Association of maternal pre-pregnancy BMI, gestational weight gain, and gestational diabetes mellitus with BMI trajectory in early childhood: a prospective cohort study

Abstract

Objective: To examine the associations of pre-pregnancy body mass index (BMI), gestational weight gain, and gestational diabetes mellitus (GDM) with early childhood BMI trajectories. Methods: A total of 1 227 mother-child pairs from the Peking University Birth Cohort in Tongzhou were included in this study. In the cohort, maternal pre-pregnancy weight, height, gestational weight gain, and GDM diagnosis were collected. The children were followed up at birth and at 1, 3, 6, 9, 12, 18, 24, 30, and 36 months of age to obtain height/length and weight data. The longitudinal data-based k-means clustering algorithm was used to identify early childhood BMI trajectory groups. The associations of maternal pre-pregnancy BMI, gestational weight gain, and GDM with early childhood BMI trajectories were analyzed using the logistic regression model. We further explored whether there is an interaction effect between pre-pregnancy overweight/obesity and excessive gestational weight gain on the risk of the high BMI trajectory in early childhood through multiplicative and additive interaction analyses. Results: The prevalence rates of overweight and obesity before pregnancy were 21.2% (260 cases) and 6.6% (81 cases) respectively. The prevalence of excessive gestational weight gain and GDM was 57.7% (708 cases) and 30.9% (379 cases). The early childhood BMI trajectories were named low, medium, and high trajectories, accounting for 30.5%, 45.4% and 24.1%, respectively. After controlling potential confounding factors, it was found that pre-pregnancy overweight (OR=1.54, 95%CI: 1.12-2.12), obesity (OR=2.33, 95%CI: 1.41-3.85), and excessive gestational weight gain (OR=1.47, 95%CI: 1.10-1.97) were risk factors for being in the high BMI trajectory in early childhood. GDM was not significantly associated with early childhood BMI trajectories (P>0.05). Compared with the independent effects of pre-pregnancy overweight/obesity (OR=1.90, 95%CI: 1.17-3.09) and excessive gestational weight gain (OR=1.45, 95%CI: 1.03-2.04), the risk of being in the high BMI trajectory in early childhood was greater when the two factors coexisted (OR=2.38, 95%CI: 1.60-3.54). However, both the multiplicative and additive models showed no interaction effect between pre-pregnancy overweight/obesity and excessive gestational weight gain. Conclusions: Maternal pre-pregnancy overweight/obesity and excessive gestational weight gain are independent risk factors for children being in the high BMI trajectory in early childhood, providing scientific evidence for obesity prevention.