Lifestyle of women before pregnancy and the risk of offspring obesity during childhood through early adulthood



In women, adhering to an overall healthy lifestyle is associated with a dramatically reduced risk of cardio-metabolic disorders. Whether such a healthy lifestyle exerts an intergenerational effects on child health deserves examination.


We included 5701 children (9–14 years old at baseline) of the Growing Up Today Study 2, and their mothers, who are participants in the Nurses’ Health Study II. Pre-pregnancy healthy lifestyle was defined as a normal body mass index, no smoking, physical activity ≥150 min/week, and diet in the top 40% of the Alternative Healthy Eating Index-2010. Obesity during childhood and adolescence was defined using the International Obesity Task Force age- and sex-specific cutoffs. Multivariable log-binominal regression models with generalized estimating equations were used to evaluate the association of pre-pregnancy healthy lifestyle and offspring obesity.


We identified 520 (9.1%) offspring who became obese during follow-up. A healthy body weight of mothers and no smoking before pregnancy was significantly associated with a lower risk of obesity among offspring: the relative risks [RRs; 95% confidence intervals (CIs)] were 0.37 (0.31–0.43) and 0.64 (0.49–0.84), respectively. Eating a healthy diet and regular moderate-to-vigorous physical activities were inversely related to offspring obesity risk, but these relations were not statistically significant. Compared to children of mothers who did not meet any low-risk lifestyle factors, offspring of women who adhered to all four healthy lifestyle factors had 75% lower risk of obesity (RR: 0.25, 95% CI: 0.14–0.43).


Adherence to an overall healthy lifestyle before pregnancy is strongly associated with a low risk of offspring obesity in childhood, adolescence, and early adulthood. These findings highlight the importance of an overall healthy lifestyle before pregnancy as a potential strategy to prevent obesity in future generations.

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We thank the thousands of participants in the Growing Up Today Study as well as their mothers. This study was supported by grants UM1-CA176726, P30-DK046200, U54-CA155626, T32-DK007703-16, HD066963, HL096905, DK084001, OH009803, and MH087786 from the National Institutes of Health. CZ is supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health. QS is supported by NIH grants, ES021372, ES022981, and HL34594. GZ is supported by a Unilever postdoctoral fellowship. ES is supported by Center for Disease Control and Prevention/The National Institute for Occupational Safety and Health.

Author contributions

KD and QS conceptualized the analysis, performed data analysis, interpreted the data, drafted the initial manuscript, and revised the manuscript; ES and AEF designed the study, obtained funding and critically reviewed and revised the manuscript; GZ and CY performed statistical analysis and critically reviewed and revised the manuscript; CZ, XW, FBH, and JEC critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

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Correspondence to Qi Sun.

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The authors declare that they have no conflict of interest.

Ethics approval

The study was approved by the Human Subjects Committees of the Harvard T. H. Chan School of Public Health and Brigham and Women’s Hospital. In NHSII and GUTS2 return of the questionnaire was considered as informed consent.

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Dhana, K., Zong, G., Yuan, C. et al. Lifestyle of women before pregnancy and the risk of offspring obesity during childhood through early adulthood. Int J Obes 42, 1275–1284 (2018).

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