Risk Of Overweight In Offspring Research Articles

Maternal weight and its association with risk of overweight in offspring: a trajectory analysis from a birth cohort in China.

Most studies on the association of maternal pregnancy weight with offspring weight trajectory have a short follow-up time. This study aimed to explore the associations of maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) with childhood weight trajectories in a 7-year birth cohort. A total of 946 mother-child pairs (467 boys and 479 girls) from a longitudinal birth cohort in TianjinCity, China, were included in this study, ranging from pregnancy to offspring at 7years. The outcome variable was defined as overweight or not overweight in offspring at the last round. A group-based trajectory model was applied to identify childhood BMI trajectory groups. Five discrete BMI trajectory groups were identified and characterized as constant underweight (25.2%), constant normal weight (42.8%), and high or increasing trajectory [at risk of overweight (16.9%), progressive overweight (11.0%) and progressive obesity (4.1%)]. Maternal prepregnancy overweight was associated with 1.72 (95% CI 1.14-2.60, P = 0.01) to 4.02 (95% CI 1.94-8.36, P < 0.001) times the risk of all high or increasing trajectory groups, and excessive GWG was related to groups at risk of overweight [relative risk ratio (RRR) 2.09, 95% CI 1.27-3.46, P = 0.004] and progressive obesity (RRR 3.33, 95% CI 1.13-9.79, P = 0.029). Children in all high or increasing trajectory groups were associated with greater overweight risk at the last round [risk ratios (RRs) ranged from 3.54 (95% CI 2.53-4.95, P < 0.001) to 6.18 (95% CI 4.05-9.42, P < 0.001)]. Maternal prepregnancy overweight and excessive gestational weight gain were associated with increasing or high-level childhood body mass index trajectories as well as a greater risk of overweight at 7 years.

Parental exposure to famine in early life and child overweight in offspring in Chinese populations

Little is known about the transgenerational effect of nutrition deficiency in early life. This study aimed to evaluate the associations of fetal and childhood exposure to famine of parents with their offspring's risk of overweight during childhood. This analysis included a total of 3734 participants of the China Health and Nutrition Survey aged 1-17 years whose fathers and/or mothers were born in 1955-1966. These children were classified into subgroups according to parental famine exposure status (unexposed and exposed) and timing (fetal-exposed and childhood-exposed). Random effects models were applied to evaluate the associations of parental famine exposure with body mass index (BMI) and overweight of offspring. Fractional polynomial functions were adopted to describe trajectories of BMI against age. Compared with children of unexposed parents, there was a lower risk of overweight among offspring of childhood-exposed fathers [OR (95%CI): 0.80 (0.61, 1.04)] or exposed parents [0.84 (0.68, 1.04)], particularly among male offspring, but not among those with exposed mothers only [0.98 (0.65, 1.47)]. For BMI, children with exposed mothers only had a slightly higher BMI [β(95%CI): 0.17 (-0.15, 0.49)], while those with exposed fathers only had no difference [-0.02 (-0.23, 0.19)] or exposed parents had a slightly lower BMI [-0.17 (-0.33, 0.00)] (p<0.05 for interaction between maternal and paternal exposures). Stratified analysis showed little heterogeneity between male and female offspring, but the association between paternal childhood exposure to famine and lower overweight risk in offspring was more evident in high (vs low) paternal education group (p for interaction< 0.05). The transgenerational associations of early-life exposure to famine with lower risks of child overweight may be via the paternal line and differ by the educational levels of parents. Further studies are warranted to confirm the results and reveal the biological mechanisms underlying.

Association between gestational weight gain and risk of overweight at 3 years old: The Japan Environment and Children's Study.

It is unclear if gestational weight gain (GWG) increases the risk of children with overweight. We examined the association between GWG and the risk of overweight in 3-year-old children in the Japanese nationwide birth cohort study. Among 64 336 singleton births, we calculated the risk ratios (RRs) and 95% confidence intervals (95% CIs) of the association between GWG categories and children with overweight, following an adjustment of the confounding variables. GWG was positively associated with the risk of overweight among 3-year-old children. The multivariable RR (95% CI) was 1.21 (1.17-1.25) per 5kg increase of the GWG. The multivariable RR (95% CI) for excessive GWG was 1.20 (1.12-1.28) and 1.27 (1.16-1.39) based on the modified Japanese and IOM criteria, respectively, compared to adequate GWG. The multivariable RR (95% CI) of overweight with children for inadequate versus adequate GWG was 0.83 (0.78-0.88) and 0.84 (0.79-0.89) based on the modified Japanese and IOM criteria, respectively. GWG was positively associated with a high risk of overweight at 3 years of age. The risk of offspring overweight was 20%-27% higher and 16%-17% lower with excessive GWG and inadequate GWG, respectively, compared to adequate GWG, based on the aforementioned criteria.

Risks of overweight in the offspring of women with gestational diabetes at different developmental stages: A meta-analysis with more than half a million offspring.

We conducted a meta-analysis to evaluate the association of maternal gestational diabetes mellitus (GDM) and offspring overweight from birth to adulthood, and to assess the effects of lifestyle interventions in women with GDM on this risk of offspring overweight. We identified literature from PubMed and 12 other electronic databases and retrieved relevant literature published before October 20, 2020. Random-effects model analysis was used to calculate relative risks (RRs) of overweight and weighted mean differences of body mass index among children stratified into different developmental stages. Forty-nine cohort studies (n = 559,377) and four randomized controlled trials (n = 1277) were included. We found that offspring of women with GDM were at an increased risk for overweight with age, from 1.14 (95% confidence interval [CI]: 1.06-1.22) under 5 years, 1.37 (95% CI: 1.31-1.44) at 5 to <10 years, 2.00 (95% CI: 1.79-2.23) at 10 to <18 years, to 2.05 (95% CI: 1.65-2.55) over 18 years of age (p < 0.05 for differences among groups). However, it was not observed that lifestyle interventions for GDM decreased the elevated overweight risk (RR: 0.94, 95% CI: 0.80-1.11, I2 = 0.0%). These findings highlight the need for adopting an active and healthy lifestyle in this high-risk group.

Maternal fatty acid intake during pregnancy and the development of childhood overweight: a birth cohort study.

Maternal diet during pregnancy may contribute to the risk of offspring adiposity. The objective of the study is to explore the associations between maternal antenatal dietary fatty acid intake and the risk of offspring overweight and obesity at the ages of 2 to 7 years. In a prospective Finnish birth cohort with 3807 mother-child pairs, maternal diet in late pregnancy was assessed with a food frequency questionnaire. Intakes of total fatty acids and individual saturated, monounsaturated and polyunsaturated fatty acids (PUFAs) were calculated. Generalized estimating equation models were used to study the associations of maternal dietary variables with repeatedly measured offspring overweight and obesity. In girls, maternal intake ratio of n-6:n-3 PUFAs had a U-shaped association with obesity (adjusted OR for the lowest 2.0 [95% CI 1.27-3.20] and the highest 1.7 [1.03-2.73] vs. the two middle quartiles of n-6:n-3 PUFAs, p = 0.01). In boys, arachidonic acid (20:4n-6): docosahexaenoic acid + eicosapentaenoic acid ratio was associated with obesity (adjusted OR for the lowest 1.0 [0.60-1.57] and the highest 0.5 [0.26-0.88] vs. the two middle quartiles, p = 0.02). Saturated fatty acids and monounsaturated fatty acids were not associated with overweight or obesity in either sex. Maternal intakes of PUFAs in late pregnancy were associated with risk of later obesity differently in girls and boys.

Caesarean delivery and the risk of offspring overweight and obesity over the life course: a systematic review and bias-adjusted meta-analysis.

A causal role of Caesarean delivery (CD) on developing overweight and obesity in the life course of offspring has been postulated. However, the true strength of this association is not clear and the potential for confounding has not been adequately addressed. A systematic review and meta-analysis were conducted to evaluate the strength of this association, this time using a bias-adjusted model in addition to conventional methods. Our search yielded 32 estimates from 14 publications (n = 261,000) for meta-analysis. The pooled analysis of seven estimates (n = 194,463) demonstrated a trend only towards a risk increase (RR = 1.15; 95% CI:0.94, 1.40) in overweight and obesity combined (ow+ob) due to CD in early childhood (0-5 years) and a similar trend was observed for mid-childhood and adolescence (5-18 years). In adulthood, a moderate increase in risk for ow+ob due to CD was observed (n = 30,200) (RR = 1.28; 95% CI 1.02, 1.34). Results for obesity and overweight separately were stronger for obesity and demonstrated a decreasing effect across the three life stages. Conventional methods of analysis suggested less uncertainty than we report and publication bias assessment was strongly suggestive of a bias in favour of positive studies. The current analysis therefore suggests that the small effects seen with CD in this and previous meta-analyses are probably a cumulative consequence of several biases we have outlined, including confounding effect and publication bias.

Fetal programming of overweight through the microbiome: boys are disproportionately affected.

Maternal and childhood obesity in pregnancy are worrisome public health issues facing our world today. New gene sequencing methods have advanced our knowledge of the disruptive effect of birth interventions and postnatal exposures on the maturation of gut microbiota and immunity during infancy. Yet, little is known about the impact of maternal pregnancy overweight on gut microbes and related processes, and how this may affect overweight risk in offspring. To address this gap in knowledge, we surveyed human studies for evidence in children, infants and pregnant women to piece together the limited literature and generate hypotheses for future investigation. From this literature, we learned that higher Lactobacillus yet lower Bacteroides spp. colonization of gut microbiota within 3 months of birth predicted risk for infant and child overweight. The abundance of bifidobacteria and staphylococci also appeared to play a role in the association with overweight, as did infant fecal immunoglobulin A levels, glycoproteins of the gut immune system that are acquired from breast milk and produced by the infant. We proposed that pregnancy overweight influences the compositional structure of gut microbiota in infants through vertical transfer of microbiota and/or their metabolites during pregnancy, delivery and breastfeeding. Finally, we brought forward emerging evidence on sex dimorphism, as well as ethnic and geographic variation, in reported associations between maternal overweight-induced gut microbiota dysbiosis and overweight risk.

Maternal protein intake during pregnancy and offspring overweight 20 y later

Animal studies have shown that protein intake in pregnancy may influence offspring fat metabolism and adiposity. The macronutrient ratio in human pregnancy appears to be important for offspring glucose tolerance; however, less is known about the influence on offspring adiposity. We examined the relation between maternal dietary protein intake during pregnancy and offspring anthropometric measures and biomarkers of adiposity and glucose metabolism. We used a prospective cohort of 965 Danish pregnant women recruited in 1988-1989 with offspring follow-up at 19-21 y. Macronutrient intake was collected in gestational week 30, and we divided protein according to its source (animal and vegetable including cereals). Offspring body mass index (BMI; in kg/m(2)) and waist circumference were recorded at follow-up (n = 695-697), and biomarkers were quantified in a subset (n = 443) of participants. We used multivariable linear and log-binomial regression to calculate effect estimates and 95% CIs for a 1:1-g substitution of carbohydrates for protein. Offspring mean (±SD) BMI was 22.1 ± 3.3 and 22.8 ± 2.9 for women and men, respectively. The prevalence of overweight (BMI ≥25) was 16.9% for women and 19.1% for men. We showed that a 1:1-g substitution of animal protein for carbohydrates increased risk of BMI ≥25 in female [quartile 4 compared with quartile 1: risk ratio (RR): 3.36; 95% CI: 1.52, 7.42] and male (quartile 4 compared with quartile 1: RR: 2.22; 95% CI: 0.92, 5.35) offspring. These results appeared to be accounted for by protein from meat sources. The results could not be explained by postnatal risk factors. Protein from animal sources, primarily meat products, consumed during pregnancy may increase risk of overweight in offspring; this association appeared to be stronger for female offspring. Because of the lack of information on postnatal exposure in this cohort, these results are hypothesis-generating and need to be replicated in other cohorts.

Deficit of vitamin D in pregnancy and growth and overweight in the offspring.

Maternal vitamin D status during fetal development may influence offspring growth and risk of obesity; however, evidence in humans is limited. To investigate whether maternal circulating 25-hydroxyvitamin D3 (25(OH)D3) concentration in pregnancy is associated with offspring prenatal and postnatal growth and overweight. Plasma 25(OH)D3 concentration was measured in pregnant women (median weeks of gestation 14.0, range 13.0-15.0) from the INMA (INfancia y Medio Ambiente) cohort (Spain, 2003-2008) (n = 2358). Offspring femur length (FL), biparietal diameter (BPD), abdominal circumference (AC) and estimated fetal weight (EFW) were evaluated at 12, 20 and 34 weeks of gestation by ultrasound examinations. Fetal overweight was defined either as AC or as EFW ⩾ 90th percentile. Child's anthropometry was recorded at ages 1 and 4 years. Rapid growth was defined as a weight gain z-score of >0.67 from birth to ages 6 months and 1 year. Age- and sex-specific z-scores for body mass index (BMI) were calculated at ages 1 and 4 years (World Health Organization referent); infant's overweight was defined as a BMI z-score ⩾ 85th percentile. We found no association of maternal 25(OH)D3 concentration with FL and a weak inverse association with BPD at 34 weeks. Maternal deficit of 25(OH)D3 (<20 ng ml(-1)) was associated with increased risk of fetal overweight defined as AC ⩾ 90th percentile (odds ratio (OR) = 1.50, 95% confidence interval (CI): 1.01-2.21; P = 0.041) or either as EFW ⩾ 90th percentile (OR = 1.47, 95% CI: 1.00-2.16; P = 0.046). No significant associations were found with rapid growth. Deficit of 25(OH)D3 in pregnancy was associated with an increased risk of overweight in offspring at age 1 year (OR = 1.42, 95% CI: 1.02-1.97; P = 0.039); however, the association was attenuated at age 4 years (OR = 1.19, 95% CI: 0.83-1.72; P = 0.341). Vitamin D deficiency in pregnancy may increase the risk of prenatal and early postnatal overweight in offspring. Clinical trials are warranted to determine the role of vitamin D in the early origins of obesity.

Maternal animal protein intake during pregnancy and risk of overweight in offspring 20 years later: a prospective cohort study

BackgroundDevelopment of excess adiposity has been hypothesised to originate in early life. Animal studies have shown that protein intake in pregnancy might influence offspring fat metabolism and adiposity. Macronutrient ratio in human pregnancy seems to be important for child blood pressure and glucose tolerance; less is known about the influence on offspring adiposity. We investigated the relation between maternal dietary protein intake during pregnancy and child anthropometric measures and biomarkers of adiposity and glucose metabolism. MethodsWe used a prospective cohort of 965 Danish pregnant women recruited in 1988–89 with offspring followed up at 20 years. This population was 80% of a consecutive sample of 1212 women carrying singletons and attending prenatal care in the city of Aarhus, Denmark. For the follow-up study, mothers were first informed about the study by mail and then the offspring were asked to fill out a web-based questionnaire and attend a clinical examination. Almost 95% (n=915) of mother–child pairs could be identified in the central registration. 690 of the offspring filled out the questionnaire and 443 participated in the clinical examination. Macronutrient intake was collected in gestational week 30, and we divided protein according to source (animal, vegetable including cereals). Offspring body-mass index (BMI) and waist circumference were recorded at follow-up (n=696), and biomarkers were quantified in a subset (n=443) of participants. We used multivariable linear and logistic regression to calculate effect estimates and 95% CIs for a 1:1 substitution of protein for carbohydrates in percent energy. All models were adjusted for maternal energy intake, maternal age, maternal education, parity, maternal pre-pregnancy BMI, maternal smoking during pregnancy, and sibling overweight. We accounted for missing data by the missing indicator method because the covariates were poorly correlated with the exposure and were therefore weak confounders. The study was approved by the Danish Data Protection Agency and the Danish Council of Ethics. FindingsAt baseline, mean maternal age was 29·1 years (SD 4·1), 373 (54%) of 695 women reported higher academic or university education, and 411 (59%) were nulliparous. Mean pre-pregnancy BMI was 21·3 kg/m2 (SD 2·9) and 242 women (35%) reported smoking during pregnancy. Offspring mean BMI was 22·4 kg/m2 (SD 3·1) and waist circumference was 79·8 cm (9·3) for women and 84·3 cm (9·3) for men; 124 (18%) of 695 participants had a BMI of at least 25 kg/m2. We found that a 1:1 substitution of animal protein for carbohydrates increased the risk of a BMI of at least 25 kg/m2 among female (quartile 4 vs quartile 1 risk ratio 3·36, 95% CI 1·52–7·42) and male (2·24, 0·93–5·40) offspring in a multivariable model that adjusted for covariates including maternal pre-pregnancy BMI and smoking, and sibling overweight. These results seemed to be accounted for by protein from meat sources. Consumption of vegetable protein in the highest quartile was not associated with overweight but was related to reduced LDL cholesterol in male offspring. InterpretationProtein intake from animal sources, primarily meat products, consumed during pregnancy seems to increase the risk of overweight in offspring; this association seemed to be stronger for female offspring. Although we cannot exclude potential residual confounding and selection bias, we adjusted for important and relevant confounders. In a subanalysis on selection bias, we found no significant differences for maternal age and BMI, parity, birthweight, gestational age, and maternal protein intake during pregnancy among those with and without outcome data. We were unable to estimate whether part of the association was accounted for by postnatal diet. FundingThe Danish Agency for Science, Technology and Innovation (DSF: 09-067124, DSF: 09-063072, DFS: 2101-06-0005, FSS: 09-065631).

Effects of suboptimal or excessive gestational weight gain on childhood overweight and abdominal adiposity: results from a retrospective cohort study

Defining prenatal modifiable risk factors of childhood overweight and obesity has become critical as the need of primary preventive strategies increases. To investigate the interrelationship between inadequate or excessive gestational weight gain (GWG), according to maternal prepregnancy body mass index (BMI)-specific Institute of Medicine (IOM) recommendations, and childhood overweight and abdominal adiposity. In a retrospective cohort study in Germany, data of 6837 mother-child dyads were obtained from medical records, a questionnaire and by anthropometric measurements of children at school entry. Main exposure was GWG as categorized by the 2009 IOM guidelines and as a continuous variable. Outcome measures were children's overweight and abdominal adiposity defined as ≥ 90 th age- and sex-specific percentiles for BMI and waist circumference, respectively. During pregnancy, more than half of mothers (53.6%) had gained weight excessively. Among the children (mean age: 5.8 years), 10.5% were overweight and 15.1% had abdominal adiposity. A nonlinear relationship between absolute GWG and the risk of offspring overweight and abdominal adiposity was observed. An increased risk of childhood overweight was related to excessive compared with recommended GWG, after adjustment for potential confounders (odds ratio (OR): 1.57, 95% confidence interval (CI): 1.30, 1.91), but not to inadequate GWG. Similar results were obtained for the risk of childhood abdominal adiposity by excessive GWG (OR: 1.39, 95% CI: 1.19, 1.63); there was no association with inadequate GWG. Analyses stratified by maternal prepregnancy BMI category did not suggest effect modification. Exceeding the recommended BMI-specific IOM GWG ranges has an adverse impact on the risk of childhood overweight and abdominal adiposity, whereas suboptimal GWG conveys no benefit or risk, reflecting a nonlinear relationship between absolute GWG and the risk of childhood overweight and adiposity. Strategies focussing on the awareness and prevention of excessive GWG and its consequences are justified.

Maternal Distress during Pregnancy and Offspring Childhood Overweight

Background. Maternal distress during pregnancy increases the intrauterine level of glucocorticoids, which may have long-term health consequences for the child. Objective. To examine if distress as a combined measure of anxiety, depression, and stress of the mother during pregnancy was associated with offspring childhood overweight at age 7. Methods. We performed a cohort study using prospective data from 37,764 women and child dyads from the Danish National Birth Cohort (1996–2002). At a telephone interview at approximately 30 weeks gestation, the women reported whether they felt anxious, depressed, or stressed. The 95 percentile for body mass index in an international reference defined childhood overweight at any given age. Logistic regression was used for the analyses. Results. The prevalence of overweight children at 7 years of age was 9.9%. Prenatal exposure to maternal distress during pregnancy was not associated with childhood overweight at 7 years of age (adjusted OR 1.06 (95% CI 0.96; 1.18)). In analyses stratified on sex, a small tendency of overweight was seen in boys (OR 1.15 (0.99; 1.33)), but not in girls (OR 0.98 (0.85; 1.13)). Conclusions. Maternal distress during pregnancy appeared to have limited, if any, influence on the risk of overweight in offspring at 7 years of age.

Gestational weight gain and overweight in children: Results from the cross-sectional German KiGGS study

Abstract Objective. Gestational weight gain (GWG) has been associated with overweight in offspring. The aim of the study was to assess the association of GWG with childhood overweight and a potential effect modification by maternal BMI. Methods. In a cross-sectional study of 10 784 children aged 3 to 17 years from the German national child health survey (2003-2006), main outcome measure was overweight defined by the criteria of the International Obesity Task Force. Main exposure was GWG in data-derived categories. Results. Crude and adjusted odds ratios (OR) for high and low GWG with average GWG as a reference were calculated in logistic regression models. With adjustment for potential confounders, the OR of childhood overweight for high GWG was 1.16 (95% confidence interval [CI]: 1.02, 1.32), whereas for low GWG the adjusted OR was not significant at 1.01 (95% CI: 0.89, 1.15). Stratified analyses by estimated pre-pregnancy BMI revealed inconsistent effects of high GWG on childhood overweight, with a significantly increased risk for children of normal-weight mothers only. No statistically significant advantageous effect of low GWG was present for any of the maternal BMI subgroups. Conclusion. A high compared with an average GWG accounts for a moderate increase in the risk of offspring overweight, whereas a lower than average GWG does not appear to reduce this risk. Subgroup analyses suggested that the beneficial effect of avoidance of high GWG might be confined to normal-weight mothers. Interventions promoting healthy GWG should not only target overweight and obese, but also normal-weight females.

Prenatal Stress Exposure Related to Maternal Bereavement and Risk of Childhood Overweight

BackgroundIt has been suggested that prenatal stress contributes to the risk of obesity later in life. In a population–based cohort study, we examined whether prenatal stress related to maternal bereavement during pregnancy was associated with the risk of overweight in offspring during school age.Methodology/Principal FindingsWe followed 65,212 children born in Denmark from 1970–1989 who underwent health examinations from 7 to 13 years of age in public or private schools in Copenhagen. We identified 459 children as exposed to prenatal stress, defined by being born to mothers who were bereaved by death of a close family member from one year before pregnancy until birth of the child. We compared the prevalence of overweight between the exposed and the unexposed. Body mass index (BMI) values and prevalence of overweight were higher in the exposed children, but not significantly so until from 10 years of age and onwards, as compared with the unexposed children. For example, the adjusted odds ratio (OR) for overweight was 1.68 (95% confidence interval [CI] 1.08–2.61) at 12 years of age and 1.63 (95% CI 1.00–2.61) at 13 years of age. The highest ORs were observed when the death occurred in the period from 6 to 0 month before pregnancy (OR 3.31, 95% CI 1.71–6.42 at age 12, and OR 2.31, 95% CI 1.08–4.97 at age 13).Conclusions/SignificanceOur results suggest that severe pre-pregnancy stress is associated with an increased risk of overweight in the offspring in later childhood.

Predictors of Overweight During Childhood in Offspring of Parents With Type 1 Diabetes

We read with interest the article by Hummel et al. (1) regarding predictors of childhood overweight risk in offspring of type 1 diabetic parents. Beyond the reevaluation of large-for-gestational-age (LGA) status as a long-term risk factor for later overweight, it is important and became clear that in this study breast-feeding significantly decreased childhood overweight risk. Thus, the study provides new data supporting the promotion of breast-feeding, which is undoubtedly worth targeting. Moreover, the authors also confirmed that, of course, maternal type 1 diabetes is not a risk factor as such, but that tight metabolic control during pregnancy may optimize the short- …

Neonatal weight gain and childhood overweight risk in offspring of diabetic mothers

Neonatal weight gain and childhood overweight risk in offspring of diabetic mothers

Maternal Weight Gain During Pregnancy and Child Weight at Age 3 Years

To determine the importance of pregnancy weight gain as a predictor of overweight (Body Mass Index [BMI] >85th percentile) in offspring at age 3 years and if its influence varies by maternal BMI. Chi-square and logistic regression analyses were conducted on a sample of 208 mother-child pairs from an earlier observational cohort study on postpartum weight retention. In the final reduced regression model, maternal early pregnancy BMI was positively and significantly associated with overweight in offspring, as were birth weight above the sample median of 3,600 g and maternal smoking during pregnancy (P < or = 0.01). In addition, a significant interaction was found between maternal BMI and gestational weight gain (P = 0.03). The risk of offspring overweight that is associated with 5 excess pounds of net pregnancy weight gain increases with maternal BMI. Excess pregnancy weight gain is associated with increased risk of child overweight at age 3 years and its impact is greater among high and obese BMI women than it is in normal BMI women. Reducing maternal BMI in the preconception period in overweight women and preventing excessive weight gain in pregnancy for all women appear to be appropriate strategies to address the childhood obesity epidemic.