The association of prenatal adiposity characteristics with early childhood overweight and obesity: findings from a large and diverse mother–child cohort

BACKGROUND: Maternal prepregnancy body mass index (ppBMI) and gestational weight gain (GWG) are risk factors for overweight and obesity (OWO) in childhood. However, a better understanding of the magnitude, timing, and mediating mechanisms of these associations can inform interventions to improve maternal and child health. METHODS: We conducted a prospective cohort study of 2899 mother-child dyads in northern Virginia (2012-2019). Maternal ppBMI was self-reported and GWG was calculated and categorized as excess (EGWG) using 2009 Institute of Medicine guidelines. Child weight was reported by parents every six months from birth to 24 months, and annually thereafter. Childhood OWO was defined as >85th percentile of WHO growth charts at 36 months. Generalized linear and mixed models estimated maternal OWO status and GWG as predictors of children's body weight Z-score and growth velocity, adjusted for covariate. Causal mediation analysis was used to quantify birth weight and early growth velocity as intervening factors. RESULTS: ; 95% CI: 1.03-1.06) and GWG was associated with childhood risk of OWO among non-Hispanic but not Hispanic mothers (interaction P = 0.02). Similarly, maternal obesity status (RR = 1.64; 95% CI: 1.26-2.13) and EGWG (RR = 1.38; 95% CI: 1.09-1.74) were associated with childhood OWO risk. Approximately 26.8% (95% CI: 14.9%-55.9%) of the ppBMI-OWO association could be attributed to birth weight. CONCLUSIONS: Maternal ppBMI and GWG were independently associated with risk of OWO in early childhood OWO, with variations by child age and ethnicity, highlighting the potential of pre- and perinatal interventions to reduce childhood obesity risk.