Associations of maternal prepregnancy body mass index and gestational weight gain with adult offspring cardiometabolic risk factors: the Jerusalem Perinatal Family Follow-up Study

Abstract

Background: Accumulating evidence demonstrates that both maternal prepregnancy body mass index (mppBMI) and gestational weight gain (GWG) are associated with adult offspring adiposity. However, whether these maternal attributes are related to other cardiometabolic risk factors in adulthood has not been comprehensively studied.

Methods and results: We used a birth cohort of 1400 young adults born in Jerusalem who had extensive archival data and clinical information at 32 years of age to prospectively examine the associations of mppBMI and GWG with adiposity and related cardiometabolic outcomes. Greater mppBMI, independently of GWG and confounders, was significantly associated with higher offspring BMI, waist circumference, systolic and diastolic blood pressures, insulin, and triglycerides and with lower high-density lipoprotein cholesterol. For example, the effect sizes were translated to nearly 5 kg/m(2) higher mean BMI, 8.4 cm higher waist circumference, 0.13 mmol/L (11.4 mg/dL) higher triglycerides, and 0.10 mmol/L (3.8 mg/dL) lower high-density lipoprotein cholesterol among offspring of mothers within the upper mppBMI quartile (mppBMI >26.4 kg/m(2)) compared with the lower quartile (mppBMI <21.0 kg/m(2)). GWG, independently of mppBMI, was positively associated with offspring adiposity; differences of 1.6 kg/m(2) in BMI and 2.4 cm in waist were observed when offspring of mothers in the upper (GWG >14 kg) and lower (GWG <9 kg) quartiles of GWG were compared. Further adjustment for offspring adiposity attenuated the observed associations to the null.

Conclusions: Maternal size both before and during pregnancy is associated with cardiometabolic risk factors in young adult offspring. The associations appear to be driven mainly by offspring adiposity. Future studies that explore mechanisms underlying the intergenerational cycle of obesity are warranted to identify potentially novel targets for cardiometabolic risk-reduction interventions.

Figure 1

Adjusted means of offspring selected cardio-metabolic outcomes at age 32 by quartiles of maternal pre-pregnancy BMI and gestational weight gain. Maternal pre-pregnancy BMI (mppBMI) and gestational weight gain (GWG) were grouped by quartiles of distribution: mppBMI - Q1: <21.0kg/m², Q2: 21.0-23.8kg/m², Q3: 23.9-26.4kg/m², Q4: >26.4kg/m²; GWG -Q1: <9kg, Q2: 9-11kg, Q3: 12-14kg, Q4: >14kg. Estimates for the categorical variables from linear regression models adjusted for ethnicity, gender, characteristics at time of birth (i.e. parity, mother’s age, maternal smoking, SES, mother’s years of education, maternal medical condition, birth weight and gestational week) and offspring characteristics at age 32 (i.e. smoking status, physical activity, years of education) were used to determine adjusted means and standard errors (SEs) for offspring cardio-metabolic outcomes for all subjects within the same quartile. Error bars represent SEs. Difference between each value displayed on the Y axis corresponds to approximately two standard errors of the respective cardio-metabolic outcome. Conversions: insulin, μU/mL=(pmol/L)/6.945; triglycerides, mg/dL=(mmol/L)/0.0113.