perhaps priming the liver for later development of NAFLD. Innate immune dysfunction and necroinflammatory changes have been observed in postnatal offspring liver of animals born to high-fat-fed dams. Postweaning, livers of offspring exposed to maternal high-fat feeding in utero share pathophysiologic features with human NAFLD, including increased de novo lipogenesis and decreased free fatty acid oxidation. Human studies using magnetic resonance imaging have shown that maternal BMI predicts infant intrahepatocellular lipid storage, as seen in animal models. The generational transfer of NAFLD may occur via epigenetic changes in offspring liver. Transmission of microbiota from mother to infant may impact energy retention and immune function that contribute to a predisposition to NAFLD.
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Affiliation(s)
- David E. Brumbaugh
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Jacob E. Friedman
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado,Department of Biochemistry and Molecular Genetics, University of Colorado School of Medicine, Aurora, Colorado
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Yu Z, Han S, Zhu J, Sun X, Ji C, Guo X. Pre-pregnancy body mass index in relation to infant birth weight and offspring overweight/obesity: a systematic review and meta-analysis. PLoS One 2013; 8:e61627. [PMID: 23613888 PMCID: PMC3628788 DOI: 10.1371/journal.pone.0061627] [Citation(s) in RCA: 533] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 03/12/2013] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Overweight/obesity in women of childbearing age is a serious public-health problem. In China, the incidence of maternal overweight/obesity has been increasing. However, there is not a meta-analysis to determine if pre-pregnancy body mass index (BMI) is related to infant birth weight (BW) and offspring overweight/obesity. METHODS Three electronic bibliographic databases (MEDLINE, EMBASE and CINAHL) were searched systematically from January 1970 to November 2012. The dichotomous data on pre-pregnancy overweight/obesity and BW or offspring overweight/obesity were extracted. Summary statistics (odds ratios, ORs) were used by Review Manager, version 5.1.7. RESULTS After screening 665 citations from three electronic databases, we included 45 studies (most of high or medium quality). Compared with normal-weight mothers, pre-pregnancy underweight increased the risk of small for gestational age (SGA) (odds ratios [OR], 1.81; 95% confidence interval [CI], 1.76-1.87); low BW (OR, 1.47; 95% CI, 1.27-1.71). Pre-pregnancy overweight/obesity increased the risk of being large for gestational age (LGA) (OR, 1.53; 95% CI, 1.44-1.63; and OR, 2.08; 95% CI; 1.95-2.23), high BW (OR, 1.53; 95% CI, 1.44-1.63; and OR, 2.00; 95% CI; 1.84-2.18), macrosomia (OR, 1.67; 95% CI, 1.42-1.97; and OR, 3.23; 95% CI, 2.39-4.37), and subsequent offspring overweight/obesity (OR, 1.95; 95% CI, 1.77-2.13; and OR, 3.06; 95% CI, 2.68-3.49), respectively. Sensitivity analyses revealed that sample size, study method, quality grade of study, source of pre-pregnancy BMI or BW had a strong impact on the association between pre-pregnancy obesity and LGA. No significant evidence of publication bias was observed. CONCLUSIONS Pre-pregnancy underweight increases the risk of SGA and LBW; pre-pregnancy overweight/obesity increases the risk of LGA, HBW, macrosomia, and subsequent offspring overweight/obesity. A potential effect modification by maternal age, ethnicity, gestational weight gain, as well as the role of gestational diseases should be addressed in future studies.
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Affiliation(s)
- Zhangbin Yu
- State Key Laboratory of Reproductive Medicine, Department of Pediatrics, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China
| | - Shuping Han
- State Key Laboratory of Reproductive Medicine, Department of Pediatrics, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China
| | - Jingai Zhu
- State Key Laboratory of Reproductive Medicine, Department of Pediatrics, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaofan Sun
- State Key Laboratory of Reproductive Medicine, Department of Pediatrics, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China
| | - Chenbo Ji
- State Key Laboratory of Reproductive Medicine, Department of Pediatrics, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China
| | - Xirong Guo
- State Key Laboratory of Reproductive Medicine, Department of Pediatrics, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, China
- * E-mail:
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Limiting excess weight gain in healthy pregnant women: importance of energy intakes, physical activity, and adherence to gestational weight gain guidelines. J Pregnancy 2013; 2013:787032. [PMID: 23533762 PMCID: PMC3590762 DOI: 10.1155/2013/787032] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 01/16/2013] [Indexed: 11/18/2022] Open
Abstract
Few studies have investigated if compliance with energy intakes, physical activity, and weight gain guidelines attenuate postpartum weight retention (PPWR) in mothers attending prenatal classes. We investigated whether (a) daily energy intakes within 300 kcal of estimated energy requirements (EERs), (b) walking more than 5000 steps/day, (c) targeting the recommended weight gain goals for prepregnancy BMI, and/or (d) achieving weekly or total gestational weight gain (GWG) recommendations minimized PPWR in 54 women attending prenatal classes in Montreal/Ottawa, Canada. Participants completed a validated pregnancy physical activity questionnaire (PPAQ), 3 telephone-validated 24-hr dietary recalls, and wore a pedometer for one week. PPWR was measured 6 weeks after delivery. Results showed that 72% had healthy prepregnancy BMIs. However, 52% consumed >300 kcal/day in excess of their EER, 54% exceeded recommended GWG, and more overweight (93%) than normal weight women (38%) cited nonrecommended GWG targets. Following delivery, 33% were classified as overweight, and 17% were obese. Multiple logistic regressions revealed that women targeting “recommended weight gain advice” were 3 times more likely to meet total GWG recommendations (OR: 3.2, P < 0.05); women who complied with weekly GWG goals minimized PPWR (OR: 4.2, P < 0.02). In conclusion, appropriate GWG targets, lower energy intakes, and physical activity should be emphasized in prenatal education programs.
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Hearn L, Miller M, Fletcher A. Online healthy lifestyle support in the perinatal period: what do women want and do they use it? Aust J Prim Health 2013; 19:313-8. [DOI: 10.1071/py13039] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 06/28/2013] [Indexed: 12/11/2022]
Abstract
Unhealthy weight gain and retention during pregnancy and postpartum is detrimental to mother and child. Although various barriers limit the capacity for perinatal health care providers (PHCPs) to offer healthy lifestyle counselling, they could guide women to appropriate online resources. This paper presents a project designed to provide online information to promote healthy lifestyles in the perinatal period. Focus groups or interviews were held with 116 perinatal women and 76 PHCPs to determine what online information perinatal women and PHCPs want, in what form, and how best it should be presented. The results indicated that women wanted smartphone applications (apps) linked to trustworthy websites containing short answers to everyday concerns; information on local support services; and personalised tools to assess their nutrition, fitness and weight. Suggestions for improvement in these lifestyle areas should be practical and tailored to the developmental stage of their child. PHCPs wanted evidence-based, practical information, presented in a simple, engaging, interactive form. The outcome was a clinically endorsed website and app that health professionals could recommend. Preliminary evaluation showed that 10.5% of pregnant women in Western Australia signed up to the app. Use of the app appeared to be equitable across urban and rural areas of low to middle socioeconomic status.
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Størdal K. Overvektige mødre gir overvektige barn. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012. [DOI: 10.4045/tidsskr.12.1217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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