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Associations Between Gestational Weight Gain, Gestational Diabetes, and Childhood Obesity Incidence

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Abstract

Introduction

Excessive maternal gestational weight gain (GWG) is strongly correlated with childhood obesity, yet how excess maternal weight gain and gestational diabetes mellitus (GDM) interact to affect early childhood obesity is poorly understood. The purpose of this study was to investigate whether overall and trimester-specific maternal GWG and GDM were associated with obesity in offspring by age 6 years.

Methods

A cohort of 10,335 maternal-child dyads was established from electronic health records. Maternal weights at conception and delivery were estimated from weight trajectory fits using functional principal components analysis. Kaplan–Meier curves and Cox regression, together with generalized raking, examined time-to-childhood-obesity.

Results

Obesity diagnosed prior to age 6 years was estimated at 19.7% (95% CI: 18.3, 21.1). Maternal weight gain during pregnancy was a strong predictor of early childhood obesity (p < 0.0001). The occurrence of early childhood obesity was lower among mothers with GDM compared with those without diabetes (adjusted hazard ratio = 0.58, p = 0.014). There was no interaction between maternal weight gain and GDM (p = 0.55). Higher weight gain during the first trimester was associated with lower risk of early childhood obesity (p = 0.0002) whereas higher weight gain during the second and third trimesters was associated with higher risk (p < 0.0001).

Discussion

Results indicated total and trimester-specific maternal weight gain was a strong predictor of early childhood obesity, though obesity risk by age 6 was lower for children of mothers with GDM. Additional research is needed to elucidate underlying mechanisms directly related to trimester-specific weight gain and GDM that impede or protect against obesity prevalence during early childhood.

Significance

Excessive maternal gestational weight gain (GWG) and gestational diabetes mellitus (GDM) have been linked to childhood obesity. Yet, research on how excessive total and trimester-specific GWG and GDM interact to affect early childhood obesity remains inconclusive. This study found that inadequate weight gain in the first trimester and excessive weight gain in the second and third trimester were associated with higher risks of childhood obesity by age 6. No significant interaction between maternal GWG and GDM was noted suggesting that these two important maternal conditions do not have a combined effect on the risk of early childhood obesity.

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Data Availability

Not applicable.

Code Availability

Analysis code is available at https://biostat.app.vumc.org/ArchivedAnalyses.

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Funding

This work was supported by funding from the Patient Centered Outcomes Research Institute, the National Institute of Allergy and Infectious Disease, and a T32 training grant through the Agency for Healthcare Research and Quality. This content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality, Patient Centered Outcomes Research Institute, or the National Institute of Allergy and Infectious Disease.

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Authors and Affiliations

  1. Department of Pediatrics, Vanderbilt University Medical Center, 2146 Belcourt Ave., Nashville, TN, 37212, USA

    Nadia M. Sneed & William J. Heerman

  2. Center for Research Development and Scholarship, Vanderbilt University School of Nursing, 319E Godchaux Hall, Nashville, TN, 37240, USA

    Nadia M. Sneed

  3. Biostatistics Unit, Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave Suite 1600, Seattle, WA, 98101, USA

    Pamela A. Shaw

  4. Department of Mathematics, Statistics, and Computer Science, University of Illinois at Chicago, 851 S Morgan St, 503 Science and Engineering Offices, Chicago, IL, 60607, USA

    Kyunghee Han

  5. Department of Statistics, University of Auckland, 38 Princes St., Auckland, 1010, New Zealand

    Tong Chen & Thomas Lumley

  6. Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Ave., Room/Suite 11124, Nashville, TN, 37203, USA

    Aihua Bian & Bryan E. Shepherd

  7. Department of Emergency Medicine, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA

    Shannon Pugh

  8. Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Ave., Nashville, TN, 37203, USA

    Stephany Duda

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  1. Nadia M. Sneed
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  2. William J. Heerman
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  10. Bryan E. Shepherd
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Contributions

NMS, WJH, and BES contributed to the study conception and design. Material preparation and data collection were performed by SD and SP. Data analysis and interpretation were performed by KH, TC, AB, PS, TL, WJH, BES, and NMS. The first draft of the manuscript was written by NMS with substantial contributions from WJH, and BES. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Nadia M. Sneed.

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The authors declared no conflict of interest.

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This study was approved by the Institutional Review Board at Vanderbilt University Medical Center under a waiver of informed consent.

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Sneed, N.M., Heerman, W.J., Shaw, P.A. et al. Associations Between Gestational Weight Gain, Gestational Diabetes, and Childhood Obesity Incidence. Matern Child Health J 28, 372–381 (2024). https://doi.org/10.1007/s10995-023-03853-8

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