Overall gestational weight gain mediates the relationship between maternal and child obesity
Michele J Josey1,2, Lauren E McCullough3, Cathrine Hoyo4
1Arnold School of Public Health, Department of Epidemiology & Biostatistics, University of South Carolina, 915 Greene Street, Columbia, SC, USA.
Insights
Maternal obesity increases child obesity risk, with excessive gestational weight gain (GWG) mediating 8.1% of this effect. Addressing pre-pregnancy weight and GWG is crucial for preventing childhood adiposity.
Area of Science:
- Pediatrics
- Public Health
- Epidemiology
Background:
- Maternal obesity is a significant risk factor for childhood obesity.
- Obese children face higher risks of chronic diseases and premature death.
- Gestational weight gain (GWG) is a potential intrauterine mechanism linking maternal obesity to offspring weight status.
Purpose of the Study:
- To quantify the indirect effect of maternal obesity on child obesity mediated by GWG.
- To decompose the direct and indirect effects of maternal pre-pregnancy BMI on offspring adiposity.
- To identify GWG as a modifiable risk factor in the maternal obesity-childhood obesity pathway.
Main Methods:
- Birth cohort study of 766 mother-offspring pairs from the Duke/Durham Regional health care system (2005-2009).
- Maternal pre-pregnancy BMI and GWG (dichotomized as excessive/not excessive) as exposure and mediator.
- Childhood obesity at age 4 measured by BMI z-scores using electronic medical records.
- Counterfactual theory-based product method analysis adjusted for maternal race, socioeconomic status, and smoking.
Main Results:
- 25% of children were overweight or obese at age 4; 31% of mothers were obese pre-pregnancy.
- Maternal BMI was associated with a 0.04 increase in offspring BMI z-score.
- Gestational weight gain (GWG) mediated 8.1% of the effect of maternal obesity on child obesity at age 4.
Conclusions:
- Gestational weight gain (GWG) partially mediates the association between maternal pre-pregnancy BMI and childhood adiposity.
- Maternal obesity independently increases offspring BMI z-score, even when GWG is accounted for.
- Public health initiatives should emphasize the importance of pre-pregnancy weight and controlled GWG for mitigating childhood obesity risk.
Background:
Approximately 17% of children in the U.S. are obese. Children that are overweight or obese are also more likely to be obese as adults and suffer from various chronic diseases and premature death. Maternal obesity can affect the weight status of her offspring through intrauterine mechanisms like excessive gestational weight gain (GWG). Current literature shows a positive association between maternal weight status and GWG on child obesity, yet the direct and indirect effects have not been decomposed or quantified. The purpose of this study was to estimate the effect of maternal obesity on child obesity, mediated by GWG, which is a modifiable risk factor.
Methods:
The study participants were a birth cohort of offspring from women who received prenatal care in the Duke/Durham Regional health care system in Durham, NC between 2005 and 2009. Anthropomorphic data was collected via electronic medical records (EMRs) during each voluntary visit to a health care facility. The exposure of interest was maternal obesity, measured by pre-pregnancy body mass index, the mediator was GWG, dichotomized into excessive and not excessive based on maternal prenatal BMI, and the outcome was child obesity at age 4, measured as BMI z-scores from the last recorded height and weight. A counterfactual theory-based product method analysis estimated the mediated effects of GWG, adjusted for maternal race, socioeconomic status, and smoking status.
Results:
Of the 766 children, 25% were overweight or obese, and among all mothers, 25 and 31% were overweight and obese, respectively. Maternal BMI was associated with an overall increase of 0.04 in offspring z-score. The proportion of the effect of maternal obesity on child age 4 obesity mediated by GWG was 8.1%.
Conclusion:
GWG, in part, mediated the relationship between maternal BMI and childhood adiposity. Even when the mediator is fixed, children are at an increased risk of a higher BMI if the mother is obese. These findings highlight an important public health education opportunity to stress the impact of a pre-pregnancy weight and excessive GWG on the risk of child obesity for all mothers.
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