Abstract
BackgroundApproximately 17% of children in the U.S. are obese. Children that are overweight or obese are also more likely to be obese as adults and suffer from various chronic diseases and premature death. Maternal obesity can affect the weight status of her offspring through intrauterine mechanisms like excessive gestational weight gain (GWG). Current literature shows a positive association between maternal weight status and GWG on child obesity, yet the direct and indirect effects have not been decomposed or quantified. The purpose of this study was to estimate the effect of maternal obesity on child obesity, mediated by GWG, which is a modifiable risk factor.MethodsThe study participants were a birth cohort of offspring from women who received prenatal care in the Duke/Durham Regional health care system in Durham, NC between 2005 and 2009. Anthropomorphic data was collected via electronic medical records (EMRs) during each voluntary visit to a health care facility. The exposure of interest was maternal obesity, measured by pre-pregnancy body mass index, the mediator was GWG, dichotomized into excessive and not excessive based on maternal prenatal BMI, and the outcome was child obesity at age 4, measured as BMI z-scores from the last recorded height and weight. A counterfactual theory-based product method analysis estimated the mediated effects of GWG, adjusted for maternal race, socioeconomic status, and smoking status.ResultsOf the 766 children, 25% were overweight or obese, and among all mothers, 25 and 31% were overweight and obese, respectively. Maternal BMI was associated with an overall increase of 0.04 in offspring z-score. The proportion of the effect of maternal obesity on child age 4 obesity mediated by GWG was 8.1%.ConclusionGWG, in part, mediated the relationship between maternal BMI and childhood adiposity. Even when the mediator is fixed, children are at an increased risk of a higher BMI if the mother is obese. These findings highlight an important public health education opportunity to stress the impact of a pre-pregnancy weight and excessive GWG on the risk of child obesity for all mothers.
Highlights
17% of children in the U.S are obese
Overall, elevated maternal pre-pregnancy Body Mass Index (BMI) increased the risk of offspring obesity [β = 0.04, 95% confidence interval (CI) (0.02, 0.06)]
The natural indirect effect (NIE) mediated through gestational weight gain (GWG) increased offspring BMI z-score by 0.02 [95% CI (0.003, 0.04)]
Summary
17% of children in the U.S are obese. Children that are overweight or obese are more likely to be obese as adults and suffer from various chronic diseases and premature death. Maternal obesity can affect the weight status of her offspring through intrauterine mechanisms like excessive gestational weight gain (GWG). The purpose of this study was to estimate the effect of maternal obesity on child obesity, mediated by GWG, which is a modifiable risk factor. Elevated birth weight negatively affects the offspring weight status trajectory into childhood and adolescence [13], where children with higher birth weights have a higher likelihood of becoming overweight or obese [14, 15]. Insulin resistance in overweight and obese women is further exaggerated which results in maternal hyperinsulinemia, hyperglycemia and GDM [17]. GDM is associated with an increased risk of overweight or obesity in offspring [18]. Obese women are still more likely to develop GDM [18]
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