Impact of Maternal Glucose and Gestational Weight Gain on Child Obesity over the First Decade of Life in Normal Birth Weight Infants

Abstract

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.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

References

  1. 1.

    Aerts, L., & Van Assche, F. A. (2006). Animal evidence for the transgenerational development of diabetes mellitus. International Journal of Biochemistry & Cell Biology, 38(5–6), 894–903.

    CAS  Article  Google Scholar 

  2. 2.

    American College of Obstetricians and Gynecologists. (2013). Practice bulletin No. 137: Gestational diabetes mellitus. Obstet Gynecol, 122(2 Pt), 406–416.

    Google Scholar 

  3. 3.

    Berends, L. M., & Ozanne, S. E. (2012). Early determinants of type-2 diabetes. Best Practice & Research Clinical Endocrinology & Metabolism, 26(5), 569–580.

    CAS  Article  Google Scholar 

  4. 4.

    Catalano, P. M., Farrell, K., Thomas, A., Huston-Presley, L., Mencin, P., de Mouzon, S. H., et al. (2009). Perinatal risk factors for childhood obesity and metabolic dysregulation. American Journal of Clinical Nutrition, 90(5), 1303–1313.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  5. 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.

  6. 6.

    Crozier, S. R., Robinson, S. M., Borland, S. E., Godfrey, K. M., Cooper, C., & Inskip, H. M. (2009). Do women change their health behaviours in pregnancy? Findings from the Southampton Women’s Survey. Paediatric and Perinatal Epidemiology, 23(5), 446–453.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 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.

  8. 8.

    Frias, A. E., & Grove, K. L. (2012). Obesity: A transgenerational problem linked to nutrition during pregnancy. Seminars in Reproductive Medicine, 30(6), 472–478.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Gillman, M. W. (2005). Developmental origins of health and disease. New England Journal of Medicine, 353(17), 1848–1850.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Gillman, M. W., Oakey, H., Baghurst, P. A., Volkmer, R. E., Robinson, J. S., & Crowther, C. A. (2010). Effect of treatment of gestational diabetes mellitus on obesity in the next generation. Diabetes Care, 33(5), 964–968.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Hillier, T. A., Pedula, K. L., Schmidt, M. M., Mullen, J. A., Charles, M. A., & Pettitt, D. J. (2007). Childhood obesity and metabolic imprinting: The ongoing effects of maternal hyperglycemia. Diabetes Care, 30(9), 2287–2292.

    Article  PubMed  Google Scholar 

  12. 12.

    Hillier, T. A., Pedula, K. L., Vesco, K. K., Schmidt, M. M., Mullen, J. A., LeBlanc, E. S., et al. (2008). Excess gestational weight gain: Modifying fetal macrosomia risk associated with maternal glucose. Obstetrics and Gynecology, 112(5), 1007–1014.

    Article  PubMed  Google Scholar 

  13. 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. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 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

  16. 16.

    Klein, J. D., & Dietz, W. (2010). Childhood obesity: The new tobacco. Health Affairs (Millwood), 29(3), 388–392.

    Article  Google Scholar 

  17. 17.

    Kleinbaum, D. G., Kupper, L., & Morgenstern, H. (1982). Epidemiologic research: principles and quantitative methods. London: Wiley.

    Google Scholar 

  18. 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. 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.

  20. 20.

    Landon, M. B., Rice, M. M., Varner, M. W., Casey, B. M., Reddy, U. M., Wapner, R. J., et al. (2015). Mild gestational diabetes mellitus and long-term child health. Diabetes Care, 38(3), 445–452.

    Article  PubMed  Google Scholar 

  21. 21.

    Lau, C., Rogers, J. M., Desai, M., & Ross, M. G. (2011). Fetal programming of adult disease: Implications for prenatal care. Obstetrics and Gynecology, 117(4), 978–985.

    CAS  Article  PubMed  Google Scholar 

  22. 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.

  23. 23.

    Ludwig, D. S., & Currie, J. (2010). The association between pregnancy weight gain and birthweight: A within-family comparison. Lancet, 376(9745), 984–990.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Ludwig, D. S., Rouse, H. L., & Currie, J. (2013). Pregnancy weight gain and childhood body weight: A within-family comparison. PLoS Medicine, 10(10), e1001521.

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Lustig, R. H. (2001). The neuroendocrinology of childhood obesity. Pediatric Clinics of North America, 48(4), 909–930.

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Mayer-Davis, E. J., Rifas-Shiman, S. L., Zhou, L., Hu, F. B., Colditz, G. A., & Gillman, M. W. (2006). Breast-feeding and risk for childhood obesity: does maternal diabetes or obesity status matter? Diabetes Care, 29(10), 2231–2237.

    Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Mission, J. F., Marshall, N. E., & Caughey, A. B. (2013). Obesity in pregnancy: A big problem and getting bigger. Obstetrical & Gynecological Survey, 68(5), 389–399.

    Article  Google Scholar 

  28. 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 

  29. 29.

    Pham, M. T., Brubaker, K., Pruett, K., & Caughey, A. B. (2013). Risk of childhood obesity in the toddler offspring of mothers with gestational diabetes. Obstetrics and Gynecology, 121(5), 976–982.

    Article  PubMed  Google Scholar 

  30. 30.

    Sridhar, S. B., Darbinian, J., Ehrlich, S. F., Markman, M. A., Gunderson, E. P., Ferrara, A., et al. (2014). Maternal gestational weight gain and offspring risk for childhood overweight or obesity. American Journal of Obstetrics and Gynecology, 211(3), 259.e1-8.

    Article  PubMed  Google Scholar 

  31. 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 

  32. 32.

    The HAPO Study Cooperative Research Group. (2008). Hyperglycemia and adverse pregnancy outcomes. New England Journal of Medicine, 358(19), 1991–2002.

    Article  Google Scholar 

  33. 33.

    Tie, H. T., Xia, Y. Y., Zeng, Y. S., Zhang, Y., Dai, C. L., Guo, J. J., et al. (2014). Risk of childhood overweight or obesity associated with excessive weight gain during pregnancy: A meta-analysis. Archives of Gynecology and Obstetrics, 289(2), 247–257.

    Article  PubMed  Google Scholar 

  34. 34.

    Vignini, A., Raffaelli, F., Cester, A., Iannilli, A., Cherubini, V., Mazzanti, L., et al. (2012). Environmental and genetical aspects of the link between pregnancy, birth size, and type 2 diabetes. Current Diabetes Review, 8(3), 155–161.

    CAS  Article  Google Scholar 

  35. 35.

    Waterland, R. A., & Garza, C. (1999). Potential mechanisms of metabolic imprinting that lead to chronic disease. American Journal of Clinical Nutrition, 69(2), 179–197.

    CAS  PubMed  Google Scholar 

  36. 36.

    Wattez, J. S., Delahaye, F., Lukaszewski, M. A., Risold, P. Y., Eberle, D., Vieau, D., et al. (2013). Perinatal nutrition programs the hypothalamic melanocortin system in offspring. Hormone and Metabolic Research, 45(13), 980–990.

    CAS  Article  PubMed  Google Scholar 

  37. 37.

    Williams, S., Davie, G., & Lam, F. (1999). Predicting BMI in young adults from childhood data using two approaches to modelling adiposity rebound. International Journal of Obesity and Related Metabolic Disorders, 23(4), 348–354.

    CAS  Article  PubMed  Google Scholar 

  38. 38.

    Williams, S. M. (2005). Weight and height growth rate and the timing of adiposity rebound. Obesity Research, 13(6), 1123–1130.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work is supported by a Research Award from the American Diabetes Association, and grant award 1R01HD058015 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (both awards to TH). We would also like to thank Martie Sucec for her editorial review and Robin Daily for her formatting assistance.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Teresa A. Hillier.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hillier, T.A., Pedula, K.L., Vesco, K.K. et al. Impact of Maternal Glucose and Gestational Weight Gain on Child Obesity over the First Decade of Life in Normal Birth Weight Infants. Matern Child Health J 20, 1559–1568 (2016). https://doi.org/10.1007/s10995-016-1955-7

Download citation

Keywords

  • Childhood obesity
  • Metabolic imprinting
  • Gestational weight gain
  • Hyperglycemia
  • GDM
  • Normal birth weight