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Prenatal risk factors influencing childhood BMI and overweight independent of birth weight and infancy BMI: a path analysis within the Danish National Birth Cohort

Abstract

Background and objectives:

Prenatal risk factors for childhood overweight may operate indirectly through development in body size in early life and/or directly independent hereof. We quantified the effects of maternal and paternal body mass index (BMI), maternal age, socioeconomic position (SEP), parity, gestational weight gain, maternal smoking during pregnancy, caesarean section, birth weight, and BMI at 5 and 12 months on BMI and overweight at 7 and 11 years.

Methods:

Family triads with information on maternal, paternal and child BMI at ages 7 (n=29 374) and 11 years (n=18 044) were selected from the Danish National Birth Cohort. Information originated from maternal interviews and medical health examinations. Path analysis was used to estimate the direct and indirect effects of prenatal risk factors on childhood BMI z-scores (BMIz per unit score of the risk factor). Logistic regression was used to examine associations with overweight.

Results:

The strongest direct effects on BMIz at age 7 were found for maternal and paternal BMI (0.19 BMIz and 0.14 BMIz per parental BMIz), low SEP (0.08 BMIz), maternal smoking (0.12 BMIz) and higher BMIz at 5 and 12 months (up to 0.19 BMIz per infant BMIz). For BMIz at age 11 with BMIz at age 7 included in the model, similar effects were found, but the direct effects of BMIz at age 5 and 12 months were mediated through BMI at age 7 (0.62 BMIz per BMIz). Same results were found for overweight. The sum of the direct effects can be translated to approximate absolute measures: 2.4 kg at 7 years, 5.7 kg at 11 years, in a child with average height and BMI.

Conclusions:

Parental BMI, low SEP and smoking during pregnancy have persisting, strong and direct effects on child BMI and overweight independent of birth weight and infancy BMI.

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Acknowledgements

We acknowledge the mothers and families who have participated in the cohort for their contribution with detailed telephone interviews and for completing questionnaires. The Danish National Research Foundation has established the Danish Epidemiology Science Centre that initiated and created the Danish National Birth Cohort. The cohort is furthermore a result of a major grant from this Foundation. Additional support for the Danish National Birth Cohort is obtained from the Pharmacy Foundation, the Egmont Foundation, the March of Dimes Birth Defects Foundation, the Augustinus Foundation and the Health Foundation. The DNBC 7-year follow-up is supported by the Lundbeck Foundation (195/04) and the Danish Medical Research Council (SSVF 0646). The 11-year follow-up was funded by the Danish Independent Research Council, the Lundbeck Foundation and a strategic grant from Department of Public Health, University of Copenhagen. The funders had no role in the planning, conduct, or interpretation of the study.

Author contributions

TIAS and CSM: conceived the study; TIAS, LÄ and CSM: planned the analyses; CSM: prepared the data set for analysis and conducted the data analysis by supervision of LÄ; TIAS, KFM, LÄ, ANA, JLB and CSM: interpreted the results; CSM: prepared the manuscript; TIAS, KFM, LÄ, ANA and JLB: critically revised the manuscript; TIAS and ANA: participated in the planning and building of the DNBC. All authors read and approved the final manuscript.

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Correspondence to C S Morgen.

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Supplementary Information accompanies this paper on International Journal of Obesity website

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Morgen, C., Ängquist, L., Baker, J. et al. Prenatal risk factors influencing childhood BMI and overweight independent of birth weight and infancy BMI: a path analysis within the Danish National Birth Cohort. Int J Obes 42, 594–602 (2018). https://doi.org/10.1038/ijo.2017.217

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