vor 8 Jahren
Background: Childhood overweight has become a growing public health challenge. It has been suggested that inadequate or excessive gestational weight gain (GWG) may result in permanent metabolic and neuronal changes in the developing fetus. Although effects of GWG on birth weight are established, less is known about its effects on the long-term weight status of the child. In 2009, the Institute of Medicine (IOM) and the National Research Council (NRC) published recommendations for trimester-specific and total GWG depending on maternal pre-pregnancy body mass index (BMI). It is unknown, however, how well the trimester-specific IOM/NRC recommendations for GWG identify women at risk of total GWG outside those recommendations. It is also unknown, whether a reverse from excessive GWG in early or mid-pregnancy reduces the risk of childhood overweight.
Aims: Contribute to the existing knowledge on the association between GWG and childhood overweight (study 1). Examine whether and to what extent inadequate or excessive total GWG can be predicted in the first, second and third trimester, based on trimester-specific GWG cut-off values (study 2). Investigate whether a reverse from excessive GWG before the third trimester is associated with a risk reduction of childhood overweight (study 3).
Methods: A retrospective cohort study was conducted. The sample was recruited prior to the school entry health examinations in 2009 and 2010. Data on maternal weight was derived from medical records and child’s anthropometric data were measured. From 11,730 mother-child pairs available, 6,837 were included in study 1, 7,962 in study 2 and 6,767 in study 3. To investigate the effect of total GWG, overall and stratified by maternal pre-pregnancy BMI, and reverse from excessive GWG in early or mid-pregnancy, multivariate logistic regression analyses were conducted including a large number of potential confounders. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. The prognostic values of lower and upper trimester-specific GWG cut-off values were examined by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and positive diagnostic likelihood ratio (DLR+).
Results: 1) Overall, the risk of childhood overweight increased by 4% per additional kg GWG (OR: 1.04, 95% CI: 1.02, 1.05). Excessive total GWG was associated with a 57 % higher risk of childhood overweight (OR: 1.57, 95% CI: 1.30, 1.91). Stratified by maternal pre-pregnancy BMI, significant associations between excessive GWG and childhood overweight found among normal weight mothers (OR: 1.29, 95% CI: 1.01, 1.66) and overweight mothers (OR: 1.64, 95% CI: 1.06, 2.63). 2) Prediction of total GWG within the IOM/NRC recommendations increased with gestational age and was related to the maternal BMI category and outcome. In trimester two, inadequate total GWG could be predicted with a sensitivity of 49% and 60.2% and a PPV of 72.1% and 68.3% in underweight and normal-weight mothers, respectively. Excessive GWG could be predicted with a sensitivity of 72.7% and 70.4% and a PPV of 94.3% and 93.3% in overweight and obese mothers, respectively. 3) Compared to mothers who always gained below the excessive GWG cut-off values (reference category), children of mothers with excessive GWG in the third and any previous trimester had a 42% higher risk of overweight at school entry (OR: 1.42, 95% CI: 1.17, 1.72). There was a 39% higher risk if mothers gained excessively in the third trimester only (OR: 1.39, 95% CI: 1.06, 1.82). No higher risk was observed for mothers who reversed from excessive GWG before the third trimester compared to reference category.

Conclusions: Excessive total GWG appears to be a risk factor for childhood overweight. It can be well predicted from the second trimester on, in particular in overweight and obese women. Reverse from excessive GWG before the third trimester may reduce the risk of childhood overweight. More research is required to further establish the strength of association between GWG and childhood overweight. It appears possible to identify women at risk of gaining outside the recommendations as early as the second trimester. Those women should be allocated to appropriate weight modifying measures. The long-term benefit of GWG modifying measures on childhood overweight, especially a reverse from excessive GWG in the first or second trimester, should be investigated in randomised controlled studies.

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