Elsevier

The Lancet

Volume 376, Issue 9745, 18–24 September 2010, Pages 984-990
The Lancet

Articles
The association between pregnancy weight gain and birthweight: a within-family comparison

https://doi.org/10.1016/S0140-6736(10)60751-9Get rights and content

Summary

Background

Excessive weight gain during pregnancy seems to increase birthweight and the offspring's risk of obesity later in life. However, this association might be confounded by genetic and other shared effects. We aimed to examine the association between maternal weight gain and birthweight using state-based birth registry data that allowed us to compare several pregnancies in the same mother.

Methods

In this population-based cohort study, we used vital statistics natality records to examine all known births in Michigan and New Jersey, USA, between Jan 1, 1989, and Dec 31, 2003. From an initial sample of women with more than one singleton birth in the database, we made the following exclusions: gestation less than 37 weeks or 41 weeks or more; maternal diabetes; birthweight less than 500 g or more than 7000 g; and missing data for pregnancy weight gain. We examined how differences in weight gain that occurred during two or more pregnancies for each woman predicted the birthweight of her offspring, using a within-subject design to reduce confounding to a minimum.

Findings

Our analysis included 513 501 women and their 1 164 750 offspring. We noted a consistent association between pregnancy weight gain and birthweight (β 7·35, 95% CI 7·10–7·59, p<0·0001). Infants of women who gained more than 24 kg during pregnancy were 148·9 g (141·7–156·0) heavier at birth than were infants of women who gained 8–10 kg. The odds ratio of giving birth to an infant weighing more than 4000 g was 2·26 (2·09–2·44) for women who gained more than 24 kg during pregnancy compared with women who gained 8–10 kg.

Interpretation

Maternal weight gain during pregnancy increases birthweight independently of genetic factors. In view of the apparent association between birthweight and adult weight, obesity prevention efforts targeted at women during pregnancy might be beneficial for offspring.

Funding

US National Institutes of Health.

Introduction

The fetal origin of adult disease, or prenatal programming, has been the subject of much study during the past two decades. Compelling evidence exists in support of the hypothesis, proposed by Barker and colleagues,1 that undernutrition during pregnancy and low birthweight increase risk of diabetes and cardiovascular disease in adulthood.2, 3 Indeed, the adverse effect of perinatal undernutrition on long-term health might equal or exceed that of many conventional risk factors measured in adulthood. In view of the rising prevalence of obesity, a variant of the original Barker hypothesis has been formulated wherein overnutrition during pregnancy and high birthweight might cause obesity and related disorders in adulthood.4, 5, 6, 7, 8, 9 According to this idea, excessive maternal bodyweight or weight gain during pregnancy perturbs the intrauterine environment during fetal development, producing permanent changes in the hypothalamus, pancreatic islet cells, adipose tissue, or other biological systems that regulate bodyweight. Research in animals has provided an experimental basis for this hypothesis.10, 11 Levin and Govek10 studied diet-sensitive female rats on standard or high-energy diets before and during gestation. Progeny of the mothers in the high-energy diet group gained more weight and had higher leptin concentrations than did progeny of mothers in the standard diet group, even though offspring from both groups were fed the same diet. In man, high birthweight predicts body-mass index (BMI) and adverse health outcomes later in life.12, 13, 14, 15, 16, 17, 18, 19, 20, 21

Results of observational studies have generally shown direct associations between maternal bodyweight or weight gain during pregnancy and birthweight or infant adiposity.22, 23, 24, 25, 26 Moreover, maternal adiposity tends to be more strongly related to birthweight27, 28 or childhood BMI29 than does paternal adiposity. However, these studies involving comparisons between individuals have fundamental limitations, most notably confounding due to genetic and environmental factors. For example, excessive maternal weight gain might be related to high birthweight simply because a mother and her infant share obesity-related genes. Therefore, we aimed to examine the association between maternal weight gain, as a measure of overnutrition during pregnancy, and birthweight using state-based birth registry data that allowed comparison of outcomes from several pregnancies in the same mother. This within-subject design serves to reduce or eliminate potential confounding by genetic, sociodemographic, and other individual characteristics.

Section snippets

Study design and population

Data for this population-based cohort study were from individual vital statistics natality records covering all births in Michigan and New Jersey, USA, from Jan 1, 1989, to Dec 31, 2003. These records provide information about birth outcomes and maternal characteristics, including weight gain during pregnancy. A summary of the data files, including covariates, is available from the US National Center for Health Statistics. The state of Michigan provided a file that identified children born to

Results

From an initial sample size of 2 359 843 singleton births, we made the following exclusions: gestational age less than 37 weeks or 41 weeks or more (358 833 births); maternal diabetes (75 665 births); extreme values for birthweight (2225 births); missing data for pregnancy weight gain (192 810 births); and births to mothers with only one child in the database (1 204 249 births). The final study sample consisted of 1 164 750 singleton births to 513 501 mothers. The table shows descriptive

Discussion

Weight gain during pregnancy has been associated with high birthweight and measures of adiposity early in life. Our study, using a state-based registry with more than one million singleton births, provides evidence for a causal association that is independent of shared genes. We noted that every kg increase in pregnancy weight gain increases birthweight by about 7·35 g, and that variation in pregnancy weight gain through the recorded range can affect birthweight by about 200 g. Because high

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