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Patey O, Bartsota M, Maric T, Patel D, Savvidou M, Carvalho JS. Impact of maternal bariatric surgery on offspring perinatal cardiac function: A prospective study. BJOG 2024; 131:1080-1088. [PMID: 38155109 DOI: 10.1111/1471-0528.17747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/15/2023] [Accepted: 12/13/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE To assess perinatal cardiac function in offspring of women with previous bariatric surgery and examine its association with maternal glucose control. DESIGN Prospective study. SETTING Maternity unit, UK. POPULATION Fifty-four fetuses/neonates; 29 of post-bariatric surgery women and 25 of women without surgery. METHODS Prospective, longitudinal observational study of pregnant women with and without previous bariatric surgery, matched for early pregnancy body mass index. Cardiac function of all offspring was assessed by two-dimensional conventional, spectral tissue Doppler and speckle-tracking echocardiography at 35-37 weeks of gestation and at 5-7 weeks of age. Maternal glycated haemoglobin (HbA1c) was measured at 27-30 weeks of gestation. Maternal demographics and fetal/infant cardiac function indices were compared between the groups. Correlation coefficient (r) is reported. MAIN OUTCOME MEASURES Fetal/infant cardiac function indices. RESULTS Compared with no-bariatric neonates, offspring of post-bariatric women were smaller at birth (birthweight centiles: 64.96 ± 36.41 versus 40.17 ± 27.99; p = 0.007). There were no significant differences in fetal/infant cardiac function indices and perinatal cardiac changes, between groups. There was a positive correlation between maternal HbA1c and fetal left ventricular (LV) longitudinal strain (r = 0.33) and LV longitudinal strain rate (r = 0.29), suggesting an inverse relation between HbA1c and fetal LV systolic function, but this was mainly seen in offspring of women with no previous bariatric surgery (r = 0.56 and r = 0.50, respectively). CONCLUSIONS Maternal bariatric surgery does not appear to inadvertently affect the offspring cardiac performance. We found an inverse correlation between maternal HbA1c levels and fetal LV systolic function but this was mainly seen in the no-bariatric pregnancies.
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Affiliation(s)
- Olga Patey
- Brompton Centre for Fetal Cardiology, Royal Brompton Hospital NHS Foundation Trust, London, UK
| | - Margarita Bartsota
- Brompton Centre for Fetal Cardiology, Royal Brompton Hospital NHS Foundation Trust, London, UK
| | - Tanya Maric
- Academic Department of Obstetrics and Gynaecology, Chelsea & Westminster Hospital, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College, London, UK
| | - Deesha Patel
- Academic Department of Obstetrics and Gynaecology, Chelsea & Westminster Hospital, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College, London, UK
| | - Makrina Savvidou
- Academic Department of Obstetrics and Gynaecology, Chelsea & Westminster Hospital, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College, London, UK
- Fetal Medicine Unit, Chelsea & Westminster Hospital, London, UK
| | - Julene S Carvalho
- Brompton Centre for Fetal Cardiology, Royal Brompton Hospital NHS Foundation Trust, London, UK
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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Niebrzydowska-Tatus M, Pełech A, Rekowska AK, Satora M, Masiarz A, Kabała Z, Kimber-Trojnar Ż, Trojnar M. Recent Insights and Recommendations for Preventing Excessive Gestational Weight Gain. J Clin Med 2024; 13:1461. [PMID: 38592297 PMCID: PMC10932422 DOI: 10.3390/jcm13051461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/13/2024] [Accepted: 02/28/2024] [Indexed: 04/10/2024] Open
Abstract
Recommendations for weight gain during pregnancy are based on pre-pregnancy body mass index (BMI). Pregnancy is a risk factor for excessive weight gain and many endocrine problems, making it difficult to return to pre-pregnancy weight and increasing the risk of postpartum obesity and, consequently, type 2 diabetes and metabolic syndrome. Both excessive gestational weight gain (EGWG) and obesity are associated with an increased risk of gestational hypertension, pre-eclampsia, gestational diabetes, cesarean section, shoulder dystocia, and neonatal macrosomia. In the long term, EGWG is associated with increased morbidity and mortality, particularly from diabetes, cardiovascular disorders, and some cancers. This study aims to present recommendations from various societies regarding weight gain during pregnancy, dietary guidance, and physical activity. In addition, we discuss the pathophysiology of this complication and the differential diagnosis in pregnant women with EGWG. According to our research, inadequate nutrition might contribute more significantly to the development of EGWG than insufficient physical activity levels in pregnant women. Telehealth systems seem to be a promising direction for future EGWG prevention by motivating women to exercise. Although the importance of adequate pre-pregnancy weight and weight gain during pregnancy is well known, an increasing number of women gain excessive weight during pregnancy.
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Affiliation(s)
| | - Aleksandra Pełech
- Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland; (M.N.-T.); (A.P.)
| | - Anna K. Rekowska
- Student’s Scientific Association and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland; (A.K.R.); (M.S.); (A.M.); (Z.K.)
| | - Małgorzata Satora
- Student’s Scientific Association and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland; (A.K.R.); (M.S.); (A.M.); (Z.K.)
| | - Angelika Masiarz
- Student’s Scientific Association and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland; (A.K.R.); (M.S.); (A.M.); (Z.K.)
| | - Zuzanna Kabała
- Student’s Scientific Association and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland; (A.K.R.); (M.S.); (A.M.); (Z.K.)
| | - Żaneta Kimber-Trojnar
- Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland; (M.N.-T.); (A.P.)
| | - Marcin Trojnar
- Department of Internal Diseases, Medical University of Lublin, 20-059 Lublin, Poland;
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Sneed NM, Heerman WJ, Shaw PA, Han K, Chen T, Bian A, Pugh S, Duda S, Lumley T, Shepherd BE. Associations Between Gestational Weight Gain, Gestational Diabetes, and Childhood Obesity Incidence. Matern Child Health J 2024; 28:372-381. [PMID: 37966561 PMCID: PMC10922599 DOI: 10.1007/s10995-023-03853-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 11/16/2023]
Abstract
INTRODUCTION Excessive maternal gestational weight gain (GWG) is strongly correlated with childhood obesity, yet how excess maternal weight gain and gestational diabetes mellitus (GDM) interact to affect early childhood obesity is poorly understood. The purpose of this study was to investigate whether overall and trimester-specific maternal GWG and GDM were associated with obesity in offspring by age 6 years. METHODS A cohort of 10,335 maternal-child dyads was established from electronic health records. Maternal weights at conception and delivery were estimated from weight trajectory fits using functional principal components analysis. Kaplan-Meier curves and Cox regression, together with generalized raking, examined time-to-childhood-obesity. RESULTS Obesity diagnosed prior to age 6 years was estimated at 19.7% (95% CI: 18.3, 21.1). Maternal weight gain during pregnancy was a strong predictor of early childhood obesity (p < 0.0001). The occurrence of early childhood obesity was lower among mothers with GDM compared with those without diabetes (adjusted hazard ratio = 0.58, p = 0.014). There was no interaction between maternal weight gain and GDM (p = 0.55). Higher weight gain during the first trimester was associated with lower risk of early childhood obesity (p = 0.0002) whereas higher weight gain during the second and third trimesters was associated with higher risk (p < 0.0001). DISCUSSION Results indicated total and trimester-specific maternal weight gain was a strong predictor of early childhood obesity, though obesity risk by age 6 was lower for children of mothers with GDM. Additional research is needed to elucidate underlying mechanisms directly related to trimester-specific weight gain and GDM that impede or protect against obesity prevalence during early childhood.
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Affiliation(s)
- Nadia M Sneed
- Department of Pediatrics, Vanderbilt University Medical Center, 2146 Belcourt Ave., Nashville, TN, 37212, USA.
- Center for Research Development and Scholarship, Vanderbilt University School of Nursing, 319E Godchaux Hall, Nashville, TN, 37240, USA.
| | - William J Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, 2146 Belcourt Ave., Nashville, TN, 37212, USA
| | - Pamela A Shaw
- Biostatistics Unit, Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave Suite 1600, Seattle, WA, 98101, USA
| | - Kyunghee Han
- Department of Mathematics, Statistics, and Computer Science, University of Illinois at Chicago, 851 S Morgan St, 503 Science and Engineering Offices, Chicago, IL, 60607, USA
| | - Tong Chen
- Department of Statistics, University of Auckland, 38 Princes St., Auckland, 1010, New Zealand
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Ave., Room/Suite 11124, Nashville, TN, 37203, USA
| | - Shannon Pugh
- Department of Emergency Medicine, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA
| | - Stephany Duda
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Ave., Nashville, TN, 37203, USA
| | - Thomas Lumley
- Department of Statistics, University of Auckland, 38 Princes St., Auckland, 1010, New Zealand
| | - Bryan E Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Ave., Room/Suite 11124, Nashville, TN, 37203, USA
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Ross MG, Kavasery MP, Cervantes MK, Han G, Horta B, Coca KP, Costa SO, Desai M. High-Fat, High-Calorie Breast Milk in Women with Overweight or Obesity and Its Association with Maternal Serum Insulin Concentration and Triglycerides Levels. CHILDREN (BASEL, SWITZERLAND) 2024; 11:141. [PMID: 38397253 PMCID: PMC10887191 DOI: 10.3390/children11020141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/25/2024]
Abstract
The childhood obesity epidemic continues to be a challenge. Maternal obesity and excessive infant weight gain are strong predictors of childhood obesity, which itself is a major risk factor for adult obesity. The primary source of nutrition during early life is breast milk, and its composition is impacted by maternal habitus and diet. We thus studied the relationship between maternal BMI, serum lipids and insulin, and breast milk fat and calorie content from foremilk to hindmilk. Women who were exclusively breastfeeding at 7-8 weeks postpartum were BMI classified as Normal (18.5-24.9, n = 9) and women with Overweight/Obese (OW/OB ≥ 25, n = 13). Maternal blood and continuous breast milk samples obtained from foremilk to hindmilk were analyzed, and infant milk intake was assessed. Women with OW/OB had significantly higher milk fat and calorie content in the first foremilk and last hindmilk sample as compared to Normal BMI women. Amongst all women, maternal serum triglycerides, insulin, and HOMA were significantly correlated with foremilk triglyceride concentration, suggesting that maternal serum triglyceride and insulin action contribute to human milk fat content. As the milk fat content of OW/OB women has caloric implications for infant growth and childhood obesity, these results suggest the potential for modulating milk fat content by a reduction in maternal serum lipids or insulin.
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Affiliation(s)
- Michael G. Ross
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles at Harbor-UCLA, Torrance, CA 90502, USA;
- The Lundquist Institute at Harbor-UCLA Medical Center, 1124 West Carson Street, RB3 Building, Torrance, CA 90502, USA; (M.P.K.); (M.K.C.); (G.H.)
- Department of Obstetrics and Gynecology, Charles R. Drew University, Los Angeles, CA 90059, USA
| | - Manasa P. Kavasery
- The Lundquist Institute at Harbor-UCLA Medical Center, 1124 West Carson Street, RB3 Building, Torrance, CA 90502, USA; (M.P.K.); (M.K.C.); (G.H.)
| | - MacKenzie K. Cervantes
- The Lundquist Institute at Harbor-UCLA Medical Center, 1124 West Carson Street, RB3 Building, Torrance, CA 90502, USA; (M.P.K.); (M.K.C.); (G.H.)
| | - Guang Han
- The Lundquist Institute at Harbor-UCLA Medical Center, 1124 West Carson Street, RB3 Building, Torrance, CA 90502, USA; (M.P.K.); (M.K.C.); (G.H.)
| | - Bernardo Horta
- School of Medicine, Universidade Federal de Pelotas, Pelotas 96010-610, Brazil;
| | - Kelly P. Coca
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo 04023-900, Brazil;
| | - Suleyma O. Costa
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas, Campinas 13083-970, Brazil;
| | - Mina Desai
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles at Harbor-UCLA, Torrance, CA 90502, USA;
- The Lundquist Institute at Harbor-UCLA Medical Center, 1124 West Carson Street, RB3 Building, Torrance, CA 90502, USA; (M.P.K.); (M.K.C.); (G.H.)
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Katzow MW, Messito MJ, Mendelsohn AL, Scott MA, Gross RS. Protective Effect of Prenatal Social Support on the Intergenerational Transmission of Obesity in Low-Income Hispanic Families. Child Obes 2023; 19:382-390. [PMID: 36112108 PMCID: PMC10468550 DOI: 10.1089/chi.2021.0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Prepregnancy overweight/obesity (OW/OB) is a strong risk factor for child obesity. Few studies have identified modifiable factors that mitigate this risk. Objective: The objective of this study was to determine if prenatal social support buffers the effect of prepregnancy OW/OB on child birth weight z-score (BWz) and weight-for-age z-score (WFAz) trajectory. Methods: We performed a longitudinal secondary analysis of 524 mother-infant pairs enrolled in a randomized controlled trial of the Starting Early Program, a child obesity prevention program for Hispanic families with low income. Social support was assessed in the third trimester of pregnancy; maternal prepregnancy OW/OB and child WFAz from birth to age 3 years were obtained from medical records. Linear regression and multilevel modeling tested the effects of maternal prepregnancy OW/OB on child weight outcomes, and whether prenatal social support moderated these effects. Results: Prepregnancy OW/OB was associated with significantly higher child BWz (B = 0.23, p = 0.01) and WFAz trajectories (B = 0.19, 0.01). The interaction between social support and prepregnancy OW/OB was negatively related to child BWz (B = -0.26, p = 0.02) and WFAz trajectory (B = -0.40, p = 0.047). Conclusions: Prenatal social support may be protective against the intergenerational transmission of obesity risk. Interventions for the prevention of child obesity should consider incorporating social support into their design. Clinical Trial Registration Number: NCT01541761.
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Affiliation(s)
- Michelle W. Katzow
- Division of General Pediatrics, Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Mary Jo Messito
- Division of General Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Alan L. Mendelsohn
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Marc A. Scott
- Department of Applied Statistics, Social Science, and Humanities, New York University Steinhardt School of Culture, Education, and Human Development, New York, NY, USA
| | - Rachel S. Gross
- Division of General Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
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Purcell AR, Glastras SJ. Maternal Weight Management to Prevent the Developmental Programming of MAFLD in Offspring of Obese Mothers. Nutrients 2023; 15:2155. [PMID: 37432265 DOI: 10.3390/nu15092155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 07/12/2023] Open
Abstract
The global surge of obesity amongst women of reproductive age has raised concerns surrounding the health consequences for their offspring as there is a formidable link between an obesogenic maternal environment and the developmental programming of metabolic dysfunction in the offspring. Specifically, the offspring of mothers with obesity have a three-fold higher risk of developing metabolic-associated fatty liver disease (MAFLD) compared to the offspring of healthy-weight mothers. Given the burgeoning burden of obesity and its comorbidities, it is essential to focus research efforts on methods to alleviate the intergenerational onset of obesity and MAFLD. This review summarizes the current research surrounding the developmental programming of MAFLD in the offspring of mothers with obesity and examines the potential for weight interventions to prevent such metabolic dysfunction in the offspring. It focuses on the benefits of pre-pregnancy interventional strategies, including dietary and exercise intervention, to ameliorate adverse liver health outcomes in the offspring. The utility and translation of these interventions for humans may be difficult for prospective mothers with obesity, thus the use of pre-pregnancy therapeutic weight loss aids, such as glucagon-like peptide-1 receptor agonists, is also discussed.
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Affiliation(s)
- Amanda Renae Purcell
- Kolling Institute of Medical Research, Sydney 2065, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - Sarah Jean Glastras
- Kolling Institute of Medical Research, Sydney 2065, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney 2065, Australia
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Exposure to Obesogenic Environments during Perinatal Development Modulates Offspring Energy Balance Pathways in Adipose Tissue and Liver of Rodent Models. Nutrients 2023; 15:nu15051281. [PMID: 36904281 PMCID: PMC10005203 DOI: 10.3390/nu15051281] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/20/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Obesogenic environments such as Westernized diets, overnutrition, and exposure to glycation during gestation and lactation can alter peripheral neuroendocrine factors in offspring, predisposing for metabolic diseases in adulthood. Thus, we hypothesized that exposure to obesogenic environments during the perinatal period reprograms offspring energy balance mechanisms. Four rat obesogenic models were studied: maternal diet-induced obesity (DIO); early-life obesity induced by postnatal overfeeding; maternal glycation; and postnatal overfeeding combined with maternal glycation. Metabolic parameters, energy expenditure, and storage pathways in visceral adipose tissue (VAT) and the liver were analyzed. Maternal DIO increased VAT lipogenic [NPY receptor-1 (NPY1R), NPY receptor-2 (NPY2R), and ghrelin receptor], but also lipolytic/catabolic mechanisms [dopamine-1 receptor (D1R) and p-AMP-activated protein kinase (AMPK)] in male offspring, while reducing NPY1R in females. Postnatally overfed male animals only exhibited higher NPY2R levels in VAT, while females also presented NPY1R and NPY2R downregulation. Maternal glycation reduces VAT expandability by decreasing NPY2R in overfed animals. Regarding the liver, D1R was decreased in all obesogenic models, while overfeeding induced fat accumulation in both sexes and glycation the inflammatory infiltration. The VAT response to maternal DIO and overfeeding showed a sexual dysmorphism, and exposure to glycotoxins led to a thin-outside-fat-inside phenotype in overfeeding conditions and impaired energy balance, increasing the metabolic risk in adulthood.
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Mannino A, Sarapis K, Moschonis G. The Effect of Maternal Overweight and Obesity Pre-Pregnancy and During Childhood in the Development of Obesity in Children and Adolescents: A Systematic Literature Review. Nutrients 2022; 14:nu14235125. [PMID: 36501155 PMCID: PMC9739272 DOI: 10.3390/nu14235125] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022] Open
Abstract
Maternal overweight/obesity has been associated with an increased risk of obesity in childhood. We investigated the effect of maternal overweight/obesity during pre-pregnancy and whether it is a stronger predictor of child obesity, compared to maternal overweight/obesity during childhood. Prospective or retrospective cohort studies published in English, reporting on obese children and adolescents (2-18 years), with overweight/obese mothers in either pre-pregnancy or during childhood were included. A search was conducted from 2012 to April 2022 in MEDLINE, Web of Science, CINAHL, and EMBASE, followed by screening, data extraction, quality assessment and narrative synthesis. Eleven eligible studies (9 prospective and 2 retrospective cohort studies; total sample, n = 27,505) were identified. Eight studies examined maternal overweight/obesity in pre-conception, presenting consistent positive associations with childhood obesity, three reported positive associations between childhood obesity and maternal overweight/obesity during childhood, and one presented positive associations between both maternal exposures. The narrative synthesis failed to identify which maternal exposure is the strongest predictor of childhood obesity, with studies reporting significant associations between maternal overweight/obesity and child obesity in both time points. Intervention programs aiming to reduce childhood obesity should focus on supporting women of childbearing age with weight management from preconception and throughout their life-course.
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Silva-Jose C, Sánchez-Polán M, Barakat R, Díaz-Blanco Á, Mottola MF, Refoyo I. A Virtual Exercise Program throughout Pregnancy during the COVID-19 Pandemic Modifies Maternal Weight Gain, Smoking Habits and Birth Weight—Randomized Clinical Trial. J Clin Med 2022; 11:jcm11144045. [PMID: 35887809 PMCID: PMC9321470 DOI: 10.3390/jcm11144045] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/29/2022] [Accepted: 07/11/2022] [Indexed: 02/01/2023] Open
Abstract
The intrauterine environment is key to health from a short- and long-term perspective. Birth weight is an important indicator that may influence the fetal environment due to epigenetics. Considering physical inactivity, in parallel with higher levels of stress, affecting smoking patterns and the physical and emotional health of the pregnant population, maintaining the health of future generations is crucial. A randomized clinical trial (NCT04563065) was conducted. One-hundred and ninety-two healthy pregnant individuals were assigned to the intervention (IG) or control (CG) group. Overall, significant differences were found between groups when stratified by birth weight (χ2 (1) = 6.610; p = 0.037) with low birth weight and macrosomia found more often in the CG (4% vs. 14% and 3% vs. 9%, respectively) and higher admissions to the neonatal intensive care unit (χ2 (1) = 5.075; p = 0.024) in the CG (20/28.6%) compared to the IG (9/13.0). Smoking during pregnancy was also found more often in the CG (12/17.1%) compared to the IG (3/4.4%) (p = 0.016). A virtual program of supervised exercise throughout pregnancy during the ongoing pandemic could help to maintain adequate birth weights, modify maternal smoking habits, and lower admissions to the neonatal intensive care unit.
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Affiliation(s)
- Cristina Silva-Jose
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.S.-J.); (R.B.)
| | - Miguel Sánchez-Polán
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.S.-J.); (R.B.)
- Correspondence: ; Tel.: +34-913364120
| | - Ruben Barakat
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.S.-J.); (R.B.)
| | - Ángeles Díaz-Blanco
- Gynecology and Obstetrics Department, Hospital Universitario Severo Ochoa de Leganés, 28911 Leganés, Spain;
| | - Michelle F. Mottola
- R. Samuel McLaughlin Foundation-Exercise and Pregnancy Lab, School of Kinesiology, Faculty of Health Sciences, Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, Children’s Health Research Institute, The University of Western Ontario London, London, ON N6A 3K7, Canada;
| | - Ignacio Refoyo
- Sports Department, Faculty of Physical Activity and Sports Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain;
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Sidell M, Martinez MP, Chow T, Xiang AH. Types of diabetes during pregnancy and longitudinal BMI in offspring from birth to age 10 years. Pediatr Obes 2021; 16:e12776. [PMID: 33634964 DOI: 10.1111/ijpo.12776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine longitudinal BMI trajectory from birth to age 10 years in a clinical cohort after exposure to maternal pre-existing type 1 (T1D), type 2 (T2D), gestational diabetes managed with or without anti-diabetes medication, and no diabetes during pregnancy. METHODS Data included 218 227 singleton children born in 2008-2015 from a population-based integrated healthcare system; 537 exposed to maternal T1D, 7836 to T2D, 6982 to medicated GDM and 12 576 to unmedicated GDM. Differences in BMI over time among groups were assessed by non-linear mixed-effects models adjusting for covariates. RESULTS Children's BMI was significantly lower 6-months after birth for all diabetes exposed groups compared to no diabetes. Beginning at approximately age 2.5 years, BMI was significantly higher for T1D, T2D and medicated GDM groups compared to the no diabetes group. At age 3, the growth pattern started separating with highest BMI in T1D and T2D groups, followed by medicated GDM, unmedicated GDM, and the no diabetes groups. By age 7, BMI was significantly higher for the unmedicated GDM group compared to the no diabetes group. Adjusted BMI was generally comparable between T1D and T2D groups for all ages. Starting at age 5, T1D, T2D and medicated GDM groups had BMI greater than one SD over the BMI in the no diabetes group. CONCLUSION In a clinical cohort with standard diabetes management approaches, a hierarchical BMI growth pattern exists in offspring exposed to different types of diabetes during pregnancy after adjusting for important covariates, starting as early as age 3 years.
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Affiliation(s)
- Margo Sidell
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Mayra P Martinez
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Ting Chow
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Anny H Xiang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
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11
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McNamara R, Quinn R, Murrin C, Bel-Serrat S. Teachers' perspectives on the barriers to healthy lifestyle behaviors among adolescent girls of disadvantaged backgrounds in Ireland: A qualitative study. Appetite 2021; 167:105585. [PMID: 34246715 DOI: 10.1016/j.appet.2021.105585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/13/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
Though adolescence is a particularly sensitive period regarding the development of long-lasting health-related attitudes and behaviors, little research has examined the factors which influence their engagement in such behaviors. Adolescent females are particularly sensitive to suffer from overweight and obesity. It is also a time that can impact the health patterns of future generations due to the influence of preconception maternal factors on the health of their offspring. Furthermore, much research has identified a strong socioeconomic gradient in obesity in Ireland, with individuals from low socioeconomic backgrounds being particularly likely to develop unhealthy habits. The current study aimed to develop an understanding of the factors which influence the health-related behaviors of adolescent girls of low-socioeconomic status in Ireland, an underrepresented yet particularly sensitive cohort. Semi-structured interviews were conducted with nine teachers from disadvantaged schools in Dublin and were examined using a thematic analytic approach. Nine themes were identified: lack of interest and knowledge, lack of self-confidence, the dual role of modern technology, behaviors of significant others, need for good role models, availability of convenience foods, inadequate existing approaches and initiatives, lack of resources to promote a healthy lifestyle, and living difficulties at home and in the community. Findings suggested ways for intervening at personal, interpersonal, organizational and community levels. In conclusion, a range of practical changes are required in the home, school, and community environments in order to improve the health of these individuals, and ultimately to improve the health of future generations.
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Affiliation(s)
- Roisin McNamara
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Roisin Quinn
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Celine Murrin
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Silvia Bel-Serrat
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
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12
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Predictors of preconception care behaviour among women of reproductive age using a behaviour-change model. PROCEEDINGS OF SINGAPORE HEALTHCARE 2021. [DOI: 10.1177/2010105820958727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: Although preconception care (PCC) has been integrated into women’s care programmes in the country for more than a decade, it has not yet been welcomed by Iranian women, and the rate of PCC uptake is very low. Therefore, this study aims to determine predictors of uptake of PCC based on the Beliefs, Attitudes, Subjective Norms and Enabling Factors (BASNEF) model among women of reproductive age referred to health centres in Urmia, Northwest Iran, in 2019. Methods: This cross-sectional study was carried out on 230 women of childbearing age at Urmia health centres during 2019. Subjects were selected using a multistage sampling method. A valid reliable researcher-made questionnaire, including demographic information, items related to the BASNEF model constructs regarding PCC and items related to PCC behaviour, was used to collect data. Data were analysed using descriptive and inferential statistics (frequencies, means and standard deviations, independent t-test, chi-square test, logistic and linear regression). Results: The findings showed that the rate of receiving PCC was 19.6%. Overall, the BASNEF model predicted 42% of the intention to receive health care. Among the model constructs, enabling factors (β=0.32, p<0.001) and attitude (β=0.41, p<0.001) significantly explained women’s behavioural intention towards receiving PCC. In the logistic regression model, intention (β=0.15, p<0.001) and enabling factors (β=0.12, p=0.034) had a significant role in predicting PCC. Conclusion: The low uptake of PCC by women of childbearing age in Urmia suggests the need to design and implement interventions based on women’s attitudes, intentions and enabling factors in order to stimulate and maintain women’s health-promoting behaviours during childbearing age.
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Desai M, Ross MG. Maternal-infant nutrition and development programming of offspring appetite and obesity. Nutr Rev 2021; 78:25-31. [PMID: 33196091 PMCID: PMC7667467 DOI: 10.1093/nutrit/nuaa121] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In the United States and Mexico, the obesity epidemic represents a significant public health problem. Although obesity is often attributed to a Western-style, high-fat diet and decreased activity, there is now compelling evidence that this, in part, occurs because of the developmental programming effects resulting from exposure to maternal overnutrition. Human and animal studies demonstrate that maternal obesity and high-fat diet result in an increased risk for childhood and adult obesity. The potential programming effects of obesity have been partly attributed to hyperphagia, which occurs as a result of increased appetite with reduced satiety neuropeptides or neurons. However, depending on maternal nutritional status during the nursing period, the programmed hyperphagia and obesity can be exacerbated or prevented in offspring born to obese mothers. The underlying mechanism of this phenomenon likely involves the plasticity of the appetite regulatory center and thus presents an opportunity to modulate feeding and satiety regulation and break the obesity cycle.
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Affiliation(s)
- Mina Desai
- Department of Obstetrics and Gynecology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, USA; and David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Michael G Ross
- Department of Obstetrics and Gynecology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, USA; and David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
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Petrov ME, Whisner CM, McCormick D, Todd M, Reyna L, Reifsnider E. Sleep-wake patterns in newborns are associated with infant rapid weight gain and incident adiposity in toddlerhood. Pediatr Obes 2021; 16:e12726. [PMID: 32915514 PMCID: PMC8344177 DOI: 10.1111/ijpo.12726] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/24/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Rapid weight gain (RWG) by 6 months of life is a significant risk factor of childhood overweight (OW)/obesity. Infant sleep patterns are associated with incident OW in childhood, but few have examined its relationship with RWG. OBJECTIVE Examine associations between newborn sleep-wake patterns and incident RWG at 6 months of life and OW at 36 months. METHODS Low-income Mexican/Mexican-American women with OW/obesity and their infants (n = 126) enrolled in a 1-year randomized controlled trial designed to prevent incident, infant RWG and toddlerhood OW/obesity. Sleep pattern metrics at 1 month were extracted from the Brief Infant Sleep Questionnaire-Revised. Outcome measures included RWG (>0.67 positive change in weight-for-age Z-score) from birth to 6 months and incident OW (body mass index percentile ≥85) at 36 months. RESULTS By 6 months, 35.7% (n = 45) of infants experienced RWG, and by 36 months 42.3% (n = 41) of toddlers were OW. Napping ≥5x/day at 1-month was significantly associated with decreased odds for RWG compared to napping <5x (OR = 0.11, 95%CI:0.02, 0.63). Each 1-hour increase in nocturnal vs diurnal sleep was associated with greater odds of incident OW at 36 mos (OR = 1.51, 95%CI:1.13, 2.03). CONCLUSIONS Early-life sleep patterns related to infant nap frequency and nocturnal vs diurnal sleep distribution were associated with obesity outcomes and may be important intervention targets to prevent lasting consequences on infant growth.
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Affiliation(s)
- Megan E. Petrov
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Corrie M. Whisner
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - David McCormick
- Division of General Academic Pediatrics, University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Michael Todd
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | | | - Elizabeth Reifsnider
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
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Kim M, Kim I. Ovariectomy, but not orchiectomy, exacerbates metabolic syndrome after maternal high-fructose intake in adult offspring. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2021; 25:39-49. [PMID: 33361536 PMCID: PMC7756538 DOI: 10.4196/kjpp.2021.25.1.39] [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] [Received: 06/02/2020] [Revised: 10/30/2020] [Accepted: 11/17/2020] [Indexed: 11/23/2022]
Abstract
High fructose diet is associated with the global metabolic syndrome (MtS) pandemic. MtS develops in early life, depending on prenatal and postnatal nutritional status. We hypothesized that ovariectomy increases the chances of developing MtS in adult offspring following high fructose intake by the mother. Pregnant C57BL/6J mouse dams drank water with or without 20% fructose during pregnancy and lactation. After weaning, the pups were fed regular chow. The offspring were evaluated until they were 7 months of age after the mice in each group, both sexes, were gonadectomized at 4 weeks of age. The offspring (both sexes) of the dams who had high fructose intake developed MtS. In the offspring of dams who drank tap water, orchiectomy increased the body weight gain and body fat accumulation, while ovariectomy increased the body fat accumulation as compared to the sham controls. In the offspring of dams with high fructose intake, orchiectomy decreased the body weight gain, body fat accumulation, visceral adiposity, and glucose intolerance, while ovariectomy exacerbated all of them as compared to the sham operations. These data indicate that ovariectomy encourages the development of MtS in adult offspring after maternal high fructose intake, while orchiectomy prevents the development of MtS. The sex difference indicates that male and female sex hormones play contradictory roles in the development of MtS.
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Affiliation(s)
- Mina Kim
- Department of Pharmacology, School of Medicine, Kyungpook National University, Daegu 41944, Korea
- Cardiovascular Research Institute, Kyungpook National University, Daegu 41944, Korea
| | - Inkyeom Kim
- Department of Pharmacology, School of Medicine, Kyungpook National University, Daegu 41944, Korea
- Cardiovascular Research Institute, Kyungpook National University, Daegu 41944, Korea
- BK21 Plus KNU Biomedical Convergence Program, Department of Biomedical Science, Kyungpook National University, Daegu 41944, Korea
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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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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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18
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Wang X, Martinez MP, Chow T, Xiang AH. BMI growth trajectory from ages 2 to 6 years and its association with maternal obesity, diabetes during pregnancy, gestational weight gain, and breastfeeding. Pediatr Obes 2020; 15:e12579. [PMID: 31691508 DOI: 10.1111/ijpo.12579] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/08/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To identify latent BMI growth trajectories from ages 2 to 6 years and examine their independent associations with maternal prepregnancy obesity or overweight, pre-existing type 1 (T1D) or type 2 diabetes (T2D) or gestational diabetes (GDM) with or without requiring antidiabetic medications during pregnancy, excessive gestational weight gain (EGWG), and breastfeeding ≤ 6 months. RESEARCH DESIGN AND METHOD Data included 71 892 children born at Kaiser Permanente Southern California hospitals in 2007 to 2011 with complete information on maternal risk factors. Group-based trajectory modelling was used to identify latent BMI trajectory groups. Logistic regression was used to assess independent associations adjusted for covariates. RESULTS Three distinct BMI trajectory groups were identified: Group 1 (59% of the cohort) had stable low BMI, Group 2 (35% of the cohort) had stable median BMI, and Group 3 (6% of the cohort) had high and increasing BMI over time. Relative to Groups 1 and 2 combined, the adjusted odds ratio (OR) (95% CI) of being in Group 3 associated with maternal exposures were 5.6 (5.1-6.2) for prepregnancy obesity, 2.4 (2.2-2.7) for prepregnancy overweight, 2.1 (1.2-3.7) for T1D, 1.6 (1.4-1.8) for T2D, 1.4 (1.3-1.6) for GDM requiring medication treatment, 1.1 (1.0-1.3) for GDM not requiring medication, 1.3 (1.2-1.4) for EGWG, and 1.2 (1.2-1.3) for breastfeeding ≤ 6 months. CONCLUSION Child's high and increasing BMI trajectory was strongly associated with maternal prepregnancy obesity and overweight, modestly associated with maternal T1D, T2D, and GDM requiring medication treatment and EGWG, and slightly associated with breastfeeding ≤ 6 months. GDM not requiring medication treatment during pregnancy had little association.
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Affiliation(s)
- Xinhui Wang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Mayra P Martinez
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Ting Chow
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Anny H Xiang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
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Buffarini R, Barros AJD, Matijasevich A, Loret de Mola C, Santos IS. Gestational diabetes mellitus, pre-gestational BMI and offspring BMI z-score during infancy and childhood: 2004 Pelotas Birth Cohort. BMJ Open 2019; 9:e024734. [PMID: 31289054 PMCID: PMC6629409 DOI: 10.1136/bmjopen-2018-024734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) affects a significant number of women. Evidence regarding the association between GDM and offspring body mass index (BMI) is unclear due to small samples and lack of adequate confounding control. The objective of this study was to investigate the association between GDM and offspring BMI z-scores from birth to early adolescence and to examine the role of maternal pre-gestational BMI in this relationship. DESIGN Prospective study. SETTING Pelotas 2004 Birth Cohort, Brazil. PARTICIPANTS Cohort participants that were followed-up from birth up to early adolescence (~3500) and their mothers. PRIMARY OUTCOME MEASURES BMI z-scores at birth, 3, 12, 24, 48 months and 6 and 11 years of age, calculated according to the WHO growth charts. RESULTS Unadjusted and adjusted linear regressions were performed and interaction terms between maternal pre-gestational BMI and GDM were included. Prevalence of self-reported GDM was 2.6% (95% CI 2.1% to 3.1%). The offspring BMI z-scores (SD) at birth, 3, 12, 24, 48 months and at 6 and 11 years were 0.10 (1.12), -0.47 (1.10), 0.59 (1.10), 0.59 (1.08), 0.78 (1.32), 0.70 (1.43) and 0.75 (1.41), respectively. Unadjusted regression models showed positive associations between GDM and offspring BMI z-scores at birth, 6 and 11 years. After adjustment, the associations attenuated towards the null. Statistical evidence of effect modification between maternal pre-gestational BMI and GDM was observed at birth (p=0.007), with the association between GDM and offspring BMI z-score being apparent only in those children born to overweight or obese mothers (β=0.72, 95% CI 0.30 to 1.14 and β=0.61, 95% CI 0.20 to 1.01, respectively). CONCLUSIONS We observed that in the association between GDM and offspring BMI z-scores, there is a predominant role for maternal nutritional status before pregnancy and that the association between GDM and newborn's BMI is apparent only among those born to overweight or obese mothers.
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Affiliation(s)
- Romina Buffarini
- Postgraduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Aluisio J D Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | | | | | - Ina S Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
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Katzow M, Messito MJ, Mendelsohn AL, Scott MA, Gross RS. The Protective Effect of Prenatal Social Support on Infant Adiposity in the First 18 Months of Life. J Pediatr 2019; 209:77-84. [PMID: 30879731 PMCID: PMC6535345 DOI: 10.1016/j.jpeds.2019.02.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/22/2019] [Accepted: 02/13/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine whether prenatal social support was associated with infant adiposity in the first 18 months of life in a low-income, Hispanic sample, known to be at high risk of early child obesity. STUDY DESIGN We performed a longitudinal analysis of 262 low-income, Hispanic mother-infant pairs in the control group of the Starting Early child obesity prevention trial. Prenatal social support was measured using an item from the Maternal Social Support Index. We used multilevel modeling to predict weight-for-length z-score trajectories from birth to age 18 months and logistic regression to predict macrosomia and overweight status at ages 6, 12, and 18 months. RESULTS High prenatal social support was independently associated with lower infant adiposity trajectories from birth to age 18 months (B = -0.40; 95% CI, -0.63 to -0.16), a lower odds of macrosomia (aOR = 0.35; 95% CI, 0.15-0.80), and a lower odds of overweight at ages 12 (aOR = 0.28; 95% CI, 0.10-0.74) and 18 months (aOR = 0.35; 95% CI, 0.14-0.89). Prenatal social support was not significantly associated with overweight status at age 6 months. CONCLUSIONS Prenatal social support may protect against excessive infant adiposity and overweight in low-income, Hispanic families. Further research is needed to elucidate mechanisms underlying these associations and to inform preventive strategies beginning in pregnancy.
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Affiliation(s)
- Michelle Katzow
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, New York, NY.
| | - Mary Jo Messito
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, New York, NY
| | - Alan L Mendelsohn
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, New York University School of Medicine, New York, NY
| | - Marc A Scott
- Department of Applied Statistics, Social Science, and Humanities, New York University Steinhardt School of Culture, Education, and Human Development, New York, NY
| | - Rachel S Gross
- Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, New York, NY
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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: 216] [Impact Index Per Article: 43.2] [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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Brik M, Fernández-Buhigas I, Martin-Arias A, Vargas-Terrones M, Barakat R, Santacruz B. Does exercise during pregnancy impact on maternal weight gain and fetal cardiac function? A randomized controlled trial. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:583-589. [PMID: 30328169 DOI: 10.1002/uog.20147] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 09/28/2018] [Accepted: 10/05/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the association between physical exercise during pregnancy and maternal gestational weight gain and fetal cardiac function. METHODS This was a randomized controlled trial of women with a singleton pregnancy managed from the first trimester at the Hospital de Torrejón, Madrid, between November 2014 and June 2015. Women were randomized to either follow a supervised physical conditioning program, consisting of a 60-min session 3 days per week for the duration of pregnancy, or not attend any exercise program (controls). The primary outcome was maternal weight gain during pregnancy. Secondary outcomes included fetal cardiac function parameters evaluated at 20, 28 and 36 weeks' gestation, Cesarean section, preterm delivery, induction of labor and birth weight. A sample size of 45 in each group was planned to detect differences in maternal weight gain of at least 1 kg, with a power of > 80% and α of 0.05. RESULTS During the study period, 120 women were randomized into the exercise (n = 75) and control (n = 45) groups. Following exclusions, the final cohort consisted of 42 women in the exercise group and 43 in the control group. Baseline characteristics (maternal age, prepregnancy body mass index, parity, conception by in-vitro fertilization, Caucasian ethnicity, physical exercise prior to pregnancy and smoker) were similar between the two groups. No differences were found between the groups in maternal weight at 20, 28, 36 and 38 weeks' gestation or in weight gain at 38 weeks. However, the proportion of women with weight loss ≥ 9 kg at 6 weeks postpartum was higher in the exercise compared with the control group (68.2% vs 42.8%; relative risk 1.593; P = 0.02). The ductus arteriosus pulsatility index (DA-PI) at 20 weeks (2.43 ± 0.40 vs 2.26 ± 0.33, P < 0.05) and the ejection fraction (EF) at 36 weeks (0.85 ± 0.13 vs 0.81 ± 0.11, P < 0.05) were higher in the exercise compared with the control group. All other evaluated fetal cardiac function parameters were similar between the two groups. CONCLUSIONS Performing exercise during pregnancy is not associated with a reduction in maternal weight gain but increases weight loss at 6 weeks postpartum. Physical exercise during pregnancy is associated with increased fetal DA-PI at 20 weeks and EF at 36 weeks, which could reflect adaptive mechanisms. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Brik
- Fetal Medicine Department, Hospital Universitario de Torrejón, Madrid, Spain
- School of Medicine, Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain
| | - I Fernández-Buhigas
- Fetal Medicine Department, Hospital Universitario de Torrejón, Madrid, Spain
- School of Medicine, Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain
| | - A Martin-Arias
- Fetal Medicine Department, Hospital Universitario de Torrejón, Madrid, Spain
- School of Medicine, Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain
| | - M Vargas-Terrones
- Facultad de Ciencias del Deporte INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | - R Barakat
- Facultad de Ciencias del Deporte INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | - B Santacruz
- Fetal Medicine Department, Hospital Universitario de Torrejón, Madrid, Spain
- School of Medicine, Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain
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Liu J, Boghossian NS, Frongillo EA, Cai B, Hazlett LJ, Liu J. Associations of maternal gestational weight gain with the risk of offspring obesity and body mass index Z scores beyond the mean. Ann Epidemiol 2019; 32:64-71.e2. [PMID: 30799201 DOI: 10.1016/j.annepidem.2019.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 12/09/2018] [Accepted: 01/22/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE We examined the association of meeting the 2009 Institute of Medicine gestational weight gain (GWG) guidelines with offspring obesity and body mass index Z score (BMIZ) at age six overall and by maternal weight status. METHODS Data were from the Infant Feeding Practices Survey II Study (2005-2007) and their Year Six Follow-Up Study (2012). Logistic regression and quantile regression models were used. RESULTS Eleven percent of children were obese. Children born to mothers who gained excessive weight during pregnancy had an increased risk of obesity as compared with those born to mothers who gained adequate weight (adjusted odds ratio: 1.67). The association was stronger among normal-weight mothers (adjusted odds ratio: 3.50). Inadequate GWG was not associated with offspring obesity overall or in subsamples by maternal prepregnancy BMI. Children born to mothers who gained excessive weight had higher BMIZ. This distributional association was more pronounced among normal-weight mothers. Children born to obese mothers who gained inadequate weight had lower BMIZ at some percentiles of the BMIZ distribution. CONCLUSIONS Excessive GWG was associated with increased risk of offspring obesity and higher BMIZ at age six, whereas inadequate GWG was protective of high BMIZ among children born to obese mothers.
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Affiliation(s)
- Junxiu Liu
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Nansi S Boghossian
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia
| | - Bo Cai
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Linda J Hazlett
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Jihong Liu
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia.
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Magalhães EIDS, Sousa BAD, Lima NP, Horta BL. Maternal smoking during pregnancy and offspring body mass index and overweight: a systematic review and meta-analysis. CAD SAUDE PUBLICA 2019; 35:e00176118. [DOI: 10.1590/0102-311x00176118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 08/02/2019] [Indexed: 08/30/2023] Open
Abstract
Abstract: The present study aimed to conduct a systematic review and meta-analysis to evaluate the evidence on the association of maternal smoking during pregnancy with offspring body composition in childhood, adolescence and adulthood. MEDLINE, Web of Science and LILACS databases were searched. Reference lists were also screened. We included original studies, conducted in humans, that assessed the association of maternal smoking during pregnancy with offspring body mass index (BMI) and overweight in childhood, adolescence and adulthood, published through May 1st, 2018. A meta-analysis was used to estimate pooled effect sizes. The systematic review included 64 studies, of which 37 evaluated the association of maternal smoking during pregnancy with overweight, 13 with BMI, and 14 evaluated both outcomes. Of these 64 studies, 95 measures of effect were extracted and included in the meta-analysis. We verified that the quality of evidence across studies regarding maternal smoking in pregnancy and overweight and BMI of offspring to be moderate and low, respectively. Most studies (44 studies) were classified as moderate risk bias. Heterogeneity among studies included was high and, in the random-effects pooled analysis, maternal smoking during pregnancy increased the odds of offspring overweight (OR: 1.43, 95%CI: 1.35; 1.52) and mean difference of BMI (β: 0.31, 95%CI: 0.23; 0.39). In conclusion, offspring of mothers who smoked during pregnancy have higher odds of overweight and mean difference of BMI, and these associations persisted into adulthood.
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Njuieyon F, Cuadro-Alvarez E, Martin E, Lachaume N, Mrsic Y, Henaff F, Maniassom C, Defo A, Elenga N. Mother's obesity and high child's waist circumference are predictive factors of severe child's obesity: an observational study in French Guiana. BMC Pediatr 2018; 18:188. [PMID: 29885650 PMCID: PMC5994247 DOI: 10.1186/s12887-018-1158-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 05/24/2018] [Indexed: 12/20/2022] Open
Abstract
Background This study aims to describe the predictive factors of severe obesity in children followed in French Guiana. Methods In this observational study, the patients from the French Guianese Childhood Obesity Group database were prospectively included, after giving a statement of patient’s non opposition. Results Our group classifications revealed that 36 of 150 (24%) participants were classified as being metabolically abnormal obesity“ (MAO), while 114 of 150 (76%) were categorized as metabolically normal obesity” (MNO). MAO-patients were older. Their mothers had more severe obesity. We also observed that their systolic blood pressure was higher. The median Z-score BMI of children with MAO was 4, 9 [4, 05–5, 38], which shows a more obese condition than the MNO group. The median waist-to-height ratio (WTHR) of our study population was high, either 0.63 [0.54–0.59]. No significant differences in the term of pregnancy, father’s obesity, gender, birth weight, feeding, diastolic blood pressure and WTHR were found between the two groups. The predictors of MAO status, after adjusting for age and sex, were mother’s obesity and high child’s waist circumference. Among the comorbidity, there were two Down syndrome, one Cornelia de Lange syndrome, one Nephrotic Syndrome and one Epilepsy. The leptin hormone and insulin levels were higher in MAO than in MNO, while 25-OH D-vitamin was higher in MNO. Conclusion This study indicates the need to incorporate waist circumference into routine clinical practice, in addition to traditional measures of weight, height, body mass index and waist-to-height ratio.
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Affiliation(s)
- Falucar Njuieyon
- Department of Pediatric Medicine and Surgery, Cayenne Hospital, Rue des flamboyants, BP 6006, 97306, Cayenne Cedex, French Guiana
| | - Emma Cuadro-Alvarez
- Department of Pediatric Medicine and Surgery, Cayenne Hospital, Rue des flamboyants, BP 6006, 97306, Cayenne Cedex, French Guiana
| | - Elise Martin
- Department of Pediatric Medicine and Surgery, Cayenne Hospital, Rue des flamboyants, BP 6006, 97306, Cayenne Cedex, French Guiana
| | - Noémie Lachaume
- Department of Pediatric Medicine and Surgery, Cayenne Hospital, Rue des flamboyants, BP 6006, 97306, Cayenne Cedex, French Guiana
| | - Yajaira Mrsic
- Department of Pediatric Medicine and Surgery, Cayenne Hospital, Rue des flamboyants, BP 6006, 97306, Cayenne Cedex, French Guiana
| | - Fanny Henaff
- Department of Pediatric Medicine and Surgery, Cayenne Hospital, Rue des flamboyants, BP 6006, 97306, Cayenne Cedex, French Guiana
| | - Chimène Maniassom
- Department of Pediatric Medicine and Surgery, Cayenne Hospital, Rue des flamboyants, BP 6006, 97306, Cayenne Cedex, French Guiana
| | - Antoine Defo
- Department of Pediatric Medicine and Surgery, Cayenne Hospital, Rue des flamboyants, BP 6006, 97306, Cayenne Cedex, French Guiana
| | - Narcisse Elenga
- Department of Pediatric Medicine and Surgery, Cayenne Hospital, Rue des flamboyants, BP 6006, 97306, Cayenne Cedex, French Guiana. .,Department of Pediatric Medicine and Surgery, Regional Hospital, Rue des Flamboyants BP 6006, 97306, Cayenne Cedex, French Guiana.
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Clarke MA, Joshu CE. Early Life Exposures and Adult Cancer Risk. Epidemiol Rev 2018; 39:11-27. [PMID: 28407101 DOI: 10.1093/epirev/mxx004] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/19/2017] [Indexed: 12/14/2022] Open
Abstract
Very little is known about the influence of early life exposures on adult cancer risk. The purpose of this narrative review was to summarize the epidemiologic evidence relating early life tobacco use, obesity, diet, and physical activity to adult cancer risk; describe relevant theoretical frameworks and methodological strategies for studying early life exposures; and discuss policies and research initiatives focused on early life. Our findings suggest that in utero exposures may indirectly influence cancer risk by modifying biological pathways associated with carcinogenesis; however, more research is needed to firmly establish these associations. Initiation of exposures during childhood and adolescence may impact cancer risk by increasing duration and lifetime exposure to carcinogens and/or by acting during critical developmental periods. To expand the evidence base, we encourage the use of life course frameworks, causal inference methods such as Mendelian randomization, and statistical approaches such as group-based trajectory modeling in future studies. Further, we emphasize the need for objective exposure biomarkers and valid surrogate endpoints to reduce misclassification. With the exception of tobacco use, there is insufficient evidence to support the development of new cancer prevention policies; however, we highlight existing policies that may reduce the burden of these modifiable risk factors in early life.
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Borges TS, Chaffee BW, Kramer PF, Feldens EG, Vítolo MR, Feldens CA. Relationship between overweight/obesity in the first year of age and traumatic dental injuries in early childhood: Findings from a birth cohort study. Dent Traumatol 2017; 33:465-471. [PMID: 28965356 PMCID: PMC5725191 DOI: 10.1111/edt.12377] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND/AIM The impact of traumatic dental injuries (TDI) in the primary dentition on oral health-related quality of life indicates the need for the planning of prevention strategies. The aim of this study was to assess whether anthropometric characteristics in early life are associated with TDI by preschool age. MATERIALS AND METHODS A birth cohort was recruited from the public healthcare system in the city of Porto Alegre, Brazil. Socio-demographic variables, type of birth, head circumference, weight, and length were collected at birth (WHO standards). Head circumference, body mass index for age, and height for age were collected at 12 months. TDI (Andreasen criteria) at three years of age (n = 458) were recorded by two examiners who had undergone training and calibration exercises. Multivariable analysis was carried out with Poisson regression with robust variance. RESULTS A total of 31.0% of the children (142/458) exhibited TDI at three years of age. In the final model, the risk of TDI was 47% higher among children with a smaller head circumference upon birth and nearly 60% higher among those who were overweight/obese at 12 months of age (RR: 1.58; 95% CI: 1.15-2.17). The risk of TDI was also significantly higher among boys (RR 1.50; 95% CI: 1.13-2.00), but the outcome was not significantly associated with socioeconomic variables or other anthropometric variables. CONCLUSION Overweight/obesity in early life is a risk factor for TDI in preschool children.
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Affiliation(s)
| | - Benjamin W Chaffee
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, USA
| | | | | | - Márcia Regina Vítolo
- Department of Nutrition, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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Rhoton-Vlasak AS, Roussos-Ross K, Cua GM, Odera EL, Irani TA, Vasilopoulos T. Obesity and reproduction: a study to determine how effectively medical education enhances awareness of the reproductive risks related to obesity. JBRA Assist Reprod 2017; 21:330-335. [PMID: 29068182 PMCID: PMC5714601 DOI: 10.5935/1518-0557.20170059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective To explore awareness of the reproductive versus the medical risks of obesity
in a medical and non-medical college educated population. Methods An exploratory prospective research design was used. A 26-question online
survey was developed and offered to a sample of medical students/residents
(n=325) and non-medical college students (n=102). The data were analyzed
using Graph Pad software. Results 102 non-medical undergraduate students (28% male and 72% female) and 325
resident physicians and medical students (46% male, 47% female, 7%
unspecified) responded. Both groups reported higher awareness of the general
risks of obesity as compared to the reproductive risks. As expected, lay
students reported less awareness of female reproductive issues as compared
to the medical group (all p-values <0.01). Over 90% of
respondents would be motivated to lose weight before pregnancy if they knew
of these risks, with more than half planning to have children in the
future. Conclusion This exploratory study found that despite having at least a college
education, the populations studied had relatively low levels of awareness of
obesity-related reproductive risks. The medical population had much more
knowledge about the other health risks of obesity. The survey provided
initial data that might be used to consider knowledge gaps and strategies
for engaging and educating medical trainees and the public about the
reproductive risks of obesity.
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Affiliation(s)
| | - Kay Roussos-Ross
- Obstetrics and Gynecology, University of Florida, Gainesville, FL 32610, USA
| | - Girard M Cua
- Department of Family Medicine Residency, University of South Florida College of Medicine, Tampa, FL 33612, USA
| | - Erica L Odera
- PIE Center/IFAS, University of Florida, Gainesville, FL 32610, USA
| | - Tracy A Irani
- PIE Center/IFAS, University of Florida, Gainesville, FL 32610, USA
| | - Terrie Vasilopoulos
- Department of Anesthesiology and Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL 32610, USA
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Jiang X, Liu M, Song Y, Mao J, Zhou M, Ma Z, Qian X, Han Z, Duan T. The Institute of Medicine recommendation for gestational weight gain is probably not optimal among non-American pregnant women: a retrospective study from China. J Matern Fetal Neonatal Med 2017; 32:1353-1358. [PMID: 29172881 DOI: 10.1080/14767058.2017.1405388] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate whether the Institute of Medicine (IOM) recommended gestational weight gain (GWG) range is optimal among Chinese singleton pregnant women. METHODS For the purpose of a retrospective observational study, data on 8209 mature singleton deliveries in Shanghai from January 2014 to December 2016 were extracted from medical records in terms of clinical performance. All cases were categorized as undergainers, appropriate-gainers, and above-gainers according to IOM recommended gestational weight gain range after stratification of maternal BMI and proportions of three categories were calculated. Comparisons of maternal and neonatal outcome were conducted among three categories and the associations of those outcome including risks of low birth weight (LBW) and macrosomia (MAC) with GWG were estimated by logistic regression analysis. To examine the applicability of IOM recommendation for Chinese pregnant women, the accumulated risk of LBW and MAC was displayed by stacked column chart and comparison was made among GWG category. The joint predicted risk (JPR) curve of both LBW and MAC in relation to GWG (continuous measurement) was plotted to demonstrate the relation of lowest JPR corresponding GWG with IOM range. RESULTS The IOM recommended weight gain was achieved only by 3502 (42.7%) pregnant women and 41.6% gained excessive weight during pregnancy, especially for the overweight and obese women, the proportions of above-gainers mounting to 65.7 and 75.9%, respectively. By multivariate analysis GWG significantly influenced the risk of MAC and caesarean section. Although the association between the risk of LBW and GWG was not significant, p value reached .051. The risk of delivering macrosomia and caesarean section doubled when GWG exceeded the IOM rang. Appropriate gainers did not always gain the lowest joint risk of low birth weight and macrosomia from stacked column chart and it is obvious that the GWG point according to the lowest JPR was always located left to the IOM recommended range for each BMI category from the JPR curve chart in relation to GWG. CONCLUSIONS The IOM recommended GWG range is possibly too much for Chinese singleton pregnant population for each BMI category. It is necessary to build different gestational weight gain standards for specific ethnic population.
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Affiliation(s)
- Xiang Jiang
- a Department of Obstetrics and Gynecology , Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine , Shanghai , China
| | - Ming Liu
- a Department of Obstetrics and Gynecology , Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine , Shanghai , China
| | - Yuehua Song
- a Department of Obstetrics and Gynecology , Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine , Shanghai , China
| | - Jing Mao
- a Department of Obstetrics and Gynecology , Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine , Shanghai , China
| | - Mulan Zhou
- a Department of Obstetrics and Gynecology , Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine , Shanghai , China
| | - Zhenfang Ma
- a Department of Obstetrics and Gynecology , Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine , Shanghai , China
| | - Xiaohu Qian
- a Department of Obstetrics and Gynecology , Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine , Shanghai , China
| | - Zhimin Han
- a Department of Obstetrics and Gynecology , Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine , Shanghai , China
| | - Tao Duan
- a Department of Obstetrics and Gynecology , Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine , Shanghai , China
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Leonard SA, Rasmussen KM, King JC, Abrams B. Trajectories of maternal weight from before pregnancy through postpartum and associations with childhood obesity. Am J Clin Nutr 2017; 106:1295-1301. [PMID: 28877895 PMCID: PMC5657288 DOI: 10.3945/ajcn.117.158683] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/08/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Prepregnancy body mass index [BMI (in kg/m2)], gestational weight gain, and postpartum weight retention may have distinct effects on the development of child obesity, but their combined effect is currently unknown.Objective: We described longitudinal trajectories of maternal weight from before pregnancy through the postpartum period and assessed the relations between maternal weight trajectories and offspring obesity in childhood.Design: We analyzed data from 4436 pairs of mothers and their children in the National Longitudinal Survey of Youth 1979 (1981-2014). We used latent-class growth modeling in addition to national recommendations for prepregnancy BMI, gestational weight gain, and postpartum weight retention to create maternal weight trajectory groups. We used modified Poisson regression models to assess the associations between maternal weight trajectory group and offspring obesity at 3 age periods (2-5, 6-11, and 12-19 y).Results: Our analysis using maternal weight trajectories based on either latent-class results or recommendations showed that the risk of child obesity was lowest in the lowest maternal weight trajectory group. The differences in obesity risk were largest after 5 y of age and persisted into adolescence. In the latent-class analysis, the highest-order maternal weight trajectory group consisted almost entirely of women who were obese before pregnancy and was associated with a >2-fold increase in the risk of offspring obesity at ages 6-11 y (adjusted RR: 2.39; 95% CI: 1.97, 2.89) and 12-19 y (adjusted RR: 2.74; 95% CI: 2.13, 3.52). In the analysis with maternal weight trajectory groups based on recommendations, the risk of child obesity was consistently highest for women who were overweight or obese at the beginning of pregnancy.Conclusion: These findings suggest that high maternal weight across the childbearing period increases the risk of obesity in offspring during childhood, but high prepregnancy BMI has a stronger influence than either gestational weight gain or postpartum weight retention.
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Affiliation(s)
| | | | - Janet C King
- Nutrition and Metabolism Center, Children’s Hospital Oakland Research Institute, Oakland, CA
| | - Barbara Abrams
- Division of Epidemiology, University of California, Berkeley, CA
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Differences in the Protective Effect of Exclusive Breastfeeding on Child Overweight and Obesity by Mother's Race. Matern Child Health J 2017; 20:1971-9. [PMID: 27178429 DOI: 10.1007/s10995-016-2015-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives To examine the relationship between infant feeding and risk of child overweight and obesity across race and ethnicity in a diverse community-based cohort. Methods 2172 mother baby dyads were drawn from a prospective cohort constructed using data from electronic medical records linked to birth records. The primary exposure was exclusive breastfeeding at 2 months of age; outcome was BMI Z-score and BMI ≥ 85th percentile (overweight and obese) at 4 years of age. Regression models were adjusted for confounding using covariance balanced propensity score and inverse probability weighting. Results At age 4, exclusively breast fed children had lower BMI Z-score (-0.109, SE = 0.048) and a decreased odds of a BMI ≥ 85th percentile (0.832; 95 % CI 0.792, 0.994), when compared to those exclusively formula-fed or had mixed feeding. Race and ethnicity significantly moderated these associations. Sub-population analysis showed the effect was significant for BMI Z-score (p = 0.0002) and BMI ≥ 85th percentile (p < 0.0001) only for children of NH white mothers. For children of NH black mothers exclusive breastfeeding was not associated with a significant difference in BMI Z-score, however there was an increased odds of overweight or obesity (p = 0.0145). Conclusions The protective effect of breastfeeding against early childhood overweight and obesity may differ by race and ethnicity. This suggests that programs aiming to reduce obesity by increasing rates of breastfeeding may have limited impact for some groups and should be coupled with other racially and ethnically focused efforts to encourage healthy feeding practices in infancy and early childhood.
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Association of maternal gestational weight gain with their offspring's anthropometric outcomes at late infancy and 6 years old: mediating roles of birth weight and breastfeeding duration. Int J Obes (Lond) 2017; 42:8-14. [PMID: 28775373 DOI: 10.1038/ijo.2017.183] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 07/08/2017] [Accepted: 07/23/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Longitudinal studies examining the potential mediating roles of birth weight and breastfeeding duration on the pathways between maternal gestational weight gain (GWG) and offspring anthropometric outcomes are lacking. METHODS We analyzed data from the mother-child pairs in the Infant Feeding Practices Study II (IFPS II) in late infancy (n=1548) and at the Year 6 Follow-up (n=1514) Study. Child anthropometrics included age- and sex-specific Z-scores for weight for age (WAZ), height /length for age, weight for height/length and body mass index (BMIZ). Structural equation models were used to estimate the total, direct and indirect effects of GWG on child anthropometrics through birth weight and breastfeeding duration. RESULTS The total effect of GWG on offspring anthropometric outcomes was significant for WAZ (β=0.107, 95% confidence interval (CI): 0.052, 0.161) at late infancy and for WAZ (β=0.122, 95% CI: 0.066, 0.177) and BMIZ (β=0.120, 95% CI: 0.063, 0.178) at 6 years old. The direct effects of GWG on offspring's WAZ and BMIZ were observed only at 6 years old. The indirect effects of GWG through birth weight were significant on most of the offspring's anthropometric measures. Compared to breastfeeding duration, birth weight was a stronger mediator on the pathways between GWG and all proposed anthropometric measures both in late infancy and in early childhood. Longer duration of breastfeeding was inversely associated with all offspring anthropometric outcomes at late infancy but not with those outcomes at 6 years old. CONCLUSIONS Our findings suggest a stronger indirect rather than direct effect of GWG on children's anthropometric outcomes mainly through birth weight, independent of maternal sociodemographic and reproductive factors. Longer duration of breastfeeding might suppress the positive relationship between GWG, birth weight and anthropometric outcomes in late infancy but not among 6 years old.
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Xie Y, Zhu Y, Cotton CA, Wu P. A model averaging approach for estimating propensity scores by optimizing balance. Stat Methods Med Res 2017; 28:84-101. [DOI: 10.1177/0962280217715487] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many approaches, including traditional parametric modeling and machine learning techniques, have been proposed to estimate propensity scores. This paper describes a new model averaging approach to propensity score estimation in which parametric and nonparametric estimates are combined to achieve covariate balance. Simulation studies are conducted across different scenarios varying in the degree of interactions and nonlinearities in the treatment model. The results show that, based on inverse probability weighting, the proposed propensity score estimator produces less bias and smaller standard errors than existing approaches. They also show that a model averaging approach with the objective of minimizing the average Kolmogorov–Smirnov statistic leads to the best performing IPW estimator. The proposed approach is also applied to a real data set in evaluating the causal effect of formula or mixed feeding versus exclusive breastfeeding on a child’s body mass index Z-score at age 4. The data analysis shows that formula or mixed feeding is more likely to lead to obesity at age 4, compared to exclusive breastfeeding.
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Affiliation(s)
- Yuying Xie
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Canada
| | - Yeying Zhu
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Canada
| | - Cecilia A Cotton
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Canada
| | - Pan Wu
- Value Institute, Christiana Care Health System, Newark, USA
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Bider-Canfield Z, Martinez MP, Wang X, Yu W, Bautista MP, Brookey J, Page KA, Buchanan TA, Xiang AH. Maternal obesity, gestational diabetes, breastfeeding and childhood overweight at age 2 years. Pediatr Obes 2017; 12:171-178. [PMID: 26956226 DOI: 10.1111/ijpo.12125] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/21/2016] [Accepted: 02/10/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Maternal obesity, excessive gestational weight gain (EGWG), gestational diabetes mellitus (GDM) and breastfeeding are four important factors associated with childhood obesity. OBJECTIVES The objective of the study was to assess the interplay among these four factors and their independent contributions to childhood overweight in a cohort with standard clinical care. METHODS The cohort included 15 710 mother-offspring pairs delivered in 2011. Logistic regression was used to assess associations between maternal exposures and childhood overweight (body mass index >85th percentile) at age 2 years. RESULTS Mothers with pre-pregnancy obesity or overweight were more likely to have EGWG, GDM and less likely to breastfeed ≥6 months. Mothers with GDM had 40-49% lower EGWG rates and similar breastfeeding rates compared with mothers without GDM. Analysis adjusted for exposures and covariates revealed an adjusted odds ratio (95% confidence interval) associated with childhood overweight at age 2 years of 2.34 (2.09-2.62), 1.50 (1.34-1.68), 1.23 (1.12-1.35), 0.95 (0.83-1.10) and 0.76 (0.69-0.83) for maternal obesity, overweight, EGWG, GDM and breastfeeding ≥6 months vs. <6 months, respectively. CONCLUSIONS In this large clinical cohort, GDM was not associated with, but maternal pre-pregnancy obesity or overweight and EGWG were independently associated with an increased risk, and breastfeeding ≥6 months was associated with a decreased risk of childhood overweight at age 2 years.
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Affiliation(s)
- Z Bider-Canfield
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - M P Martinez
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - X Wang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - W Yu
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - M P Bautista
- Consulting & Implementation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - J Brookey
- Quality and Risk, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - K A Page
- Department of Medicine and Diabetes and Obesity Research Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - T A Buchanan
- Department of Medicine and Diabetes and Obesity Research Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - A H Xiang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
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Abstract
PURPOSE OF REVIEW The huge percentages of persons with obesity in many countries constitute a public health crisis. The severe consequences of obesity for physical health and emotional wellbeing already emerge in childhood. Therefore, the acknowledgment of early risk factors is essential to provide recommendations for prevention strategies. This review outlines the current state of research concerning early risk factors for obesity, that is, factors that even contribute to later obesity of the offspring during gestation. In this regard, this review specifically addresses the link between restricted eating behavior of the mother and obesity in her offspring. We systematically searched for articles in PsychINFO, PsychINDEX, MEDLINE, PubMed, MEDPILOT, and Web of Science, and we identified additional studies in bibliographies. RECENT FINDINGS Although some risk factors (e.g., short period of breastfeeding, gestational diabetes, and high maternal BMI) have a vast evidence base, others (e.g., restricted eating behavior and second-hand smoking) are insufficiently studied. SUMMARY Physical activity and diet programs in pregnancy can reduce not only the occurrence of gestational diabetes, but also the risk of inappropriate weight gain. As smoking during pregnancy and inappropriate eating behavior are associated with lower education, psychoeducation, for instance in sex education classes, could be easily conceivable.
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Current status on obesity in childhood and adolescence: Prevalence, etiology, co-morbidities and management. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.obmed.2016.05.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Nutrition in the First 1000 Days: The Origin of Childhood Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13090838. [PMID: 27563917 PMCID: PMC5036671 DOI: 10.3390/ijerph13090838] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/12/2016] [Accepted: 08/18/2016] [Indexed: 12/13/2022]
Abstract
Childhood obesity is a major global issue. Its incidence is constantly increasing, thereby offering a threatening public health perspective. The risk of developing the numerous chronic diseases associated with this condition from very early in life is significant. Although complex and multi-factorial, the pathophysiology of obesity recognizes essential roles of nutritional and metabolic aspects. Particularly, several risk factors identified as possible determinants of later-life obesity act within the first 1000 days of life (i.e., from conception to age 2 years). The purpose of this manuscript is to review those key mechanisms for which a role in predisposing children to obesity is supported by the most recent literature. Throughout the development of the human feeding environment, three different stages have been identified: (1) the prenatal period; (2) breast vs. formula feeding; and (3) complementary diet. A deep understanding of the specific nutritional challenges presented within each phase might foster the development of future preventive strategies.
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Patterns and Determinants of Preconception Health Behaviors in Iranian Women. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016. [DOI: 10.5812/ircmj.28565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Woo Baidal JA, Locks LM, Cheng ER, Blake-Lamb TL, Perkins ME, Taveras EM. Risk Factors for Childhood Obesity in the First 1,000 Days: A Systematic Review. Am J Prev Med 2016; 50:761-779. [PMID: 26916261 DOI: 10.1016/j.amepre.2015.11.012] [Citation(s) in RCA: 566] [Impact Index Per Article: 70.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 11/17/2015] [Accepted: 11/18/2015] [Indexed: 12/27/2022]
Abstract
CONTEXT Mounting evidence suggests that the origins of childhood obesity and related disparities can be found as early as the "first 1,000 days"-the period from conception to age 2 years. The main goal of this study is to systematically review existing evidence for modifiable childhood obesity risk factors present from conception to age 2 years. EVIDENCE ACQUISITION PubMed, Embase, and Web of Science were searched for studies published between January 1, 1980, and December 12, 2014, of childhood obesity risk factors present during the first 1,000 days. Prospective, original human subject, English-language research with exposure occurrence during the first 1,000 days and with the outcome of childhood overweight or obesity (BMI ≥85th percentile for age and sex) collected between age 6 months and 18 years were analyzed between December 13, 2014, and March 15, 2015. EVIDENCE SYNTHESIS Of 5,952 identified citations, 282 studies met inclusion criteria. Several risk factors during the first 1,000 days were consistently associated with later childhood obesity. These included higher maternal pre-pregnancy BMI, prenatal tobacco exposure, maternal excess gestational weight gain, high infant birth weight, and accelerated infant weight gain. Fewer studies also supported gestational diabetes, child care attendance, low strength of maternal-infant relationship, low SES, curtailed infant sleep, inappropriate bottle use, introduction of solid food intake before age 4 months, and infant antibiotic exposure as risk factors for childhood obesity. CONCLUSIONS Modifiable risk factors in the first 1,000 days can inform future research and policy priorities and intervention efforts to prevent childhood obesity.
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Affiliation(s)
- Jennifer A Woo Baidal
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Medical Center, New York City, New York
| | - Lindsey M Locks
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Erika R Cheng
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Tiffany L Blake-Lamb
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts; Kraft Center for Community Health Leadership, Partners Healthcare, Boston, Massachusetts
| | - Meghan E Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
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Diesel JC, Eckhardt CL, Day NL, Brooks MM, Arslanian SA, Bodnar LM. Gestational Weight Gain and Offspring Longitudinal Growth in Early Life. ANNALS OF NUTRITION AND METABOLISM 2016; 67:49-57. [PMID: 26279171 DOI: 10.1159/000437149] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 06/21/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Excessive gestational weight gain (GWG) increases the risk of childhood obesity, but little is known about its association with infant growth patterns. AIM The aim of this study was to examine the association between GWG and infant growth patterns. METHODS Pregnant women (n = 743) self-reported GWG at delivery, which we classified as inadequate, adequate or excessive based on the current guidelines. Offspring weight-for-age z-score (WAZ), length-for-age z-score (LAZ (with height-for-age (HAZ) in place of length at 36 months)) and body mass index z-score (BMIZ) were calculated at birth, 8, 18 and 36 months using the 2006 World Health Organization growth standards. Linear mixed models estimated the change in z-score from birth to 36 months by GWG. RESULTS The mean (SD) WAZ was -0.22 (1.20) at birth. Overall, WAZ and BMIZ increased from birth to, approximately, 24 months and decreased from 24 to 36 months, while LAZ/HAZ decreased from birth through 36 months. Excessive GWG was associated with higher offspring WAZ and BMIZ at birth, 8 and 36 months, and higher HAZ at 36 months, compared with adequate GWG. Compared with the same referent, inadequate GWG was associated with smaller WAZ and BMIZ at birth and 8 months. CONCLUSION Excessive GWG may predispose infants to obesogenic growth patterns, while inadequate GWG may not have a lasting impact on infant growth.
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Ingul CB, Lorås L, Tegnander E, Eik-Nes SH, Brantberg A. Maternal obesity affects fetal myocardial function as early as in the first trimester. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:433-442. [PMID: 25761057 DOI: 10.1002/uog.14841] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 02/14/2015] [Accepted: 02/20/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate cardiac function from 14 weeks' gestation in fetuses of obese pregnant women (FOW). Animal studies have shown that maternal obesity induces fibrosis in fetal myocardium. We hypothesized that fetal cardiac function would be impaired among FOW. METHODS A case-control study with longitudinal follow-up was performed at Trondheim University Hospital, Norway. In total, 80 pregnant women were included and the final population comprised 52 obese and 24 of normal weight (mean body mass index before pregnancy, 34.8 ± 4.1 vs 21.0 ± 2.2 kg/m(2) ; P < 0.001). The main outcome measures were global strain rate (GSR) and strain by tissue Doppler imaging, tissue Doppler velocities (TDVs) and interventricular septal thickness assessed by fetal echocardiography at gestational ages of 14, 20 and 32 weeks. RESULTS In FOW, fetal left ventricle (LV) and right ventricle (RV) GSR and strain were significantly lower than in fetuses of normal-weight pregnant women: LV GSR was 33.3% lower at 14 weeks, 22.4% lower at 20 weeks and 22.8% lower at 32 weeks of gestation (P < 0.001) with no difference in fetal heart rate. Systolic and late diastolic TDVs for LV were significantly lower from 20 weeks' gestation and remained lower throughout pregnancy. Fetal interventricular septum was 26.6% (P < 0.001) thicker in late pregnancy in FOW compared with normal-weight pregnancies. CONCLUSIONS At 14 weeks of gestation, we detected fetal myocardial dysfunction with reduced LV and RV GSR and strain in FOW compared with fetuses of women with normal weight. Our finding is alarming considering the high prevalence of obesity and may partly explain the predisposition of offspring to cardiovascular disease later in life.
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Affiliation(s)
- C B Ingul
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - L Lorås
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - E Tegnander
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - S H Eik-Nes
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - A Brantberg
- National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
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The Effects of Maternal Obesity on Neonates, Infants, Children, Adolescents, and Adults. Clin Obstet Gynecol 2016; 59:216-27. [DOI: 10.1097/grf.0000000000000179] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lin X, Aris IM, Tint MT, Soh SE, Godfrey KM, Yeo GSH, Kwek K, Chan JKY, Gluckman PD, Chong YS, Yap F, Holbrook JD, Lee YS. Ethnic Differences in Effects of Maternal Pre-Pregnancy and Pregnancy Adiposity on Offspring Size and Adiposity. J Clin Endocrinol Metab 2015; 100. [PMID: 26200236 PMCID: PMC4628100 DOI: 10.1210/jc.2015-1728] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
CONTEXT Maternal adiposity and overnutrition, both before and during pregnancy, plays a key role in the subsequent development of obesity and metabolic outcomes in offspring. OBJECTIVE We explored the hypothesis that maternal adiposity (pre-pregnancy and at 26-28 weeks' gestation) and mid-pregnancy gestational weight gain (GWG) are independently associated with offspring size and adiposity in early childhood, and determined whether these effects are ethnicity dependent. DESIGN In a prospective mother-offspring cohort study (N = 976, 56% Chinese, 26% Malay, and 18% Indian), we assessed the associations of offspring size (weight, length) and adiposity (subscapular and triceps skinfolds), measured at birth and age 6, 12, 18, and 24 mo, with maternal pre-pregnancy body mass index (ppBMI), mid-pregnancy GWG, and mid-pregnancy four-site skinfold thicknesses (triceps, biceps, subscapular, suprailiac). RESULTS ppBMI and mid-pregnancy GWG were independently associated with postnatal weight up to 2 y and skinfold thickness at birth. Weight and subscapular and triceps skinfolds at birth increased by 2.56% (95% confidence interval, 1.68-3.45%), 3.85% (2.16-5.57%), and 2.14% (0.54-3.75%), respectively for every SD increase in ppBMI. Similarly, a one-SD increase in GWG increased weight and subscapular and triceps skinfolds at birth by 2.44% (1.66-3.23%), 3.28% (1.75-4.84%), and 3.23% (1.65-4.84%), respectively. ppBMI and mid-pregnancy suprailiac skinfold independently predicted postnatal skinfold adiposity up to 2 years of age, whereas only GWG predicted postnatal length. The associations of GWG with postnatal weight and length were present only among Chinese and Indians, but not Malays (P < .05 for interaction). CONCLUSIONS ppBMI and GWG are independent modifiable factors for child size and adiposity up to 2 years of age. The associations are ethnic-dependent, and underscore the importance of ethnic specific studies before generalizing the applicability of risk factors reported in other populations.
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Affiliation(s)
- Xinyi Lin
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
| | - Izzuddin M Aris
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
| | - Mya Thway Tint
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
| | - Shu E Soh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
| | - Keith M Godfrey
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
| | - George Seow-Heong Yeo
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
| | - Kenneth Kwek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
| | - Jerry Kok-Yen Chan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
| | - Fabian Yap
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
| | - Joanna D Holbrook
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore
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Connor KA, Cheng D, Strobino D, Minkovitz CS. Preconception health promotion among Maryland women. Matern Child Health J 2015; 18:2437-45. [PMID: 24748212 DOI: 10.1007/s10995-014-1482-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Despite current guidelines that all reproductive age women receive preconception care (PCC), most US women do not, especially women with a prior birth. The objective of our study was to identify factors associated with receipt of PCC health promotion counseling among Maryland women and to assess whether prior birth outcome affects receipt of counseling. We analyzed Maryland pregnancy risk assessment monitoring system data for a stratified random sample of women with a live birth in 2009-2010; 3,043 women with PCC data were included in the analysis. The dependent variable was receipt of any PCC counseling, and the primary independent variable, prior pregnancy outcome (no prior live birth, term, preterm). 33.1 % of the weighted sample received PCC. Odds of PCC were similar for women with a history of prior prior preterm birth (aOR 1.00, 95 % CI 0.57-1.78) and no prior live birth, but decreased for women with a prior full term delivery (aOR 0.69, 95 % CI 0.51-0.94). They were decreased for women with unintended births (aOR 0.36, 95 % CI 0.26-0.51) and increased for women with a diagnosis of asthma (aOR 1.74, 95 % CI 1.05-2.89) or diabetes (aOR 2.79, 95 % CI 1.20-6.45), who used multivitamins (aOR 2.58, 95 % CI 1.92-3.47), and had dental cleanings (aOR 1.60, 95 % CI 1.16-2.18). Although selected preventive health behaviors and high-risk conditions were associated with PCC, most women did not receive PCC. Characterization of women who do not receive PCC health promotion counseling in Maryland may assist in efforts to enhance service delivery.
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Affiliation(s)
- Katherine A Connor
- The Herman and Walter Samuelson Children's Hospital at Sinai, 5101 Lanier Avenue, Baltimore, MD, 21215, USA,
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Diesel JC, Eckhardt CL, Day NL, Brooks MM, Arslanian SA, Bodnar LM. Is gestational weight gain associated with offspring obesity at 36 months? Pediatr Obes 2015; 10:305-10. [PMID: 25267200 PMCID: PMC4379119 DOI: 10.1111/ijpo.262] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 07/29/2014] [Indexed: 01/28/2023]
Abstract
OBJECTIVE We examined the association between gestational weight gain (GWG) and offspring obesity at age 36 months. METHODS Mother-infant dyads (n = 609) were followed from a first study visit (mean [standard deviation]: 18.8 [2.7] weeks gestation) to 36 months postpartum. Total GWG over the entire pregnancy was defined as excessive or non-excessive according to the 2009 Institute of Medicine guidelines. Four mutually exclusive categories of excessive or non-excessive GWG across early (conception to first study visit) and late (first study visit to delivery) pregnancy defined GWG pattern. Body mass index (BMI) z-scores ≥95th percentile of the 2000 Centers for Disease Control (CDC) references defined offspring obesity at 36 months. Multivariable log-binomial models adjusted for pre-pregnancy BMI and breastfeeding were used to estimate the association between GWG and childhood obesity risk. RESULTS Nearly half of the women had total excessive GWG. Of these, 46% gained excessively during both early and late pregnancy while 22% gained excessively early and non-excessively late, and the remaining 32% gained non-excess weight early and excessively later. Thirteen per cent of all children were obese at 36 months. Excessive total GWG was associated with more than twice the risk of child obesity (adjusted risk ratio [95% confidence interval]: 2.20 [1.35, 3.61]) compared with overall non-excessive GWG. Compared with a pattern of non-excessive GWG in both early and late pregnancy, excessive GWG in both periods was associated with an increased risk of obesity (2.39 [1.13, 5.08]). CONCLUSIONS Excessive GWG is a potentially modifiable factor that may influence obesity development in early childhood.
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Affiliation(s)
- Jill C. Diesel
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania 15261
| | - Cara L. Eckhardt
- School of Community Health, Portland State University, Portland, Oregon 97201
| | - Nancy L. Day
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania 15261
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213
| | - Maria M. Brooks
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania 15261
| | - Silva A. Arslanian
- Division of Weight Management and Wellness, and Division of Pediatric Endocrinology, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15224
| | - Lisa M. Bodnar
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania 15261
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213
- Magee-Women’s Research Institute, Pittsburgh, Pennsylvania 15213
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Wojcicki JM, Young MB, Perham-Hester KA, de Schweinitz P, Gessner BD. Risk factors for obesity at age 3 in Alaskan children, including the role of beverage consumption: results from Alaska PRAMS 2005-2006 and its three-year follow-up survey, CUBS, 2008-2009. PLoS One 2015; 10:e0118711. [PMID: 25793411 PMCID: PMC4368660 DOI: 10.1371/journal.pone.0118711] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 01/08/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Prenatal and early life risk factors are associated with childhood obesity. Alaska Native children have one of the highest prevalences of childhood obesity of all US racial/ethnic groups. METHODS Using the Pregnancy Risk Assessment Monitoring System (PRAMS) and the follow-up survey at 3 years of age (CUBS), we evaluated health, behavioral, lifestyle and nutritional variables in relation to obesity (95th percentile for body mass index (BMI)) at 3 years of age. Multivariate logistic regression modeling was conducted using Stata 12.0 to evaluate independent risk factors for obesity in non-Native and Alaska Native children. RESULTS We found an obesity prevalence of 24.9% in all Alaskan and 42.2% in Alaska Native 3 year olds. Among Alaska Native children, obesity prevalence was highest in the Northern/Southwest part of the state (51.6%, 95%CI (42.6-60.5)). Independent predictive factors for obesity at age 3 years in Alaska non-Native children were low income (<$10,000 in the year before the child was born (OR 3.94, 95%CI 1.22--17.03) and maternal pre-pregnancy obesity (OR 2.01, 95%CI 1.01-4.01) and longer duration of breastfeeding was protective (OR 0.95, 95%CI 0.91-0.995). Among Alaska Native children, predictive factors were witnessing domestic violence/abuse as a 3 year-old (OR 2.28, 95%CI 1.17-7.60). Among obese Alaska Native children, there was an increased daily consumption of energy dense beverages in the Northern/Southwest region of the state, which may explain higher rates of obesity in this part of the state. CONCLUSIONS The high prevalence of obesity in Alaska Native children may be explained by differences in lifestyle patterns and food consumption in certain parts of the state, specifically the Northern/Southwest region, which have higher consumption of energy dense beverages.
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Affiliation(s)
- Janet M. Wojcicki
- Department of Pediatrics (GI and Nutrition), University of California San Francisco, San Francisco, California, United States of America
| | - Margaret B. Young
- Maternal and Child Health Epidemiology Unit, Alaska Division of Public Health, Section of Women's, Children's and Family Health, Anchorage, Alaska, United States of America
| | - Katherine A. Perham-Hester
- Maternal and Child Health Epidemiology Unit, Alaska Division of Public Health, Section of Women's, Children's and Family Health, Anchorage, Alaska, United States of America
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Steel A, Lucke J, Adams J. The prevalence and nature of the use of preconception services by women with chronic health conditions: an integrative review. BMC WOMENS HEALTH 2015; 15:14. [PMID: 25783639 PMCID: PMC4338627 DOI: 10.1186/s12905-015-0165-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 01/20/2015] [Indexed: 12/28/2022]
Abstract
Background There is growing evidence that preconception care may have an important role in preventing short and long term adverse health consequences for women and their offspring. This is particularly the case for women with chronic health conditions due to the rising prevalence of chronic disease in global populations. With this in mind, this paper presents an integrative systematic review of contemporary research outlining the use of preconception services and practices by women with chronic health conditions. Methods A search was conducted through PubMed, CINAHL, AMED, and Maternity and Infant Care databases which identified 672 papers examining preconception care and preconception services for women with chronic health conditions. Fourteen papers which were written in English, presented original research, and reported on the prevalence or nature of use of preconception care by women with chronic health conditions were included in the review. Critical appraisal of study quality and thematic categorical grouping of identified papers was undertaken. Results Current research evidence, as identified through this review, examines three major topic areas: the prevalence of preconception care practices, use of services and characteristics of users; knowledge of the value and impact of preconception care and availability of preconception services for women with chronic health conditions; and women’s attitudes, approaches and experiences of preconception care and preconception services. Prevalence estimates of engagement with preconception care range between 18.1% and 45%, with most studies focusing on women with type 1 or 2 diabetes. Significant gaps in women’s knowledge of preconception care for women with chronic health conditions were also identified. Women with chronic health conditions reported experiencing emotional distress as a result of their engagement with preconception care services. They also commonly described feeling a need to employ discipline to comply with preconception care programs, and experiencing a fear of pregnancy complications. Conclusion Future research requires a broad and sophisticated approach to research design and analysis, improved consideration of temporal changes to women’s health behaviour, representative samples to more effectively inform health policy, and a deeper understanding of women’s motivations, attitudes and perceptions of preconception care to assist in the development of tailored preconception health services.
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Affiliation(s)
- Amie Steel
- Office of Research, Endeavour College of Natural Health, Brisbane, Queensland, Australia,
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Carling SJ, Demment MM, Kjolhede CL, Olson CM. Breastfeeding duration and weight gain trajectory in infancy. Pediatrics 2015; 135:111-9. [PMID: 25554813 PMCID: PMC4279065 DOI: 10.1542/peds.2014-1392] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Short breastfeeding duration may exacerbate accelerated early growth, which is linked to higher obesity risk in later life. This study tested the hypothesis that infants at higher risk for obesity were more likely to be members of a rising weight-for-length (WFL) z score trajectory if breastfed for shorter durations. METHODS This prospective, observational study recruited women from an obstetric patient population in rural central New York. Medical records of children born to women in the cohort were audited for weight and length measurements (n = 595). We identified weight gain trajectories for infants' WFL z scores from 0 to 24 months by using maximum likelihood latent class models. Individual risk factors associated with weight gain trajectories (P ≤ .05) were included in an obesity risk index. Logistic regression analysis was performed to investigate whether the association between breastfeeding duration (<2 months, 2-4 months, >4 months) and weight gain trajectory varied across obesity risk groups. RESULTS Rising and stable weight gain trajectories emerged. The obesity risk index included maternal BMI, education, and smoking during pregnancy. High-risk infants breastfed for <2 months were more likely to belong to a rising rather than stable weight gain trajectory (odds ratio, 2.55; 95% confidence interval, 1.14-5.72; P = .02). CONCLUSIONS Infants at the highest risk for rising weight patterns appear to benefit the most from longer breastfeeding duration. Targeting mothers of high-risk infants for breastfeeding promotion and support may be protective against overweight and obesity during a critical window of development.
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Affiliation(s)
- Stacy J Carling
- Division of Nutritional Sciences, Cornell University, Ithaca, New York; and
| | - Margaret M Demment
- Division of Nutritional Sciences, Cornell University, Ithaca, New York; and
| | - Chris L Kjolhede
- Mary Imogene Bassett Hospital and Research Institute, Cooperstown, New York
| | - Christine M Olson
- Division of Nutritional Sciences, Cornell University, Ithaca, New York; and
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Kritzer S, Magner K, Warshak CR. Increasing maternal body mass index and the accuracy of sonographic estimation of fetal weight near delivery. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:2173-2179. [PMID: 25425375 DOI: 10.7863/ultra.33.12.2173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To evaluate whether an increasing body mass index (BMI) influences the accuracy of sonographic estimation of fetal weight. METHODS We performed a retrospective cohort study of singleton deliveries over a 2-year period in a single institution. Patients were included if they had a fetal weight estimation within 2 weeks of delivery. The Δ estimated fetal weight (EFW) was calculated by subtracting the sonographic EFW from the birth weight and compared among our study groups, which were based on the maternal BMI class. We also compared the absolute percentage error of estimation, rate of substantial error greater than 20%, rate of underestimation, and ability to predict fetal weight greater than 4000 g. Post hoc power analysis determined that our study group of 1200 patients allowed for an α of .05 and β of .90. RESULTS We included 1177 women in our analysis. The median ΔEFW varied between study groups: 137, 202, 157, 200, and 189 g, respectively, in normal-weight, overweight, and obese classes 1, 2, and 3 (P = .01). The median percentage error of estimation between study groups varied between 5.0% in normal-weight women and 7.1% in class 2 obese women (P= .05). The rate of substantial error was similar between study groups and varied between 2.7% in class 1 obese women and 4.3% in normal-weight and class 2 obese women. Linear regression analysis showed a weak association between maternal BMI and ΔEFW (R(2) = 0.005; r = 0.069). CONCLUSIONS The absolute ΔEFW was lower in normal-weight women; however, the percentage error of the EFW was similar between women of varying BMI classifications, as was the rate of substantial error and the rate of underestimation of the EFW.
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Affiliation(s)
- Sara Kritzer
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio USA (S.K., K.M., C.R.W.); and Department of Obstetrics and Gynecology, The Christ Hospital, Cincinnati, Ohio USA (S.K., K.M.)
| | - Kristin Magner
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio USA (S.K., K.M., C.R.W.); and Department of Obstetrics and Gynecology, The Christ Hospital, Cincinnati, Ohio USA (S.K., K.M.)
| | - Carri R Warshak
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio USA (S.K., K.M., C.R.W.); and Department of Obstetrics and Gynecology, The Christ Hospital, Cincinnati, Ohio USA (S.K., K.M.).
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Gaillard R, Steegers EAP, Franco OH, Hofman A, Jaddoe VWV. Maternal weight gain in different periods of pregnancy and childhood cardio-metabolic outcomes. The Generation R Study. Int J Obes (Lond) 2014; 39:677-85. [PMID: 25287752 DOI: 10.1038/ijo.2014.175] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 09/21/2014] [Accepted: 09/26/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Excessive gestational weight gain seems to be associated with offspring cardio-metabolic risk factors. Little is known about the critical periods of gestational weight gain. We examined the associations of maternal weight gain in different periods of pregnancy with childhood cardio-metabolic risk factors. METHODS In a population-based prospective cohort study from early pregnancy onwards among 5908 mothers and their children, we obtained maternal prepregnancy weight and weight in early, mid and late pregnancy. At the age of 6 years (median: 72.6 months; 95% range: 67.9, 95.8), we measured childhood body mass index (BMI), total body and abdominal fat distribution, blood pressure and blood levels of lipids, insulin and c-peptide. RESULTS Overall, the associations of maternal prepregnancy weight with childhood outcomes were stronger than the associations of maternal gestational weight gain. Independent from maternal prepregnancy weight and weight gain in other periods, higher weight gain in early pregnancy was associated with higher childhood BMI, total fat mass, android/gynoid fat mass ratio, abdominal subcutaneous fat mass and systolic blood pressure (P-values<0.05). Independent associations of maternal weight gain in early pregnancy with childhood abdominal preperitoneal fat mass, insulin and c-peptide were of borderline significance. Higher weight gain in mid pregnancy was independently associated with higher childhood BMI, total and abdominal subcutaneous fat mass and systolic blood pressure (P-values<0.05). The associations for childhood cardio-metabolic outcomes attenuated after adjustment for childhood BMI. Weight gain in late pregnancy was not associated with childhood outcomes. Higher weight gain in early, but not in mid or late pregnancy, was associated with increased risks of childhood overweight and clustering of cardio-metabolic risk factors (odds ratio (OR) 1.19 (95% confidence interval (CI): 1.10, 1.29) and OR 1.20 (95% CI: 1.07, 1.35) per standard deviation increase in early gestational weight gain, respectively). CONCLUSIONS Higher weight gain in early pregnancy is associated with an adverse cardio-metabolic profile in offspring. This association is largely mediated by childhood adiposity.
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Affiliation(s)
- R Gaillard
- 1] The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands [2] Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands [3] Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - E A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - O H Franco
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - V W V Jaddoe
- 1] The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands [2] Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands [3] Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
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