The impact of maternal gestational weight gain on cardiometabolic risk factors in children

Abstract

Aims/hypothesis: Accumulating evidence suggests an impact of gestational weight gain (GWG) on pregnancy outcomes; however, data on cardiometabolic risk factors later in life have not been comprehensively studied. This study aimed to evaluate the relationship between GWG and cardiometabolic risk in offspring aged 7 years.

Methods: We included a total of 905 mother-child pairs who enrolled in the follow-up visit of the multicentre Hyperglycemia and Adverse Pregnancy Outcome study, at the Hong Kong Centre. Women were classified as having gained weight below, within or exceeding the 2009 Institute of Medicine (IOM) guidelines. A standardised GWG according to pre-pregnancy BMI categories was calculated to explore for any quadratic relationship.

Results: Independent of pre-pregnancy BMI, gestational hyperglycaemia and other confounders, women who gained more weight than the IOM recommendations had offspring with a larger body size and increased odds of adiposity, hypertension and insulin resistance (range of p values of all the traits: 4.6 × 10^-9 < p < 0.0390) than women who were within the recommended range of weight gain during pregnancy. Meanwhile, women who gained less weight than outlined in the recommendations had offspring with increased risks of hypertension and insulin resistance, compared with those who gained weight within the recommended range (7.9 × 10^-3 < p < 0.0477). Quadratic relationships for diastolic blood pressure, AUC for insulin, pancreatic beta cell function and insulin sensitivity index were confirmed in the analysis of standardised GWG (1.4 × 10^-3 < p_quadratic < 0.0282). Further adjustment for current BMI noticeably attenuated the observed associations.

Conclusions/interpretation: Both excessive and inadequate GWG have independent and significant impacts on childhood adiposity, hypertension and insulin resistance. Our findings support the notion that adverse intrauterine exposures are associated with persistent cardiometabolic risk in the offspring.

Keywords: Adiposity; Cardiometabolic risk factors; Chinese children; Gestational weight gain; Hypertension; Insulin resistance; Maternal pre-pregnancy BMI.

Fig. 1

(a) Plasma glucose and (b) insulin concentrations at 0, 15, 30, 60 and 120 min during the OGTTs, stratified by IOM recommendations of GWG categories. Data are presented as mean ± SD and median ± absolute median deviation for glucose and insulin concentration, respectively, according to the time intervals. Black triangles with dotted line, group below recommendations; black circles with solid line, group within recommendations; black squares with dashed line, group exceeding recommendations. *p < 0.05 for the association across the IOM categories at each time point, with adjustments for children’s sex and age (ANOVA)