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Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine
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June 16, 2008 — Increased weight gain by pregnant women may increase the risk for overweight children at age 7 years, according to the results of a retrospective cohort study reported in the June issue of the American Journal of Clinical Nutrition.
"The earliest determinants of obesity may operate during intrauterine life, and gestational weight gain may influence the intrauterine environment in a way that may impact the risk of overweight in the offspring," write Brian H. Wrotniak, PT, PhD, GCS, from The Children's Hospital of Philadelphia in Philadelphia, Pennsylvania. "Children who are overweight are at risk of health conditions that include dyslipidemia, hypertension, and type 2 diabetes. Childhood obesity is also a risk factor for obesity in adulthood and associated diseases such as cardiovascular disease and cancer."
The goal of this study was to evaluate the association of gestational weight gain with overweight in the offspring, with use of data from 10,226 participants in the Collaborative Perinatal Project conducted from 1959 to 1972. The investigators determined anthropometric and sociodemographic information during gestation, at birth, and at age 7 years. After adjustment for important confounding factors, the association between gestational weight gain and overweight in the offspring at age 7 years was assessed.
For every 1 kg of gestational weight gain, the odds of overweight in offspring at age 7 years increased by 3% (adjusted odds ratio [OR], 1.03; 95% confidence interval [CI],1.02 - 1.05). The odds of overweight was 48% greater for children of mothers who gained more than the Institute of Medicine weight gain recommendations vs children of mothers who met these weight gain guidelines (adjusted OR, 1.48; 95% CI, 1.06 - 2.06).
Additional adjustment for birth weight did not abolish the significance of this association. The association between gestational weight gain and overweight in the offspring was most dramatic in those women who were underweight before pregnancy (P for interaction < .01).
"Helping pregnant women to meet the recommended weight gain during pregnancy may be an important and novel strategy for preventing pediatric obesity," the study authors write. "Women who are underweight and gain more gestational weight have the greatest odds of offspring overweight."
Limitations of this study include self-reported prepregnancy weight, analyses based on a cohort of individuals born in US cities during the 1960s, missing data because of changes in the data collected during the study, a higher prepregnancy body mass index (BMI) and birth weight in individuals lost to follow-up, all cases of preeclampsia not definitively identified at the time the data were collected, apparently low prevalence of gestational diabetes, and use of BMI rather than a more direct estimate of adiposity.
"Additional research is needed to clarify whether the association between greater gestational weight gain and increased odds of overweight in the offspring is causal and exists in today's obesogenic environment," the study authors conclude. "If our findings are confirmed, improving compliance with pregnancy weight gain recommendations may be an important and novel strategy in preventing childhood obesity, because almost half of US women exceed these recommendations."
The National Collaborative Perinatal Project was supported by the National Institute of Neurologic Disease and Stroke. The Nutrition Center of The Children's Hospital of Philadelphia supported this study. The study authors have disclosed no relevant financial relationships.
Am J Clin Nutr. 2008;87:1818-1824.
Although weight gain is a normal part of pregnancy for many women, the Institute of Medicine stratifies the recommended amount of gestational weight gain according to the mother's prepregnancy weight. Women with a BMI of less than 19.8 kg/m2 are recommended to gain between 12.5 and 18 kg during pregnancy, whereas the range of weight gain among women with a prepregnancy BMI between 19.8 and 26 kg/m2 should be between 11.5 and 16 kg. Women with a BMI of more than 29 kg/m2 should gain less weight, approximately 6.8 kg, during pregnancy.
High degrees of gestational weight gain have previously been associated with an increased risk for overweight among young children. The current study examines the effect of gestational weight gain on the risk for overweight among children aged 7 years.
