Pregestational BMI and higher offspring's risk of overweight/obesity in smoker and non-smoker mothers

Abstract

Objective: To assess the association between pregestational BMI and offspring's risk of overweight/obesity after accounting for the most important confounders, especially maternal smoking habit.

Design: Prospective cohort study.

Setting: The Seguimiento Universidad de Navarra (SUN) study is a prospective cohort of Spanish graduates with more than 22 000 participants nationwide. Recruitment started in 1999, and it is permanently open. Data on diet, lifestyle and clinical diagnoses are collected at baseline and every 2 years.

Participants: Women from the SUN cohort who reported at least one pregnancy during follow-up (n 3496) were invited to this study. Among them, 1527 agreed to participate and completed an additional more detailed online questionnaire on their pregnancy history and their offspring's nutritional status.

Results: After excluding 165 children, we analysed data of 2791 participants born to 1485 mothers and observed that each 5 kg/m2 increase in pregestational BMI was associated with a 0·22 (95 % CI 0·15, 0·29) higher z-score in offspring's BMI and higher risk of overweight/obesity (multivariable-adjusted relative risk (RR) 1·57 (95 % CI 1·39, 1·77)) in childhood or adolescence. Furthermore, we observed stronger association in children born to smoker mothers (RR 1·91; 95 % CI 1·48, 2·46) than from non-smoker mothers (RR 1·51; 95 % CI 1·31, 1·73) (Pfor interaction = 0·02).

Conclusions: We found a synergistic interaction between pregestational BMI and maternal smoking habit on offspring's z-score of the BMI and in their risk of overweight/obesity. Although further research is needed to analyse dose-response relationships, these findings reinforce the importance of promoting healthy lifestyles in pregnant women in order to prevent childhood obesity.

Trial registration: ClinicalTrials.gov NCT02669602.

Keywords: Childhood obesity; Interaction; Maternal BMI; Smoking.

Fig. 1

Difference and 95 % CI in offspring’s z-score of the BMI associated with maternal pregestational BMI (kg/m²). Pregestational BMI of 22 kg/m² was used as reference. The histogram represents the frequency distribution of maternal pregestational BMI (kg/m²)

Fig. 2

Risk ratio (RR) and 95 % CI for offspring’s overweight or obesity associated with each additional 5 kg/m² increase in maternal pregestational BMI by maternal smoking habit (P_{for interaction} = 0·02)