Increased Gestational Weight Gain is Associated with a Higher Risk of Offspring Adiposity Before Five Years of Age: A Population-Based Cohort Study

Figures & data

Table 1 Characteristics of the Study Population

Characteristics	Overall	Prepregnancy BMI Category				P-value
		Underweight	Normal weight	Overweight	Obesity
n	58,332	6464	36,143	11,449	4276
Maternal age, year	27.95 (4.06)	26.65 (3.59)	27.94 (3.97)	28.62 (4.31)	28.24 (4.37)	<0.001
Ethnic Han	55,807 (95.7%)	6198 (95.9%)	34,548 (95.6%)	10,966 (95.8%)	4095 (95.8%)	0.623
Education >12 years	36,495 (62.6%)	4169 (64.5%)	23,802 (65.9%)	6601 (57.7%)	1923 (45.0%)	<0.001
First pregnancy conception	30,647 (52.5%)	4113 (63.6%)	19,699 (54.5%)	5123 (44.7%)	1712 (40.0%)	<0.001
Multiparity	17,313 (29.7%)	1151 (17.8%)	9965 (27.6%)	4371 (38.2%)	1826 (42.7%)	<0.001
Smoking	211 (0.4%)	26 (0.4%)	117 (0.3%)	46 (0.4%)	22 (0.5%)	0.170
Total GWG, kg	14.27 (4.65)	15.54 (4.19)	14.69 (4.40)	13.33 (4.82)	11.30 (5.25)	<0.001
f-GWG, kg	7.82 (3.47)	8.77 (3.12)	8.13 (3.26)	7.15 (3.61)	5.54 (3.98)	<0.001
s-GWG, kg	6.46 (3.03)	6.77 (2.95)	6.57 (3.00)	6.19 (3.06)	5.76 (3.15)	<0.001
Gestational age at birth, week	39.56 (1.05)	39.61 (1.02)	39.59 (1.04)	39.52 (1.07)	39.42 (1.07)	<0.001
Cesarean delivery	28,760 (49.3%)	2325 (36.0%)	16,525 (45.7%)	6886 (60.1%)	3024 (70.7%)	<0.001
Infant sex (male)	29,898 (51.3%)	3209 (49.6%)	18,591 (51.4%)	5928 (51.8%)	2170 (50.7%)	0.031
Birthweight, g	3410.00 (412.97)	3262.37 (382.42)	3393.97 (396.69)	3493.57 (430.11)	3544.83 (456.21)	<0.001
AGA	48382 (82.9%)	5562 (86.0%)	30,635 (84.8%)	8979 (78.4%)	3206 (75.0%)	<0.001
SGA	2979 (5.1%)	589 (9.1%)	1834 (5.1%)	423 (3.7%)	133 (3.1%)
LGA	6971 (12.0%)	313 (4.8%)	3674 (10.2%)	2047 (17.9%)	937 (21.9%)
RWG (0−6 months)*	23,956 (48.7%)	2729 (49.8%)	14,972 (49.3%)	4579 (47.1%)	1676 (45.6%)	<0.001
BMI Z-score at birth	0.05 (0.99)	−0.32 (0.92)	0.00 (0.95)	0.27 (1.02)	0.41 (1.09)	<0.001
BMI Z-score at 0.5 years	0.67 (1.10)	0.37 (1.06)	0.65 (1.08)	0.83 (1.12)	0.95 (1.15)	<0.001
BMI Z-score at 1 year	0.57 (1.03)	0.31 (1.00)	0.53 (1.02)	0.72 (1.05)	0.85 (1.09)	<0.001
BMI Z-score at 1.5 years	0.53 (0.99)	0.23 (0.96)	0.50 (0.97)	0.69 (0.99)	0.84 (1.04)	<0.001
BMI Z-score at 2 years	0.43 (1.00)	0.17 (0.97)	0.40 (0.98)	0.58 (1.03)	0.76 (1.09)	<0.001
BMI Z-score at 2.5 years	0.21 (1.02)	−0.14 (0.95)	0.17 (0.98)	0.41 (1.05)	0.60 (1.12)	<0.001
BMI Z-score at 3 years	0.18 (1.05)	−0.14 (0.98)	0.12 (1.00)	0.38 (1.10)	0.60 (1.21)	<0.001
BMI Z-score at 4 years	0.20 (1.14)	−0.26 (0.95)	0.11 (1.07)	0.46 (1.19)	0.74 (1.36)	<0.001
BMI Z-score at 5 years	0.17 (1.25)	−0.32 (1.01)	0.05 (1.15)	0.48 (1.35)	0.84 (1.49)	<0.001

Notes: Mean (SD) or n (%). P-value refers to trend (except for birth weight, where p-value refers to distribution) from comparison among four groups: underweight, normal weight, overweight, and obesity. *RWG as an increase in BMI Z-score of >0.67 standard deviations from birth to six months of age (n=49,240). The total study sample size was 58,332 at birth, and 49,824 (85.4%), 47,388 (81.2%), 48,401 (83.0%), 47,709 (81.8%), 42,604 (73.0%), 43,948 (75.3%), 15,896 (27.3%), and 9661 (16.6%) at 0.5, 1, 1.5, 2, 2.5, 3, 4, and 5 years of age.

Abbreviations: BMI, body mass index; GWG, gestational weight gain; f-GWG, gestational weight gain during the first half of pregnancy; s-GWG, gestational weight gain during the second half of pregnancy; AGA, appropriate for gestational age; SGA, small for gestational age; LGA, large for gestational age; RWG, rapid weight gain.

Table 2 Linear Regression Analysis of the Effects of Gestational Weight Gain on Offspring BMI Z-Scores

	BMI Z-Score	β	95% CI	P-value	β	95% CI	P-value
		Univariate analysis			Multivariate analysis
Total GWG	0.5 years	0.005	0.003–0.007	<0.001	0.002	0.000–0.004	0.087
	1 year	0.011	0.009–0.013	<0.001	0.009	0.007–0.012	<0.001
	1.5 years	<0.001	−0.002–0.002	0.901	−0.001	−0.003–0.002	0.601
	2 years	0.012	0.010–0.014	<0.001	0.012	0.010–0.015	<0.001
	2.5 years	−0.001	−0.003–0.001	0.456	0.001	−0.001–0.003	0.483
	3 years	0.010	0.008–0.013	<0.001	0.013	0.011–0.016	<0.001
	4 years	0.004	0.000–0.008	0.043	0.010	0.006–0.014	<0.001
	5 years	0.002	−0.004–0.008	0.452	0.007	0.001–0.013	0.015
f-GWG	0.5 years	0.005	0.002–0.008	0.001	0.002	−0.001–0.005	0.208
	1 year	0.011	0.009–0.014	<0.001	0.011	0.008–0.014	<0.001
	1.5 years	0.001	−0.001–0.004	0.300	0.001	−0.002–0.004	0.390
	2 years	0.016	0.014–0.019	<0.001	0.017	0.015–0.020	<0.001
	2.5 years	0.002	−0.001–0.005	0.206	0.005	0.002–0.008	0.003
	3 years	0.014	0.011–0.017	<0.001	0.018	0.015–0.021	<0.001
	4 years	0.005	0.000–0.011	0.051	0.014	0.009–0.020	<0.001
	5 years	0.004	−0.004–0.012	0.344	0.013	0.005–0.021	0.001
s-GWG	0.5 years	0.005	0.002–0.009	0.001	0.002	−0.001–0.005	0.256
	1 year	0.010	0.007–0.014	<0.001	0.007	0.004–0.011	<0.001
	1.5 years	−0.002	−0.005–0.002	0.319	−0.003	−0.006–0.000	0.085
	2 years	0.006	0.003–0.009	<0.001	0.006	0.003–0.009	<0.001
	2.5 years	−0.004	−0.008–−0.001	0.009	−0.004	−0.007–−0.001	0.022
	3 years	0.007	0.003–0.010	<0.001	0.007	0.004–0.011	<0.001
	4 years	0.003	−0.003–0.009	0.893	0.005	−0.001–0.011	0.131
	5 years	<0.001	−0.008–0.009	0.923	0.001	−0.008–0.009	0.899

Notes: Univariate regression analysis, with gestational weight gain as the dependent variable. Multivariable regression analysis, adjusting for maternal age, prepregnancy body mass index, maternal height, smoking, cesarean section, gestational age at birth, birth weight, birth length, mode of infant feeding during 0–6 months (exclusively breastfeeding, mixed feeding, or formula only). The total study sample size was 58,332 at birth, and 49,824 (85.4%), 47,388 (81.2%), 48,401 (83.0%), 47,709 (81.8%), 42,604 (73.0%), 43,948 (75.3%), 15,896 (27.3%), and 9661 (16.6%) at 0.5, 1, 1.5, 2, 2.5, 3, 4, and 5 years of age.

Abbreviations: BMI, body mass index; CI, confidence interval; GWG, gestational weight gain; f-GWG, weight gain during the first half of pregnancy; s-GWG, weight gain during the second half of pregnancy.

Figure 1 Forest plot of odds ratios (95% confidence intervals) for the association of gestational weight gain with offspring adiposity.

Notes: The total study sample size was 58,332 at birth, and 49,824 (85.4%), 47,388 (81.2%), 48,401 (83.0%), 47,709 (81.8%), 42,604 (73.0%), 43,948 (75.3%), 15,896 (27.3%), and 9661 (16.6%) at 0.5, 1, 1.5, 2, 2.5, 3, 4, and 5 years of age. Squares (Total GWG), inverted triangle (weight gain during the first half of pregnancy), and upright triangle (weight gain during the second half of pregnancy) represent the point estimate, and the bars are the 95% confidence intervals. Multivariable regression analysis, adjusting for maternal age, prepregnancy body mass index, maternal height, smoking, cesarean section, gestational age at birth, birth weight, birth length, mode of infant feeding during 0–6 months (exclusively breastfeeding, mixed feeding, or formula only).

Abbreviations: OR, odds ratios; CI, confidence interval; GWG, gestational weight gain; f-GWG, weight gain during the first half of pregnancy; s-GWG, weight gain during the second half of pregnancy.

Figure 2 Heatmap of the prevalence of offspring adiposity at 0.5−5 years of age.

Notes: Values represent the prevalence of offspring adiposity for each body mass index and weight gain category. The total study sample size was 58,332 at birth, and 49,824 (85.4%), 47,388 (81.2%), 48,401 (83.0%), 47,709 (81.8%), 42,604 (73.0%), 43,948 (75.3%), 15,896 (27.3%), and 9661 (16.6%) at 0.5, 1, 1.5, 2, 2.5, 3, 4, and 5 years of age. BMI groups were commented the Chinese BMI criteria, underweight (BMI <18.5 kg/m²), normal weight (BMI 18.5−23.9 kg/m²), overweight (BMI 24.0− 27.9 kg/m²), and obesity (BMI ≥ 28.0 kg/m²). According to the IOM guidelines, participants were divided into three categories based on maternal weight gain during the first half of pregnancy.

Abbreviations: f-GWG, weight gain during the first half of pregnancy; AGA, appropriate for gestational age.

Table 3 Odds Ratios and 95% Confidence Intervals for the Effects of Maternal Weight Gain During the First Half of Pregnancy on Offspring Adiposity

Childhood Adiposity	Insufficient Weight Gain			Excessive Weight Gain
	OR	95% CI of OR	P-value	OR	95% CI of OR	P-value
Univariate analysis
0.5 years	0.981	0.905 − 1.063	0.634	1.140	1.027 − 1.231	0.634
1 year	1.020	0.926 − 1.125	0.685	1.275	1.183 − 1.374	<0.001
1.5 years	1.017	0.918 − 1.127	0.750	1.277	1.180 − 1.381	<0.001
2 years	0.891	0.795 − 0.997	0.045	1.303	1.198 − 1.417	<0.001
2.5 years	1.108	0.963 − 1.274	0.151	1.328	1.191 − 1.480	<0.001
3 years	1.018	0.883 − 1.174	0.809	1.418	1.273 − 1.580	<0.001
4 years	1.100	0.894 − 1.354	0.366	1.341	1.139 – 1.579	<0.001
5 years	1.259	0.986 − 1.608	0.064	1.410	1.162 – 1.710	<0.001
Multivariate analysis
0.5 years	0.954	0.879 − 1.035	0.259	0.970	0.910 − 1.033	0.340
1 year	0.981	0.888 − 1.084	0.707	1.083	1.003 − 1.169	0.042
1.5 years	0.982	0.884 − 1.090	0.729	1.080	0.996 − 1.170	0.062
2 years	0.842	0.750 − 0.946	0.004	1.087	0.998 − 1.185	0.057
2.5 years	1.025	0.889 − 1.182	0.733	1.093	0.978 − 1.221	0.116
3 years	0.921	0.188 – 1.055	0.215	1.158	1.036 − 1.293	0.009
4 years	0.980	0.792 − 1.213	0.851	1.094	0.925 − 1.294	0.294
5 years	1.056	0.819 − 1.361	0.674	1.107	0.906 − 1.352	0.322

Notes: Univariate regression analysis, with weight gain categories during the first half of pregnancy as the dependent variable. Multivariable regression analysis, adjusting for maternal age, pre-pregnancy body mass index, maternal height, smoking, cesarean section, gestational age at birth, birth weight, birth length, mode of infant feeding during 0–6 months (exclusively breastfeeding, mixed feeding, or formula only). According to the Institute of Medicine (IOM)’s recommendations, we divided participants into three categories: inadequate, appropriate (ref), or excessive, based on weight gain during the first half of gestation. The total study sample size was 58,332 at birth, and 49,824 (85.4%), 47,388 (81.2%), 48,401 (83.0%), 47,709 (81.8%), 42,604 (73.0%), 43,948 (75.3%), 15,896 (27.3%), and 9661 (16.6%) at 0.5, 1, 1.5, 2, 2.5, 3, 4, and 5 years of age.

Abbreviations: OR, odds ratios; CI, confidence interval.