Maternal metabolic factors during pregnancy predict early childhood growth trajectories and obesity risk: the CANDLE Study

• DOI: 10.1038/s41366-019-0326-z
• Publication Date: 2019-01-31T16:03:50Z
• Authors: Zunsong Hu; Frances A. Tylavsky; Joan C. Han; Mehmet Kocak; Jay H. Fowke; Robert L. Davis; Kaja Lewinn; Nicole R. Bush; Qi Zhao
• Keywords: Male; Pediatric Obesity; Biomedical and clinical sciences; Reproductive health and childbirth; Cardiovascular; Weight Gain; Medical and Health Sciences; Body Mass Index; Child Development; Risk Factors; Pregnancy; 2.1 Biological and endogenous factors; Longitudinal Studies; Prospective Studies; Aetiology; Child; Adiposity; Pediatric; 2. Zero hunger; Diabetes; Gestational Weight Gain; 3. Good health; Child, Preschool; Prenatal Exposure Delayed Effects; Gestational; Female; Public Health; Adult; Adolescent; Mothers; Article; Education; Endocrinology & Metabolism; Clinical Research; Health Sciences; Humans; Obesity; Preschool; Metabolic and endocrine; Nutrition; Biomedical and Clinical Sciences; Prevention; Infant, Newborn; Health sciences; Infant; Perinatal Period - Conditions Originating in Perinatal Period; Newborn; United States; Diabetes, Gestational; Reproductive Medicine

We investigated the individual and additive effects of three modifiable maternal metabolic factors, including pre-pregnancy overweight/obesity, gestational weight gain (GWG), and gestational diabetes mellitus (GDM), on early childhood growth trajectories and obesity risk.A total of 1425 mother-offspring dyads (953 black and 472 white) from a longitudinal birth cohort were included in this study. Latent class growth modeling was performed to identify the trajectories of body mass index (BMI) from birth to 4 years in children. Poisson regression models were used to examine the associations between the maternal metabolic risk factors and child BMI trajectories and obesity risk at 4 years.We identified three discrete BMI trajectory groups, characterized as rising-high-BMI (12.6%), moderate-BMI (61.0%), or low-BMI (26.4%) growth. Both maternal pre-pregnancy obesity (adjusted relative risk [adjRR] = 1.96; 95% confidence interval [CI]: 1.36-2.83) and excessive GWG (adjRR = 1.71, 95% CI: 1.13-2.58) were significantly associated with the rising-high-BMI trajectory, as manifested by rapid weight gain during infancy and a stable but high BMI until 4 years. All three maternal metabolic indices were significantly associated with childhood obesity at age 4 years (adjRR for pre-pregnancy obesity = 2.24, 95% CI: 1.62-3.10; adjRR for excessive GWG = 1.46, 95% CI: 1.01-2.09; and adjRR for GDM = 2.14, 95% = 1.47-3.12). In addition, risk of rising-high BMI trajectory or obesity at age 4 years was stronger among mothers with more than one metabolic risk factor. We did not observe any difference in these associations by race.Maternal pre-pregnancy obesity, excessive GWG, and GDM individually and jointly predict rapid growth and obesity at age 4 years in offspring, regardless of race. Interventions targeting maternal obesity and metabolism may prevent or slow the rate of development of childhood obesity.