Abstract
Background
We investigated the individual and additive effects of three modifiable maternal metabolic factors, including pre-pregnancy overweight/obesity, gestational weight gain (GWG), and gestational diabetes mellitus (GDM), on early childhood growth trajectories and obesity risk.
Methods
A total of 1425 mother–offspring dyads (953 black and 472 white) from a longitudinal birth cohort were included in this study. Latent class growth modeling was performed to identify the trajectories of body mass index (BMI) from birth to 4 years in children. Poisson regression models were used to examine the associations between the maternal metabolic risk factors and child BMI trajectories and obesity risk at 4 years.
Results
We identified three discrete BMI trajectory groups, characterized as rising-high-BMI (12.6%), moderate-BMI (61.0%), or low-BMI (26.4%) growth. Both maternal pre-pregnancy obesity (adjusted relative risk [adjRR] = 1.96; 95% confidence interval [CI]: 1.36–2.83) and excessive GWG (adjRR = 1.71, 95% CI: 1.13–2.58) were significantly associated with the rising-high-BMI trajectory, as manifested by rapid weight gain during infancy and a stable but high BMI until 4 years. All three maternal metabolic indices were significantly associated with childhood obesity at age 4 years (adjRR for pre-pregnancy obesity = 2.24, 95% CI: 1.62–3.10; adjRR for excessive GWG = 1.46, 95% CI: 1.01–2.09; and adjRR for GDM = 2.14, 95% = 1.47–3.12). In addition, risk of rising-high BMI trajectory or obesity at age 4 years was stronger among mothers with more than one metabolic risk factor. We did not observe any difference in these associations by race.
Conclusion
Maternal pre-pregnancy obesity, excessive GWG, and GDM individually and jointly predict rapid growth and obesity at age 4 years in offspring, regardless of race. Interventions targeting maternal obesity and metabolism may prevent or slow the rate of development of childhood obesity.
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References
Fryar C, Carroll M, Ogden C. Prevalence of overweight and obesity among children and adolescents aged 2–19 years: United States, 1963–1965 through 2013–2014. NCHS Health E-Stat. 2016. https://www.cdc.gov/nchs/data/hestat/obesity_child_15_16/obesity_child_15_16.htm
Singh AS, Mulder C, Twisk JW, van Mechelen W, Chinapaw MJ. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev. 2008;9:474–88.
Brisbois TD, Farmer AP, McCargar LJ. Early markers of adult obesity: a review. Obes Rev. 2012;13:347–67.
Lakshman R, Elks CE, Ong KK. Childhood obesity. Circulation. 2012;126:1770–9.
Dabelea D, Harrod CS. Role of developmental overnutrition in pediatric obesity and type 2 diabetes. Nutr Rev. 2013;71 Suppl 1:S62–7.
Juonala M, Magnussen CG, Berenson GS, Venn A, Burns TL, Sabin MA, et al. Childhood adiposity, adult adiposity, and cardiovascular risk factors. N Engl J Med. 2011;365:1876–85.
Baker JL, Olsen LW, Sorensen TI. Childhood body-mass index and the risk of coronary heart disease in adulthood. N Engl J Med. 2007;357:2329–37.
Umer A, Kelley GA, Cottrell LE, Giacobbi P Jr., Innes KE, Lilly CL. Childhood obesity and adult cardiovascular disease risk factors: a systematic review with meta-analysis. BMC Public Health. 2017;17:683.
Crume TL, Ogden L, Daniels S, Hamman RF, Norris JM, Dabelea D. The impact of in utero exposure to diabetes on childhood body mass index growth trajectories: the EPOCH study. J Pediatr. 2011;158:941–6.
Hammond RA, Levine R. The economic impact of obesity in the United States. Diabetes Metab Syndr Obes. 2010;3:285–95.
Cawley J. The economics of childhood obesity. Health Aff (Proj Hope). 2010;29:364–71.
Trasande L, Chatterjee S. The impact of obesity on health service utilization and costs in childhood. Obesity (Silver Spring). 2009;17:1749–54.
Nicholas LM, Morrison JL, Rattanatray L, Zhang S, Ozanne SE, McMillen IC. The early origins of obesity and insulin resistance: timing, programming and mechanisms. Int J Obes (Lond). 2016;40:229–38.
Sridhar SB, Darbinian J, Ehrlich SF, Markman MA, Gunderson EP, Ferrara A, et al. Maternal gestational weight gain and offspring risk for childhood overweight or obesity. Am J Obstet Gynecol. 2014;211:259 e251–8.
Ahmed SR, Ellah MA, Mohamed OA, Eid HM. Prepregnancy obesity and pregnancy outcome. Int J Health Sci (Qassim). 2009;3:203–8.
Kaseva N, Vaarasmaki M, Matinolli HM, Sipola-Leppanen M, Tikanmaki M, Heinonen K, et al. Pre-pregnancy overweight or obesity and gestational diabetes as predictors of body composition in offspring twenty years later: evidence from two birth cohort studies. Int J Obes (Lond). 2018;42:872–9.
Lau EY, Liu J, Archer E, McDonald SM, Liu J. Maternal weight gain in pregnancy and risk of obesity among offspring: a systematic review. J Obes. 2014;2014:524939.
Aris IM, Chen LW, Tint MT. Body mass index trajectories in the first two years and subsequent childhood cardio-metabolic outcomes: a prospective multi-ethnic Asian cohort study. Sci Rep. 2017;7:8424.
Ziyab AH, Karmaus W, Kurukulaaratchy RJ, Zhang H, Arshad SH. Developmental trajectories of body mass index from infancy to 18 years of age: prenatal determinants and health consequences. J Epidemiol Community Health. 2014;68:934–41.
Montazeri P, Vrijheid M, Martinez D, Basterrechea M, Fernandez-Somoano A, Guxens M, et al. Maternal metabolic health parameters during pregnancy in relation to early childhood BMI trajectories. Obesity (Silver Spring). 2018;26:588–96.
Naja F, Hwalla N, Itani L, Karam S, Sibai AM, Nasreddine L. A Western dietary pattern is associated with overweight and obesity in a national sample of Lebanese adolescents (13–19 years): a cross-sectional study. Br J Nutr. 2015;114:1909–19.
Isong IA, Rao SR, Bind MA, Avendano M, Kawachi I, Richmond TK. Racial and ethnic disparities in early childhood obesity. Pediatrics. 2018;141:e20170865.
Widen EM, Whyatt RM, Hoepner LA, Mueller NT, Ramirez-Carvey J, Oberfield SE, et al. Gestational weight gain and obesity, adiposity and body size in African-American and Dominican children in the Bronx and Northern Manhattan. Matern Child Nutr. 2016;12:918–28.
Heerman WJ, Bian A, Shintani A, Barkin SL. Interaction between maternal prepregnancy body mass index and gestational weight gain shapes infant growth. Acad Pediatr. 2014;14:463–70.
Mehta SH, Kruger M, Sokol RJ. Is maternal diabetes a risk factor for childhood obesity? J Matern-Fetal Neonatal Med. 2012;25:41–4.
Whitaker RC. Predicting preschooler obesity at birth: the role of maternal obesity in early pregnancy. Pediatrics. 2004;114:e29–36.
Palmer FB, Anand KJ, Graff JC, Murphy LE, Qu Y, Volgyi E, et al. Early adversity, socioemotional development, and stress in urban 1-year-old children. J Pediatr. 2013;163:1733–9.
Tylavsky FA, Kocak M, Murphy LE, Graff JC, Palmer FB, Volgyi E, et al. Gestational vitamin 25(OH)D status as a risk factor for receptive language development: a 24-month, longitudinal, observational study. Nutrients. 2015;7:9918–30.
Volgyi E, Carroll KN, Hare ME, Ringwald-Smith K, Piyathilake C, Yoo W, et al. Dietary patterns in pregnancy and effects on nutrient intake in the Mid-South: the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) study. Nutrients. 2013;5:1511–30.
Rasmussen KM, Catalano PM, Yaktine AL. New guidelines for weight gain during pregnancy: what obstetrician/gynecologists should know. Curr Opin Obstet Gynecol. 2009;21:521–6.
Colon-Ramos U, Racette SB, Ganiban J, Nguyen TG, Kocak M, Carroll KN, et al. Association between dietary patterns during pregnancy and birth size measures in a diverse population in Southern US. Nutrients. 2015;7:1318–32.
Fernandez-Barres S, Romaguera D, Valvi D, Martinez D, Vioque J, Navarrete-Munoz EM, et al. Mediterranean dietary pattern in pregnant women and offspring risk of overweight and abdominal obesity in early childhood: the INMA birth cohort study. Pediatr Obes. 2016;11:491–9.
Grummer-Strawn LM, Reinold C, Krebs NF. Use of World Health Organization and CDC growth charts for children aged 0–59 months in the United States. MMWR Recomm Rep. 2010;59:1–15.
McCutcheon AL. Latent class analysis. Newbury Park, CA: SAGE Publications; 1987.
Jones B, Nagi ND, Roeder K. SAS Procedure based on mixture models for estimating developmental trajectories. Sociol Methods Res. 2001;29:374–93.
Wacholder S. Binomial regression in GLIM: estimating risk ratios and risk differences. Am J Epidemiol. 1986;123:174–84.
McNutt LA, Wu C, Xue X, Hafner JP. Estimating the relative risk in cohort studies and clinical trials of common outcomes. Am J Epidemiol. 2003;157:940–3.
Moschonis G, Kalliora AC, Costarelli V, Papandreou C, Koutoukidis D, Lionis C, et al. Identification of lifestyle patterns associated with obesity and fat mass in children: the Healthy Growth Study. Public Health Nutr. 2014;17:614–24.
Giles LC, Whitrow MJ, Davies MJ, Davies CE, Rumbold AR, Moore VM. Growth trajectories in early childhood, their relationship with antenatal and postnatal factors, and development of obesity by age 9 years: results from an Australian birth cohort study. Int J Obes (Lond). 2015;39:1049–56.
Liu JX, Liu JH, Frongillo EA, Boghossian NS, Cai B, Hazlett LJ. Body mass index trajectories during infancy and pediatric obesity at 6 years. Ann Epidemiol. 2017;27:708–15.
Rzehak P, Oddy WH, Mearin ML, Grote V, Mori TA, Szajewska H, et al. Infant feeding and growth trajectory patterns in childhood and body composition in young adulthood. Am J Clin Nutr. 2017;106:568–80.
Peneau S, Giudici KV, Gusto G, Goxe D, Lantieri O, Hercberg S, et al. Growth trajectories of body mass index during childhood: associated factors and health outcome at adulthood. J Pediatr. 2017;186:64–71.
Pryor LE, Tremblay RE, Boivin M, Touchette E, Dubois L, Genolini C, et al. Developmental trajectories of body mass index in early childhood and their risk factors: an 8-year longitudinal study. Arch Pediatr Adolesc Med. 2011;165:906–12.
Zhang J, Wang H, Wang Y, Xue H, Wang Z, Du W, et al. Dietary patterns and their associations with childhood obesity in China. Br J Nutr. 2015;113:1978–84.
DeSisto CL, Kim SY, Sharma AJ. Prevalence estimates of gestational diabetes mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007–2010. Prev Chronic Dis. 2014;11:E104.
Bider-Canfield Z, Martinez MP, Wang X, Yu W, Bautista MP, Brookey J, et al. Maternal obesity, gestational diabetes, breastfeeding and childhood overweight at age 2 years. Pediatr Obes. 2017;12:171–8.
Robinson SM, Crozier SR, Harvey NC, Barton BD, Law CM, Godfrey KM, et al. Modifiable early-life risk factors for childhood adiposity and overweight: an analysis of their combined impact and potential for prevention. Am J Clin Nutr. 2015;101:368–75.
Anzman SL, Rollins BY, Birch LL. Parental influence on children’s early eating environments and obesity risk: implications for prevention. Int J Obes (Lond). 2010;34:1116–24.
Pitkin RM. Nutritional support in obstetrics and gynecology. Clin Obstet Gynecol. 1976;19:489–513.
Nelson SM, Matthews P, Poston L. Maternal metabolism and obesity: modifiable determinants of pregnancy outcome. Hum Reprod Update. 2010;16:255–75.
Karachaliou M, Georgiou V, Roumeliotaki T, Chalkiadaki G, Daraki V, Koinaki S, et al. Association of trimester-specific gestational weight gain with fetal growth, offspring obesity, and cardiometabolic traits in early childhood. Am J Obstet Gynecol. 2015;212:502.e501–14.
Alfaradhi MZ, Ozanne SE. Developmental programming in response to maternal overnutrition. Front Genet. 2011;2:27.
Wrotniak BH, Shults J, Butts S, Stettler N. Gestational weight gain and risk of overweight in the offspring at age 7 y in a multicenter, multiethnic cohort study. Am J Clin Nutr. 2008;87:1818–24.
Dabelea D. The predisposition to obesity and diabetes in offspring of diabetic mothers. Diabetes Care. 2007;30 Suppl 2:S169–74.
Ge ZJ, Zhang CL, Schatten H, Sun QY. Maternal diabetes mellitus and the origin of non-communicable diseases in offspring: the role of epigenetics. Biol Reprod. 2014;90:139.
Okubo H, Crozier SR, Harvey NC, Godfrey KM, Inskip HM, Cooper C, et al. Diet quality across early childhood and adiposity at 6 years: the Southampton Women’s Survey. Int J Obes (Lond). 2015;39:1456–62.
Wright CS, Weiner M, Localio R, Song L, Chen P, Rubin D. Misreport of gestational weight gain (GWG) in birth certificate data. Matern Child Health J. 2012;16:197–202.
McClure CK, Bodnar LM, Ness R, Catov JM. Accuracy of maternal recall of gestational weight gain 4 to 12 years after delivery. Obesity (Silver Spring). 2011;19:1047–53.
Acknowledgements
The CANDLE study was supported by the Urban Child Institute, the University of Tennessee Heath Science Center, and NIH (1R01HL109977) grants.
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Hu, Z., Tylavsky, F.A., Han, J.C. et al. Maternal metabolic factors during pregnancy predict early childhood growth trajectories and obesity risk: the CANDLE Study. Int J Obes 43, 1914–1922 (2019). https://doi.org/10.1038/s41366-019-0326-z
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DOI: https://doi.org/10.1038/s41366-019-0326-z
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