. 2018 Oct:201:69-77.e8.

doi: 10.1016/j.jpeds.2018.05.041. Epub 2018 Jun 28.

Pre-, Perinatal, and Parental Predictors of Body Mass Index Trajectory Milestones

Izzuddin M Aris¹, Sheryl L Rifas-Shiman², Ling-Jun Li³, Ken Kleinman⁴, Brent A Coull⁵, Diane R Gold⁶, Marie-France Hivert⁷, Michael S Kramer⁸, Emily Oken⁹

Affiliations

¹ Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA; Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Agency for Science, Technology and Research, Singapore Institute for Clinical Sciences, Singapore, Singapore. Electronic address: izzuddin_aris@harvardpilgrim.org.
² Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.
³ Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA; Division of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore, Singapore; Obstetrics and Gynecology, Academic Clinician Programme, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore.
⁴ Department of Biostatistics, School of Public Health and Human Sciences, University of Massachusetts Amherst, Amherst, MA.
⁵ Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA.
⁶ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Environmental Medicine, Harvard T.H. Chan School of Public Health, Boston, MA.
⁷ Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA; Diabetes Unit, Massachusetts General Hospital, Boston, MA.
⁸ Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Québec, Canada.
⁹ Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.

PMID: 29960766
PMCID: PMC6153023
DOI: 10.1016/j.jpeds.2018.05.041

Pre-, Perinatal, and Parental Predictors of Body Mass Index Trajectory Milestones

Izzuddin M Aris et al. J Pediatr. 2018 Oct.

. 2018 Oct:201:69-77.e8.

doi: 10.1016/j.jpeds.2018.05.041. Epub 2018 Jun 28.

Authors

Izzuddin M Aris¹, Sheryl L Rifas-Shiman², Ling-Jun Li³, Ken Kleinman⁴, Brent A Coull⁵, Diane R Gold⁶, Marie-France Hivert⁷, Michael S Kramer⁸, Emily Oken⁹

Affiliations

¹ Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA; Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Agency for Science, Technology and Research, Singapore Institute for Clinical Sciences, Singapore, Singapore. Electronic address: izzuddin_aris@harvardpilgrim.org.
² Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.
³ Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA; Division of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore, Singapore; Obstetrics and Gynecology, Academic Clinician Programme, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore.
⁴ Department of Biostatistics, School of Public Health and Human Sciences, University of Massachusetts Amherst, Amherst, MA.
⁵ Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA.
⁶ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Environmental Medicine, Harvard T.H. Chan School of Public Health, Boston, MA.
⁷ Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA; Diabetes Unit, Massachusetts General Hospital, Boston, MA.
⁸ Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Québec, Canada.
⁹ Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.

PMID: 29960766
PMCID: PMC6153023
DOI: 10.1016/j.jpeds.2018.05.041

Abstract

Objective: To assess associations of pre-, perinatal, and parental factors with age and magnitude at body mass index (BMI) peak and rebound.

Study design: Among 1681 children with BMI data from birth to mid-childhood in Project Viva, we fitted individual BMI trajectories using mixed-effect models with natural cubic spline functions and estimated age and magnitude at peak in infancy and rebound in early childhood. We used stepwise multivariable regression to identify predictors of peak and rebound in the 1354 (63.6%) children with estimable trajectory milestones.

Results: The mean (SD) of age at BMI peak was 8.4 (2.7) months and at rebound was 59.8 (19.6) months, and the mean (SD) of magnitude at peak was 18.0 (1.4) kg/m² and at rebound was 15.9 (1.2) kg/m². Girls had a later age at peak, earlier age at rebound, and lower magnitudes at peak and rebound than boys. Maternal isolated hyperglycemia (vs normoglycemia: β 0.7 months [95% CI 0.2-1.2]) and pre-eclampsia (vs normal blood pressure: 1.6 months [0.8-2.4]) were associated with a later peak, and impaired glucose tolerance (vs normoglycemia: -0.5 kg/m² [-0.9, -0.1]) was associated with a lower magnitude at peak. Greater maternal first-trimester weight gain, smoking during pregnancy, no breastfeeding, parental obesity, and no university education were associated with greater BMI at rebound.

Conclusions: We have identified modifiable prenatal and parental predictors of BMI peak in infancy and rebound in childhood. Early-life interventions that address these factors may be effective in changing BMI peak and rebound and potentially preventing later obesity.

Keywords: body mass index peak; body mass index rebound; lifecourse epidemiology; predictors.

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Conflict of interest statement

The other authors declare no conflicts of interest.

Figures

**Figure 1 online**
Flowchart of study sample

**Figure 2 online**
Plot of residual BMI values (observed – predicted BMI values) over age (A) without accounting for heteroskedasticity in residual errors, and (B) accounting for heteroskedasticity in residual errors

**Figure 3 online**
Fitted BMI trajectories of 10 children with estimable BMI peak and rebound, without estimable BMI peak (i.e. showed no decline in BMI after the rise in infancy) and without estimable BMI rebound (i.e. showed no rise in BMI after the decline in early -childhood)

**Figure 4**
Estimated BMI trajectories from birth to mid-childhood according to (A) parental obesity categories, (B) maternal hypertensive disorders of pregnancy, (C) maternal glucose tolerance status, (D) parental education level and (E) maternal smoking history during pregnancy. BMI trajectories were derived using mixed-effects models with natural cubic spline functions for age

See this image and copyright information in PMC

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Pre-, Perinatal, and Parental Predictors of Body Mass Index Trajectory Milestones

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Pre-, Perinatal, and Parental Predictors of Body Mass Index Trajectory Milestones

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Conflict of interest statement

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