Maternal Excessive Gestational Weight Gain Research Articles

A study of maternal and perinatal outcomes due to excessive maternal gestational weight gain in a district hospital in West Bengal – A cross-sectional study

Background: The weight gain that occurs in pregnancy has the potential to influence a woman’s long-term health by increasing the risk for weight retention and obesity, as well as related comorbidities such as chronic hypertension (HTN) or Type 2 diabetes mellitus. Aims and Objectives: The aim of the study was to study maternal and perinatal outcomes associated with excessive maternal gestational weight gain (GWG). Materials and Methods: The current study was a cross-sectional study conducted at the Department of Obstetrics and Gynecology, from October 2018 to October 2019. A total of 91 women attending the antenatal clinic of MR Bangur Hospital and getting admitted for delivery during the study period was considered as the study population. Medical records were maintained for variables of the mothers such as gestational diabetes mellitus (GDM), gestational HTN, pre-eclampsia, eclampsia, duration of labor, mode of delivery, indication of cesarean section, Postpartum hemorrhage, and perineal tears. coGuide v.0.01 used for statistical analysis. Results: There were majority of 55 (60.4%) participants reported 18.5–24.9 body mass index (BMI). The difference in the proportion of BMI across maternal weight gain was statistically significant. The difference in the proportion of GDM, duration of labor >18 h, and duration of the second stage of labor >2 h between maternal weight gain were statistically significant. The difference in the proportion of APGAR score at 1 min, and 5 min between groups of maternal weight gain was statistically significant. Conclusion: Our study suggested that GWG has to be achieved within the Institute of Medicine recommendation according to pre-pregnancy BMI to improve pregnancy outcomes and reduce maternal and perinatal adverse outcomes.

Maternal gestational weight gain and the long-term physical and neurological outcome of small for gestational age children: A 4-year real-world study based on a longitudinal cohort.

Globally, small for gestational age (SGA) is increasingly prevalent, paralleling the common high-risk pregnancies with inappropriate gestational weight gain (GWG). However, whether maternal GWG was associated with their SGA offspring's long-term development remained unresolved. To examine the associations of maternal GWG with the long-term physical and neurological development of SGA children based on a real-world cohort in our hospital. This retrospective cohort was conducted at our hospital between July 1, 2020, and December 2022. At baseline, we included 319 children diagnosed as SGA and followed up with these children for 12 to 48months (median: 29months). The primary outcomes were children's physical and neurological development at follow-ups which were grouped into those with inadequate, adequate, or excessive maternal GWG. We standardized the weight, height (length), body mass index, and ASQ-3 / ASQ:SE domain scores of children with different ages and genders into Z-scores to increase comparability. The adjusted odds ratio (OR) and its 95% confidence interval (CI) controlling for covariates were calculated using the Hosmer-Lemeshow test model to assess the risk of impaired neurodevelopment. Firstly, the birth weight and birth length of newborns in the inadequate GWG group were both smaller than those in the adequate GWG group and excessive GWG group. The proportions of severe SGA, neonatal respiratory distress syndrome, and bronchopulmonary dysplasia were higher in the inadequate GWG group compared to the adequate GWG group. Secondly, follow-up observations found that inadequate GWG group had significantly lower weight Z scores(0.12 vs 0.34), height Z scores(-0.11 vs 0.32)and high emaciation incidence (14.3% vs. 5.0%) compared to the adequate GWG group. Thirdly, in the follow-up of the neurodevelopment, children in the adequate GWG group had statistically higher Z scores in the gross motor, fine motor, problem-solving and personal-social domains compared to those in the inadequate GWG group and had statistically higher Z scores in the gross motor domain compared to those in the excessive GWG group; children in the excessive GWG group had statistically higher Z scores in the fine motor and personal-social domains compared to those in the inadequate GWG group. Inadequate GWG group was significantly correlated with a higher risk of delayed development in gross motor (OR 1.79, 95% CI 1.15-2.77), fine motor (OR 1.6, 95% CI 1.06-2.78), problem-solving (OR 2.08, 95% CI 1.16-3.56), personal-social (OR 1.51, 95% CI 1.05-2.18), and social-emotional (ASQ:SE) (OR 1.84, 95% CI 1.05-3.22) domains than adequate GWG group. Meanwhile, excessive GWG group was significantly correlated with a higher risk of delayed development in gross motor (OR 1.6, 95% CI 1.02-2.48) domain than adequate GWG group. Inappropriate maternal GWG (inadequate or excessive) may affect the long-term physical and neurological development of SGA infants. Pregnant women, especially those with intrauterine growth restriction, need to maintain reasonable GWG and receive close monitoring and timely interventions to improve SGA children' long-term outcomes.

Magnitude and Associated Factors of Gestational Excessive Weight Gain Among Pregnancy Women at St Paul’s Hospital, Addis Ababa, Ethiopia 2024, a Crosse-Sectional Study

<i>Background:</i> Women invariably gain weight during pregnancy due to fat deposition, fluid retention, and the weight attributed to the growth of the fetus, uterus, and breasts. Gestational weight gain can influence pregnancy outcomes as well as the long-term health of both the mother and child. It is reported that nearly 50 percent of mothers worldwide experience excessive weight gain during pregnancy. Suboptimal weight gain during pregnancy is also a recognized risk factor for adverse delivery outcomes. <i>Objective:</i> To assess the magnitude of excess maternal gestational weight gain and the associated factors influencing pregnancy complications among pregnant women at St. Paul’s Hospital, Addis Ababa, Ethiopia, in 2024. <i>Methods and Materials:</i> An institutional-based descriptive cross-sectional quantitative approach was used to conduct the study. Data were collected using both primary and secondary sources. Well-organized interviewer-administered questionnaires and a checklist were utilized. The sample size was determined using a single population formula Considering the proportion to be 50% to get the maximum possible sample size. A total of 422 mothers participated in the study, and a systematic random sampling technique was employed to select the study population. Data were collected, summarized, tabulated, and analyzed using the Statistical Package Epi-Info version 7 and SPSS version 26 software. Frequencies, proportions, and dispersions were estimated to describe the variables. Multivariate analysis was used to determine the association between explanatory variables and gestational weight gain. <i>Results:</i> A total of 422 pregnant mothers participated in the study, resulting in a 100% response rate. The majority, 201 (47.6%), were in the age group of 20 to 25 years, and 179 (42.4%) had delivered two children. Additionally, 112 (26.5%) ate more than four times per day, and 303 (71.8%) consumed carbohydrates daily. Of the participants, 375 (88.9%) gained adequate weight, 35 (8.3%) gained excessive weight, and 12 (2.8%) gained inadequate weight during their current pregnancy. Being employed and consuming fruits and vegetables were associated with a lower likelihood of excessive gestational weight gain, while high carbohydrate consumption was linked to a higher risk of excessive weight gain. <i>Conclusion and Recommendation: </i>A significant proportion of women (35%) gained excessive weight. Unemployment and daily carbohydrate and fruits consumption were significantly associated with excessive weight gain. Women of childbearing age should be informed about the importance of consuming fruits and vegetables and reducing carbohydrate intake during pregnancy to prevent excessive weight gain.

Developmental trajectories at a high risk for childhood overweight/obesity.

The associations between developmental patterns (trajectories) in children and maternal factors have been widely investigated, but paternal effects on these trajectories are unclear. This study aimed to determine children's and parental factors involved in developmental trajectories at a high risk for having adverse cardiovascular (CV) profiles in children. We analysed longitudinal anthropometric data from birth to present and CV profiles of 1832 healthy volunteers (51% girls) aged 3-15 years who participated in a nationwide study between July 2012 and January 2014. Six-trajectory latent class growth models were developed using body mass index Z-scores. Predictors for being in developmental trajectories at a high risk for adverse CV profiles were determined by multivariate regression analysis. The mean number of anthropometric data points was 12±3 for both boys and girls. Among the six trajectories, the infantile onset and continual increase groups had significantly worse levels of many CV profiles than those in the remaining groups. Paternal overweight/obesity was an independent predictor for boys being in the infantile onset group and for girls being in the continual increase group. Additionally, maternal pre-pregnancy overweight/obesity in boys and maternal excessive gestational weight gain in girls were independent predictors for being in the infantile onset group. Having no other sibling in boys and an older maternal age were independent predictors for being in the continual increase group. Interventions to prevent childhood obesity should include strategies that focus on fathers and mothers and those that focus on children with some familial backgrounds.

The roles of newborn anthropometrics in the association between maternal weight gain and childhood cardiovascular risks.

The aim was to study the association between newborn anthropometrics and childhood cardiovascular risks and whether newborn anthropometrics mediate the effect of maternal gestational weight gain (GWG) on childhood risks. Data of 926 mother-child dyads from the Hyperglycemia and Adverse Pregnancy Outcomes study were analyzed. Newborn anthropometrics were treated as predictors and mediators by using a regression model and causal mediation model, respectively. Newborn sum of skinfolds (SSF) was associated with childhood diastolic blood pressure (DBP) and pulse wave velocity (coefficients [95% CI]: 0.13 [0.06 to 0.20]; 0.08 [0.004 to 0.15]), whereas newborn ponderal index (PI) was inversely associated with childhood systolic blood pressure (SBP), DBP, and pulse wave velocity (-0.08 [-0.15 to -0.01]; -0.08 [-0.14 to -0.008]; -0.09 [-0.16 to -0.03]). Newborn SSF mediated the effects of maternal excessive GWG on childhood SSF and DBP (proportion of total effect 9% and 8%, respectively). In contrast, a significant negative mediation through newborn PI was found for the effect of maternal excessive GWG on childhood DBP (-8%) and its effect on childhood SBP through birth weight (-27%). Childhood cardiovascular risks are positively associated with newborn SSF but inversely associated with newborn PI. Newborn SSF mediates the impact of excessive maternal GWG on childhood BP, but birth weight and newborn PI negatively mediate it.

Effect of maternal hypertensive disorders during pregnancy on offspring's early childhood body weight: A population-based cohort study

ObjectiveThe prevalence of hypertensive disorder during pregnancy (HDP) and childhood obesity is increasing worldwide. HDP or obesity in mothers can increase the risk of overweight/obesity (OWOB) in their children. Few longitudinal studies have examined the associations of maternal body weight with the growth and risk factors for overweight in infants born to mothers with HDP. This study examined the risk factors for childhood OWOB through the age of 66 months in children born to mothers with HDP. Materials and methodsIn total, 24,200 pairs of mothers and their children were selected from the Taiwan Birth Cohort Study. The children's body weights were classified and analyzed to determine infant growth at birth and at the ages of 12, 24, 36, and 66 months. Multiple logistic regression analyses with different model settings were performed to identify the factors affecting growth and childhood OWOB in the children of mothers with HDP. ResultsThe average birth weight of children was lower in the HDP group than in the non-HDP group. The catch-up phenomenon began at the age of 18 months. The incidence of OWOB was higher in the children in the HDP group than in those in the non-HDP group from the age of 24 months and increased with the children's age. At every age point, maternal overweight before pregnancy was the main risk factor for childhood OWOB, and this effect increased with the children's age (odds ratio [OR]: 1.83 at 66 months). The effect of excessive maternal gestational weight gain on childhood OWOB was significant (OR: 1.26–1.44 for various age points). ConclusionMaternal overweight is the main risk factor for OWOB in children born to mothers with HDP. After adjusting for related confounders, we determined that HDP did not exert a significant effect on the risk of childhood OWOB.

Body Composition in Preschool Children and the Association With Prepregnancy Weight and Gestational Weight Gain: An Ambispective Cohort Study.

ObjectiveTo describe the body composition in preschool children and to evaluate the association with prepregnancy BMI and gestational weight gain (GWG).MethodsChildren were recruited in their first year in kindergarten (3 years old) and followed up for the next 2 years. Information during pregnancy and birth was retrieved from medical records. Height, weight, fat mass, fat-free mass, and percentage of body fat (FM%) were measured through a bioelectrical impedance analysis for each child visit, and BMI, fat mass index (FMI), and fat-free mass index (FFMI) were calculated. Generalized linear mixed models (GLMMs) were used to evaluate the associations between prepregnancy weight, GWG, and adiposity indicators.ResultsA total of 3,329 single-birth 3-year-old children were recruited as the baseline population and were followed at 4 and 5 years old. During the 3 years of follow-up, the mean (±SD) values of BMI, FMI, FFMI, and FM% of the children were 15.6 (±1.6) kg/m2, 2.8 (±1.3) kg/m2, 12.8 (±0.7) kg/m2, and 17.2% (±5.8%), respectively. The prevalence rates of overweight and obesity in mothers before pregnancy were 16.6 and 3.2%, respectively. Mothers were divided into three groups based on GWG: appropriate (1,233, 37.0%), excessive (767, 23.0%), and insufficient (1,329, 39.9%). GLMMs analyses showed that the preschool children’s BMI, FMI, FFMI, and FM% were all significantly positively related to maternal prepregnancy BMI and GWG (all P < 0.001); the children of mothers who were overweight/obese before pregnancy were more likely to be overweight/obese, high FMI, high FFMI, and high FM% at preschool age (all P < 0.001); although maternal excessive GWG was not correlated with offspring’s overweight/obese (P = 0.156), the children of mothers with excessive GWG are more likely to have higher FMI, but not to be with a higher FFMI status than the children of mothers with appropriate GWG. For prepregnancy overweight/obese women, compared with the GWG-appropriate group, maternal excessive GWG was related to the risk of high FMI (coefficient = 0.388, 95% CI: 0.129–0.647) and high FM% (coefficient = 0.352, 95% CI: 0.097–0.607), but was not related to the risk of overweight/obese or high FFMI of the offspring at preschool age.ConclusionFat mass index decreased with age, while FFMI increased with age among 3- to 5-year-old children. It is necessary to optimize maternal weight prior to conception and GWG management to improve the health outcomes of the offspring.

Maternal pre-pregnancy body mass index, gestational weight gain, and pubertal timing in daughters: A systematic review and meta-analysis of cohort studies.

The timing of daughter's puberty onset is constantly earlier. It is still unclear about the maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) as important prenatal factors that may affect offspring's onset of puberty. Thus, we evaluated the association among maternal pre-pregnancy BMI, GWG, and daughters' early pubertal development based on the existing literature. Literature review was conducted in different databases, including Web of Science, Pubmed, Wiley, ScienceDirect, Web of Science, and Chinese National Knowledge Infrastructure databases up to June 2021. We selected random effects model or fixed effects model for meta-analysis according to the I2 statistics value to obtain the summary measurement. A total of 12 cohort studies were included. Compared to maternal pre-pregnancy normal weight, maternal pre-pregnancy overall overweight/obesity (RR = 1.24; 95% CI 1.17 to 1.32), obesity (RR = 1.35; 95% CI 1.23 to 1.48), and overweight (RR = 1.17; 95% CI 1.09 to 1.26) were significantly associated with the increased risk of earlier timing of pubertal onset in daughters. Daughters born of mothers with pre-pregnancy overall overweight/obesity, obesity, and overweight had earlier pubertal onset compared to those born of mothers with normal weight ([mean difference = -3.03, 95% CI: -3.97 to -2.10], [mean difference = -3.50, 95% CI: -5.38 to -1.62], and [mean difference = -2.89, 95% CI: -4.07 to -1.71], respectively). The effects were also significant in the assessed three milestones (menarche, breast development, and pubic hair development). Maternal excessive GWG increased the risk of early pubertal timing in daughters (RR = 1.19; 95% CI 1.09 to 1.30).

Contribution of Excessive Gestational Weight Gain to the Increased Risk of Autism Spectrum Disorder Occurrence in Offspring

Background: According to epidemiological studies, the number of children affected by autism spectrum disorder (ASD) has elevated notably in recent years, which increases the importance of identifying and controlling modifiable risk factors of ASD. Aim: We aim to explore the association of maternal gestational weight gain (GWG) with the risk of ASD in offspring. Methods: This case-control study was conducted in Tabriz, Iran, from October 2019 to July 2020. Data of 426 children (208 with ASD and 218 healthy) were collected using medical records and face-to-face interviews with their mothers. Results: Maternal GWG was significantly higher in the ASD group ( P = .002). The percentage of inadequate (3.4% vs 0.5%) and excess (85.6% vs 56.0%) GWG was significantly higher in the ASD group ( P &lt; .001). Maternal ( P &lt; .001) and paternal ( P = .004) ages were significantly lower in the ASD group compared with the healthy group. Boys were shown to be more affected by ASD than girls ( P &lt; .001). Results of multivariate regression indicated that maternal GWG [OR (95% CI): 1.10 (1.03, 1.19), P = .005], gestational age [OR (95% CI): 1.21 (1.05, 1.41), P= .009], maternal age [OR (95% CI): 0.82 (0.73, 0.91), P &lt; .001], child male sex [OR (95% CI): 3.82 (2.31, 6.30), P &lt; .001], and low education of father [OR (95% CI): 4.96 (1.56, 15.72), P = .006] were independently associated with increased risk of ASD. Conclusion: The results indicate that maternal excessive GWG, maternal and gestational age, parental low education level, and male sex of infant may independently increase the risk of ASD in offspring.

Association of Maternal Gestational Weight Gain With Left Ventricle Geometry and Function in Offspring at 4 Years of Age: A Prospective Birth Cohort Study.

Background: Maternal gestational weight gain (GWG) may be associated with cardiovascular diseases in the offspring from childhood to adulthood. We aimed to investigate the association between maternal GWG and the left ventricle (LV) geometry and function in the offspring, and explore the influence of the intrauterine environment on early childhood cardiac change.Methods: Data of 981 mother-offspring pairs from the Shanghai Birth Cohort was used. Maternal pre-pregnancy weight and height, weight in the first trimester (≤ 12 weeks), and before delivery were measured. The echocardiography, blood pressure, and anthropometry assessment were evaluated in the offspring at 4 years of age.Results: Interventricular septal thickness during diastole had a significantly positive correlation with total GWG [β = 0.009, (0.001, 0.017)]. In the second and third trimesters, LV mass index [β = 0.149, (0.015,0.282)], interventricular septal thickness in systole [β = 0.027, (0.011,0.043)], and in diastole [β = 0.014, (0.005,0.023)] were positively associated with GWG. The risks of eccentric [OR = 1.115, (1.232, 1.010)] and concentric hypertrophy [OR = 1.133, (1.259,1.018)] increased with the elevation of maternal GWG.Conclusions: This study suggested that the excessive maternal GWG was associated with the thickening of the interventricular septum in the offspring, especially during the second and third trimesters. Excessive GWG in the second and third trimesters was a risk factor for LV eccentric and concentric hypertrophy in the offspring.

Maternal excessive gestational weight gain as a risk factor for autism spectrum disorder in offspring: a systematic review

BackgroundAbnormal gestational weight gain (GWG) is a prenatal complication that may contribute to long-term behavioral and neurodevelopmental differences in offspring. This systematic review summarizes research on the association between maternal GWG and risk of autism spectrum disorder (ASD) in offspring.MethodsGoogle and electronic databases, including PubMed, SCOPUS, Embase, Cochrane Library and Google Scholar, were searched for original human studies published in English through June 2020. Articles that examined the association between GWG and risk of ASD in offspring were included. Duplicate and irrelevant studies were removed; and data were obtained through critical analysis.ResultsOf 96 articles searched, eight studies were included in the final review. All studies (n = 7) investigating the association of maternal excessive GWG with risk of ASD in offspring indicated that high GWG was independently associated with an increased risk of ASD. Of five studies investigating the association of inadequate GWG with the risk of ASD, four indicated that low GWG was not associated with an increased risk of ASD. Of seven studies examining the association of maternal pre-pregnancy BMI or weight with the risk of ASD, five reported that maternal pre-pregnancy BMI or weight did not appear to be independently associated with risk of ASD. The GWG-ASD association is independent of maternal BMI and child’s intellectual disability, but offspring’s genetic susceptibility connection to the GWG-ASD association remains a topic of debate.ConclusionsThe findings suggest that maternal excessive GWG may be associated with increased risk of ASD in offspring. However, insufficient GWG does not appear to have such association.

Attenuating Pregnancy Weight Gain-What Works and Why: A Systematic Review and Meta-Analysis.

Excessive maternal gestational weight gain (GWG) contributes to generational obesity. Our aim was to explore efficacy and intervention characteristics (trimester, duration, frequency, intensity, and delivery method) of interventions to prevent excessive GWG. CINAHL, Cochrane, EMBASE, LILACS, MEDLINE, PsycINFO, and Scopus were searched up to May 2018 (no date or language restrictions). Keywords and MeSH terms for diet, GWG, intervention, lifestyle, maternal, physical activity, and pregnancy were used to locate randomized-controlled trials (RCTs). The Cochrane Collaboration tool for assessing risk of bias was applied. Eighty-nine RCTs were included. Meta-analysis (60 trials) estimated that women in diet only (WMD: −3.27; 95% CI: −4.96, −1.58, p < 0.01), physical activity (PA) (WMD: −1.02; 95% CI: −1.56, −0.49, p < 0.01), and lifestyle interventions (combining diet and PA) (WMD: −0.84; 95% CI: −1.29, −0.39, p < 0.01) gained significantly less weight than controls. The three eHealth interventions favored neither intervention nor control (WMD: −1.06; 95% CI: −4.13, 2.00, p = 0.50). Meta-regression demonstrated no optimal duration, frequency, intensity, setting, or diet type. Traditional face to face delivery of weight management interventions during pregnancy can be successful. Delivery via eHealth has potential to extend its reach to younger women but needs further evaluation of its success.

Self-monitoring Lifestyle Behavior in Overweight and Obese Pregnant Women: Qualitative Findings.

Excessive maternal gestational weight gain increases pregnancy and infant complications. Self-monitoring has been shown to be an effective strategy in weight management. Literature, however, is limited in describing pregnant women's engagement in self-monitoring. This qualitative study explored the experiences of overweight and obese pregnant women who self-monitored their eating, walking, and weight as participants in an intervention for excessive gestational weight gain prevention. Thirteen overweight and obese pregnant women participated in semistructured interviews. Reflexive iteration data analysis was conducted. Five themes were identified: making self-monitoring a habit, strategies for self-monitoring, barriers to self-monitoring, benefits of self-monitoring, and drawbacks of self-monitoring. The women viewed self-monitoring as a "habit" that could foster a sense of self-control and mindfulness. Visual or tracing aids were used to maintain the self-monitoring habit. Forgetting, defective tracking aids, complexities of food monitoring, and life events could impede self-monitoring. Being unable to keep up with self-monitoring or to achieve goals created stress. Self-monitoring is a promising approach to weight management for overweight and obese pregnant women. However, healthcare providers should be aware that, although women may identify several benefits to self-monitoring, for some women, consistently trying to track their behaviors is stressful.

Perinatal and lifestyle factors mediate the association between maternal education and preschool children's weight status: the ToyBox study.

This study aimed to explore the associations among perinatal, sociodemographic, and behavioral factors and preschool overweight/obesity. Data were collected from 7541 European preschoolers in May/June 2012. Children's anthropometrics were measured, and parents self-reported all other data via questionnaires. Level of statistical significance was set at P ≤ 0.05. Certain perinatal factors (i.e., maternal prepregnancy overweight/obesity, maternal excess gestational weight gain, excess birth weight, and "rapid growth velocity"), children's energy balance-related behaviors (i.e., high sugar-sweetened beverage consumption, increased screen time, reduced active-play time), family sociodemographic characteristics (i.e., Eastern or Southern Europe, low maternal and paternal education), and parental overweight/obesity were identified as correlates of preschoolers' overweight/obesity. Furthermore, maternal prepregnancy overweight/obesity, children's "rapid growth velocity," and increased screen time mediated by 21.2%, 12.5%, and 5.7%, respectively, the association between maternal education and preschoolers' body mass index. This study highlighted positive associations of preschooler's overweight/obesity with excess maternal prepregnancy and gestational weight gain, excess birth weight and "rapid growth velocity," Southern or Eastern European region, and parental overweight/obesity. Moreover, maternal prepregnancy overweight/obesity, children's "rapid growth velocity," and increased screen time partially mediated the association between maternal education and preschoolers' body mass index. The findings of the present study may support childhood obesity prevention initiatives, because vulnerable population groups and most specifically low-educated families should be prioritized. Among other fields, these intervention initiatives should also focus on the importance of normal prepregnancy maternal weight status, normal growth velocity during infancy, and retaining preschool children's screen time within recommendations.

Modifiable risk factors in the first 1000 days for subsequent risk of childhood overweight in an Asian cohort: significance of parental overweight status.

Many studies have identified early-life risk factors for subsequent childhood overweight/obesity, but few have evaluated how they combine to influence risk of childhood overweight/obesity. We examined associations, individually and in combination, of potentially modifiable risk factors in the first 1000 days after conception with childhood adiposity and risk of overweight/obesity in an Asian cohort. Six risk factors were examined: maternal pre-pregnancy overweight/obesity (body mass index (BMI) ⩾25 kg m-2), paternal overweight/obesity at 24 months post delivery, maternal excessive gestational weight gain, raised maternal fasting glucose during pregnancy (⩾5.1 mmol l-1), breastfeeding duration <4 months and early introduction of solid foods (<4 months). Associations between number of risk factors and adiposity measures (BMI, waist-to-height ratio (WHtR), sum of skinfolds (SSFs), fat mass index (FMI) and overweight/obesity) at 48 months were assessed using multivariable regression models. Of 858 children followed up at 48 months, 172 (19%) had none, 274 (32%) had 1, 244 (29%) had 2, 126 (15%) had 3 and 42 (5%) had ⩾4 risk factors. Adjusting for confounders, significant graded positive associations were observed between number of risk factors and adiposity outcomes at 48 months. Compared with children with no risk factors, those with four or more risk factors had s.d. unit increases of 0.78 (95% confidence interval 0.41-1.15) for BMI, 0.79 (0.41-1.16) for WHtR, 0.46 (0.06-0.83) for SSF and 0.67 (0.07-1.27) for FMI. The adjusted relative risk of overweight/obesity in children with four or more risk factors was 11.1(2.5-49.1) compared with children with no risk factors. Children exposed to maternal pre-pregnancy (11.8(9.8-13.8)%) or paternal overweight status (10.6(9.6-11.6)%) had the largest individual predicted probability of child overweight/obesity. Early-life risk factors added cumulatively to increase childhood adiposity and risk of overweight/obesity. Early-life and preconception intervention programmes may be more effective in preventing overweight/obesity if they concurrently address these multiple modifiable risk factors.

P 45 Does apolipoprotein B (apo B) level in early pregnancy predict excessive gestational weight gain and adverse pregnancy outcome?

Introduction Excessive maternal gestational weight gain (GWG) is a risk factor for several maternal and fetal complications. Lipid metabolism like apo B is linked to obesity and maintenance of pregnancy via placental cholesterol uptake and steroid hormone production. Additionally, evidence is increasing that apo B containing lipoproteins directly influence angiogenesis via modulation of the VEGF-receptor 1. Maternal ApoB levels are associated with adverse outcome of pregnancy e. g. in preeclampsia and IUGR at onset of the disease. Objectives The hypothesis of the study was that apo B level early in pregnancy are associated with excessive GWG and predictive for adverse outcomes. Material and methods A retrospective study, including 547 pregnant women, was conducted. According to IOM recommendations on GWG, there were 95 women with inadequate GWG, 171 with adequate GWG and 281 with excessive GWG. Apo B levels from early pregnancy serum samples were measured by ELISA. The Kruskal–Wallis-test was used in order to compare the apo B levels between the three GWG groups. Apo B levels were also assessed for the prediction of adverse pregnancy outcomes like SGA/ IUGR and hypertension. Results There was no significant difference in apo B levels between the different GWG groups. Compared to the women with adequate GWG neither women with inadequate GWG had differing apo B levels (p = 0,6135) nor had women with excessive GWG (p = 0,0515). We found significant higher levels of apoB in overweight and obese patients as compared to normal BMI (p Conclusions Apo B cannot be used as a marker for identifying the risk of excessive GWG or adverse pregnancy outcomes early in pregnancy and therefore remains differential only in later stages of gestation.

Effects of an antenatal lifestyle intervention on offspring obesity - a 5-year follow-up of a randomized controlled trial.

Strategies to limit excessive maternal gestational weight gain could also have positive health effects for the offspring. This study informs us on the effect of an antenatal lifestyle intervention on offspring body mass index (BMI) trajectory until age five. A secondary analysis of a randomized controlled trial aimed at reducing gestational weight gain, set in Ørebro, Sweden (Clinical Trials.gov Id NCT00451425). Offspring were followed with standardized measures of weight and height until age five. Mean BMI z-score and proportion (%) of over- and undernutrition (BMI z-score > ± 2 standard deviations) was compared between groups. Risk estimates for obesity at age five were analyzed in relation to maternal gestational weight gain and prepregnancy BMI as a secondary outcome. We analyzed 374 children at birth and 300 at age five. No significant difference in mean BMI z-score was seen at birth (0.68 (I) vs 0.56 (C), p = 0.242) or at age five (0.34 (I) vs 0.26 (C), p = 0.510) and no significant difference in proportion of over- or undernutrition was seen. Excessive maternal gestational weight gain was an independent risk factor for offspring obesity at birth (OR = 4.51, p < 0.001) but not at age five. Maternal obesity was an independent risk factor for offspring obesity at age five (OR = 4.81, p = 0.006). Our composite antenatal lifestyle intervention did not significantly reduce the risk of obesity in offspring up until age five.

Maternal and cord blood fatty acid patterns with excessive gestational weight gain and neonatal macrosomia.

This study evaluated the association of maternal excessive gestational weight gain with saturated and polyunsaturated fatty acid concentrations in maternal and cord serum. We included 77 pairs of women and their newborns and classified them into three groups as follows: mothers with normal gestational weight gain and their babies with normal birth weight in group I (30 pairs), mothers with excessive gestational weight gain and their babies with normal birth weight in group II (30 pairs), and mothers with excessive gestational weight gain and their macrosomic babies in group III (17 pairs). Serum fatty acid concentrations were determined through gas chromatography-mass spectrometry. No remarkable difference in maternal dietary intake was observed among the three groups. C16:0, C18:0, eicosapentaenoic acid, and docosahexaenoic acid concentrations were significantly higher in group III mothers than in group I mothers. Compared with group I neonates, total saturated and polyunsaturated fatty acid concentrations were significantly lower but total n-3 polyunsaturated fatty acid and docosahexaenoic acid concentrations were significantly higher in group II neonates (p<0.05). The n-6: n-3 ratio in maternal and cord serum was approximately 10:1 and 1.5:1, respectively. Women with excessive gestational weight gain who deliver a macrocosmic neonate tend to have higher total saturated fatty acid concentrations but lower docosahexaenoic acid concentrations in their neonate cord serum. Fatty acid concentrations in maternal and cord serum are not associated with maternal dietary pattern.

Maternal excess gestational weight gain and infant waist circumference: a 2-y observational study.

The purpose of this study was to examine the effects of gestational weight gain (GWG) and infant feeding practices on infant growth parameters in infants from 6 to 24 mo of age. Forty mother-infant pairs were recruited after delivery and followed up to 24 mo postpartum. GWG was calculated as prepregnancy weight subtracted from weight at delivery. Infant weight velocity was calculated as the change in weight between consecutive visits divided by the intervening time. Infant feeding practices were measured by interview and infant growth and waist circumference by standard anthropometry. Infants born to mothers with excess GWG were heavier at birth (3,521 ± 91 vs. 3,196 ± 97 g, P = 0.02) and had an average 2.16 ± 1.1 cm (P = 0.03) larger waist circumference throughout the 24 mo compared with infants born to mothers with appropriate GWG. Waist circumference increased by 0.12 and 2.0 cm for every 1 unit increase in GWG and infant birth weight. Infants born to women who exceeded the Institute of Medicine (IOM)-recommended guidelines for GWG were heavier at birth and had a significantly higher waist circumference up to 2 y of age. Strategies to control maternal excess GWG and thus the outcome on infant birth weight and waist circumference should be pursued.

Windows of Opportunity for Lifestyle Interventions to Prevent Gestational Diabetes Mellitus.

Gestational diabetes mellitus (GDM) is linked with several acute maternal health risks and long-term development of type 2 diabetes, metabolic syndrome, and cardiovascular disease. Intrauterine exposure to GDM similarly increases offspring risk of early-life health complications and later disease. GDM recurrence is common, affecting 40 to 73% of women, and augments associated maternal/fetal/child health risks. Modifiable and independent risk factors for GDM include maternal excessive gestational weight gain and prepregnancy overweight and obesity. Lifestyle interventions that target diet, activity, and behavioral strategies can effectively modify body weight. Randomized clinical trials testing the effects of lifestyle interventions during pregnancy to reduce excessive gestational weight gain have generally shown mixed effects on reducing GDM incidence. Trials testing the effects of postpartum lifestyle interventions among women with a history of GDM have shown reduced incidence of diabetes and improved cardiovascular disease risk factors. However, the long-term effects of interpregnancy or prepregnancy lifestyle interventions on subsequent GDM remain unknown. Future adequately powered and well-controlled clinical trials are needed to determine the effects of lifestyle interventions to prevent GDM and identify pathways to effectively reach reproductive-aged women across all levels of society, before, during, and after pregnancy.