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Rosenquist NA, Richards M, Ferber JR, Strickland MJ, Ryu SY, Burkin H, Weber AM, Li DK, Darrow LA. Maternal obesity and childhood asthma risk: Exploring mediating pathways. Paediatr Perinat Epidemiol 2024; 38:302-312. [PMID: 38054336 DOI: 10.1111/ppe.13023] [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] [Received: 04/27/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Growing evidence for the effect of maternal obesity on childhood asthma motivates investigation of mediating pathways. OBJECTIVE To investigate if childhood body mass index (BMI), gestational weight gain (GWG) and preterm birth mediate the association of maternal obesity on childhood asthma risk. METHODS We used electronic medical records from mother-child pairs enrolled in Kaiser Permanente Northern California integrated healthcare system. Children were followed from their birth (2005-2014) until at least age 4 (n = 95,723), age 6 (n = 59,230) or age 8 (n = 25,261). Childhood asthma diagnosis at each age was determined using ICD-9/10 codes and medication dispensings. Prepregnancy BMI (underweight [<18.5], normal [18.5-24.9], overweight [25-29.9], obese [≥30] kg/m2) were defined using height and weight measurements close to the last menstrual period date. Child's BMI (Centers for Disease Control and Prevention BMI-for-age percentiles: underweight [<5th], normal [5th-85th], overweight [85th-95th], obese [>95th]) were obtained using anthropometric measurements taken the year preceding each follow-up age. GWG (delivery weight-prepregnancy weight) was categorised based on Institutes of Medicine recommendations (inadequate, adequate, excessive). Implementing first causal inference test (CIT) then causal mediator models (to decompose the natural direct and indirect effects), we examined the potential mediating effect of childhood BMI, GWG, and preterm birth on the association between prepregnancy BMI (continuous and categorical) and childhood asthma. RESULTS Overall, risk of childhood asthma increased as prepregnancy BMI increased (age 4 risk ratio: 1.07, 95% confidence interval: 1.04, 1.09, per 5 kg/m2 increase in BMI; similar for age 6 and 8). CIT identified childhood BMI and preterm birth, but not GWG as potential mediators. Causal mediation models confirmed childhood BMI, but not preterm birth, as having a partial mediating effect. Results were similar for age 6 and 8, and when continuous mediators (instead of binary) were assessed. CONCLUSIONS Childhood overweight/obesity has a modest mediating effect on the association between prepregnancy BMI and childhood asthma.
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Affiliation(s)
| | - Megan Richards
- School of Public Health, University of Nevada, Reno, Nevada, USA
| | - Jeannette R Ferber
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | | | - So Young Ryu
- School of Public Health, University of Nevada, Reno, Nevada, USA
| | - Heather Burkin
- School of Medicine, University of Nevada, Reno, Nevada, USA
| | - Ann M Weber
- School of Public Health, University of Nevada, Reno, Nevada, USA
| | - De-Kun Li
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Lyndsey A Darrow
- School of Public Health, University of Nevada, Reno, Nevada, USA
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Yu H, Chen L, Zhang Y. Maternal prepregnancy body mass index, gestational weight gain, and allergic diseases in children: A systematic review and meta-analysis. Obes Rev 2024; 25:e13653. [PMID: 37880747 DOI: 10.1111/obr.13653] [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] [Received: 01/30/2023] [Revised: 08/21/2023] [Accepted: 09/23/2023] [Indexed: 10/27/2023]
Abstract
Several studies have investigated a link between maternal preconception body mass index, gestational weight gain (GWG), and the risk of childhood allergic diseases, but the conclusions of these studies were inconsistent. This review aimed to evaluate the relationship based on existing studies. We eventually included 18 cohort studies. The findings indicated that both maternal preconception overweight or obesity increased the risk of childhood wheezing (overweight: risk ratio (RR) 1.09, 95% confidence interval (CI) 1.04-1.15; obesity: RR 1.24, 95% CI 1.12-1.38) and asthma (overweight: RR 1.18, 95% CI 1.05-1.32; obesity: RR 1.34, 95% CI 1.13-1.58), and the risk of childhood wheezing increased with continuous prepregnancy BMI changes (per 5 kg/m2 increase) (RR 1.10, 95% CI 1.05-1.15). Preconception underweight may elevate the risk of childhood eczema ever (RR 1.05, 95% CI 1.02-1.09) and current eczema (RR 1.20, 95% CI 1.05-1.37), and preconception overweight may reduce the risk of childhood eczema ever (RR 0.98, 95% CI 0.96-0.99). No statistically significant association between GWG and the risk of allergic diseases in children was found. Preconception weight management is encouraged for the prevention of allergic diseases in children.
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Affiliation(s)
- Hongbiao Yu
- Department of Obstetrics and Gynecology, The Second Clinical College of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, Sichuan, China
| | - Ling Chen
- Department of Oncology, The Second Clinical College of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, Sichuan, China
| | - Yulin Zhang
- Department of Pain Management, The Second Clinical College of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, Sichuan, China
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Dumas O, Arroyo AC, Faridi MK, James K, Hsu S, Powe C, Camargo CA. Cohort Study of Maternal Gestational Weight Gain, Gestational Diabetes, and Childhood Asthma. Nutrients 2022; 14:nu14235188. [PMID: 36501218 PMCID: PMC9741125 DOI: 10.3390/nu14235188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/25/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Data on the association of maternal gestational weight gain (GWG) and gestational diabetes mellitus (GDM) with childhood asthma are limited and inconsistent. We aimed to investigate these associations in a U.S. pre-birth cohort. Analyses included 16,351 mother-child pairs enrolled in the Massachusetts General Hospital Maternal-Child Cohort (1998-2010). Data were obtained by linking electronic health records for prenatal visits/delivery to determine BMI, GWG, and GDM (National Diabetes Data Group criteria) and to determine asthma incidence and allergies (atopic dermatitis or allergic rhinitis) for children. The associations of prenatal exposures with asthma were evaluated using logistic regression adjusted for maternal characteristics. A total of 2306 children (14%) developed asthma by age 5 years. Overall, no association was found between GWG and asthma. GDM was positively associated with offspring asthma (OR 1.46, 95% CI 1.14-1.88). Associations between GDM and asthma were observed only among mothers with early pregnancy BMI between 20 and 24.9 kg/m2 (OR 2.31, CI 1.46-3.65, p-interaction 0.02). We report novel findings on the impact of prenatal exposures on asthma, including increased risk among mothers with GDM, particularly those with a normal BMI. These findings support the strengthening of interventions targeted toward a healthier pregnancy, which may also be helpful for childhood asthma prevention.
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Affiliation(s)
- Orianne Dumas
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France
- Correspondence:
| | - Anna Chen Arroyo
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Mohammad Kamal Faridi
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Kaitlyn James
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sarah Hsu
- Diabetes Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Camille Powe
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114, USA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
- Broad Institute, Cambridge, MA 02142, USA
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Rosenquist NA, Richards M, Ferber JR, Li DK, Ryu SY, Burkin H, Strickland MJ, Darrow LA. Prepregnancy body mass index and risk of childhood asthma. Allergy 2022; 78:1234-1244. [PMID: 36435989 DOI: 10.1111/all.15598] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/12/2022] [Accepted: 10/30/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Growing evidence suggests that maternal obesity may affect the intrauterine environment and increase a child's risk of developing asthma. We aim to investigate the relationship between prepregnancy obesity and childhood asthma risk. METHODS Cohorts of children enrolled in Kaiser Permanente Northern California integrated healthcare system were followed from birth (2005-2014) to age 4 (n = 104,467), 6 (n = 63,084), or 8 (n = 31,006) using electronic medical records. Child's asthma was defined using ICD codes and asthma-related prescription medication dispensing. Risk ratios (RR) and 95% confidence intervals (95% CIs) for child's asthma were estimated using Poisson regression with robust error variance for (1) prepregnancy BMI categories (underweight [<18.5], normal [18.5-24.9], overweight [25-29.9], obese 1 [30-34.9], and obese 2/3 [≥35]) and (2) continuous prepregnancy BMI modeled using cubic splines with knots at BMI category boundaries. Models were adjusted for maternal age, education, race, asthma, allergies, smoking, gestational weight gain, child's birth year, parity, infant sex, gestational age, and child's BMI. RESULTS Relative to normal BMI, RRs (95%CIs) for asthma at ages 4, 6, and 8 were 0.91 (0.75, 1.11), 0.95 (0.78, 1.16), and 0.97 (0.75, 1.27) for underweight, 1.06 (0.99, 1.14), 1.08 (1.01, 1.16), and 1.03 (0.94, 1.14) for overweight, 1.09 (1.00, 1.19), 1.12 (1.03, 1.23), 1.03 (0.91, 1.17) for obese 1, and 1.10 (0.99, 1.21), 1.13 (1.02, 1.25), 1.14 (0.99, 1.31) for obese 2/3. When continuous prepregnancy BMI was modeled with splines, child's asthma risk generally increased linearly with increasing prepregnancy BMI. CONCLUSIONS Higher prepregnancy BMI is associated with modestly increased childhood asthma risk.
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Affiliation(s)
| | - Megan Richards
- School of Public Health, University of Nevada, Reno, Nevada, USA
| | - Jeannette R Ferber
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - De-Kun Li
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - So Young Ryu
- School of Public Health, University of Nevada, Reno, Nevada, USA
| | - Heather Burkin
- School of Medicine, University of Nevada, Reno, Nevada, USA
| | | | - Lyndsey A Darrow
- School of Public Health, University of Nevada, Reno, Nevada, USA
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Borrelli CB, Morais SS, Barbieri MM, Leme T, Prado JFT, Surita FG. Prepregnancy overweight and obesity as risk factors for birth defects: a cross-sectional study over a 30-year period. J OBSTET GYNAECOL 2022; 42:2905-2911. [PMID: 36000806 DOI: 10.1080/01443615.2022.2112938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Overweight and obesity are public health problems worldwide despite being modifiable conditions. The association between birth defects and pregestational maternal body mass index is not entirely clear. We aimed to assess the prevalence and estimate the risk of birth defects related to pregestational body mass index and other maternal factors. We explored a 30-year time series database in a cross-section study. We analysed 40,217 cases, among them 2.8% had birth defects. Bivariate analysis showed a higher prevalence of birth defects with increased pre-pregnancy body mass index and in extremes of maternal age, white skin colour, and primiparity. Multivariable logistic regression showed a higher chance of birth defects in women with pre-pregnancy overweight/obesity (OR:1.19 [CI95%:1.01-1.41]), maternal age ≥ 40 years (OR:1.68 [CI95%:1.11-2.54]), and white skin colour (OR:1.44 [CI95%:1.19-1.75]). Maternal weight is a modifiable risk factor that must be considered and addressed in preconception counselling to minimise possible deleterious effects on embryogenesis.IMPACT STATEMENTWhat is already known on this subject? Previous studies have linked some maternal factors with birth defects. However, the association with prepregnancy maternal body mass index is not clear.What do the results of this study add? Our findings provide support for the association of prepregnancy maternal overweight and obesity with birth defects and highlight that BMI is a modified risk factor.What are the implications of these findings for clinical practice and/or further research? Maternal body mass index is a modifiable risk factor, highlighting the importance of preconception counselling for the prevention and possible reduction of factors that increase the risk of birth defects.
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Affiliation(s)
- Carolina Bicudo Borrelli
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Sirlei Siani Morais
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Mariane M Barbieri
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Thayane Leme
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Campinas, Sao Paulo, Brazil
| | | | - Fernanda G Surita
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Campinas, Sao Paulo, Brazil
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Polinski KJ, Bell GA, Trinh MH, Sundaram R, Mendola P, Robinson SL, Bell EM, Adeyeye T, Lin TC, Yeung EH. Maternal obesity, gestational weight gain, and offspring asthma and atopy. Ann Allergy Asthma Immunol 2022; 129:199-204.e3. [PMID: 35552010 PMCID: PMC9329274 DOI: 10.1016/j.anai.2022.04.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/08/2022] [Accepted: 04/27/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Maternal obesity may affect offspring asthma and atopic disease risk by altering fetal immune system development. However, few studies evaluate gestational weight gain (GWG). OBJECTIVE To evaluate relationships between maternal body mass index (BMI), GWG, and persistent wheeze, eczema, allergy, and asthma risk in offspring through middle childhood. METHODS A total of 5939 children from Upstate KIDS, a population-based longitudinal cohort of children born in upstate New York (2008-2019) were included in the analysis. Persistent wheeze or asthma, eczema, and allergy were maternally reported at multiple study time points throughout early and middle childhood. Poisson regression models with robust SEs were used to estimate adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for offspring atopic outcomes by maternal prepregnancy BMI and GWG. RESULTS Prepregnancy BMI was associated with increased risk of persistent wheeze by 3 years of age even after adjustments for maternal atopy (class I obesity: aRR, 1.58; 95% CI, 1.13-2.20; class II or III obesity: aRR, 1.69; 95% CI, 1.22-2.35). Associations with reported asthma in middle childhood did not reach statistical significance. Furthermore, no associations were found between prepregnancy BMI and atopic outcomes in either early or middle childhood. GWG was not associated with higher risk of early childhood persistent wheeze or middle childhood asthma. CONCLUSION Maternal prepregnancy BMI was associated with increased risk of offspring wheeze, whereas excessive GWG was generally not associated with childhood asthma or atopy.
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Affiliation(s)
- Kristen J Polinski
- Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Griffith A Bell
- Ariadne Labs, Boston, Massachusetts; Departments of Health Policy and Management and of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Mai-Han Trinh
- Departments of Health Policy and Management and of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Rajeshwari Sundaram
- Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Pauline Mendola
- Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, New York
| | - Sonia L Robinson
- Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Erin M Bell
- Department of Environmental Health Sciences, University at Albany, State University of New York, Albany, New York
| | - Temilayo Adeyeye
- Department of Environmental Health Sciences, University at Albany, State University of New York, Albany, New York
| | | | - Edwina H Yeung
- Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
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