Impact of Maternal Glucose and Gestational Weight Gain on Child Obesity over the First Decade of Life in Normal Birth Weight Infants
Objective To determine, among children with normal birth weight, if maternal hyperglycemia and weight gain independently increase childhood obesity risk in a very large diverse population. Methods Study population was 24,141 individuals (mothers and their normal birth weight offspring, born 1995–2003) among a diverse population with universal GDM screening [50-g glucose-challenge test (GCT); 3 h. 100 g oral glucose tolerance test (OGTT) if GCT+]. Among the 13,037 full-term offspring with normal birth weight (2500–4000 g), annual measured height/weight was ascertained between ages 2 and 10 years to calculate gender-specific BMI-for-age percentiles using USA norms (1960–1995 standard). Results Among children who began life with normal birth weight, we found a significant trend for developing both childhood overweight (>85 %ile) and obesity (>95 %ile) during the first decade of life with both maternal hyperglycemia (normal GCT, GCT+ but no GDM, GDM) and excessive gestational weight gain [>40 pounds (18.1 kg)]; p < 0.0001 for both trends. These maternal glucose and/or weight gain effects to imprint for childhood obesity in the first decade remained after adjustment for potential confounders including maternal age, parity, as well as pre-pregnancy BMI. The attributable risk (%) for childhood obesity was 28.5 % (95 % CI 15.9–41.1) for GDM and 16.4 % (95 % CI 9.4–23.2) for excessive gestational weight gain. Conclusions for Practice Both maternal hyperglycemia and excessive weight gain have independent effects to increase childhood obesity risk. Future research should focus on prevention efforts during pregnancy as a potential window of opportunity to reduce childhood obesity.
KeywordsChildhood obesity Metabolic imprinting Gestational weight gain Hyperglycemia GDM Normal birth weight
- 2.American College of Obstetricians and Gynecologists. (2013). Practice bulletin No. 137: Gestational diabetes mellitus. Obstet Gynecol, 122(2 Pt), 406–416.Google Scholar
- 5.Centers for Disease Control and Prevention (CDC). (2009). PedNSS Health Indicators. http://www.cdc.gov/pednss/what_is/pednss_health_indicators.htm#birthweight. Accessed 25 Jan 2016.
- 7.Division of Nutrition and Physical Activity: Research to Practice Series No.4. (2007). Does breastfeeding reduce the risk of pediatric oveweight? http://www.cdc.gov/nccdphp/dnpa/nutrition/pdf/breastfeeding_r2p.pdf. Accessed 25 Jan 2016.
- 13.Institute of Medicine of the National Academies. (2009). Weight Gain During Pregnancy: Reexamining the Guidelines. Report Brief, May 2009. Internet. http://www.iom.edu/CMS/3788/48191/68004/68230.aspx. Accessed 25 January 2016.
- 14.James-Todd, T. M., Karumanchi, S. A., Hibert, E. L., Mason, S. M., Vadnais, M. A., Hu, F. B., et al. (2013). Gestational age, infant birth weight, and subsequent risk of type 2 diabetes in mothers: Nurses’ Health Study II. Preventing Chronic Disease, 10, E156.CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Johnsson, I. W., Haglund, B., Ahlsson, F., & Gustafsson, J. (2014). A high birth weight is associated with increased risk of type 2 diabetes and obesity. Pediatric Obesity Google Scholar
- 17.Kleinbaum, D. G., Kupper, L., & Morgenstern, H. (1982). Epidemiologic research: principles and quantitative methods. London: Wiley.Google Scholar
- 18.Kuczmarski, R. J., Ogden, C. L., Guo, S. S., Grummer-Strawn, L. M., Flegal, K. M., Mei, Z., et al. (2002a). 2000 CDC growth charts for the United States: Methods and development. Vital and Health Statistics, 11(246), 1–190.Google Scholar
- 19.Kuczmarski, R. J., Ogden, C. L., Guo, S. S., Grummer-Strawn, L. M., Flegal, K. M., & Mei, Z. et al. (2002b). 2000 CDC growth charts for the United States: Methods and development. National Center for Health Statistics. Vital and Health Statistics 11 (246). http://www.cdc.gov/nchs/data/series/sr_11/sr11_246.pdf. Accessed 25 Jan 2016.
- 22.Lee, E., Wei, L., Amato, D., & Leurgans, S. (1992). Cox-Type regression analysis for large numbers of small groups of correlated failure time observations. In Survival analysis: state of the art Nato science, Vol. 211 (pp. 237–247). Berlin: Springer.Google Scholar
- 28.Pettitt, D. J., & Knowler, W. C. (1998). Long-term effects of the intrauterine environment, birth weight, and breast-feeding in Pima Indians. Diabetes Care 21 Supplementary, 2(1), B138–B141.Google Scholar
- 31.Tanner, J. (1987). Catch-up and catch-down growth: A review Growth Genetics and Hormones. Growth Genetics and Hormones, 3(4), 8–11.Google Scholar