ArticlesThe association between pregnancy weight gain and birthweight: a within-family comparison
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
References (46)
- et al.
Fetal nutrition and cardiovascular disease in adult life
Lancet
(1993) - et al.
Childhood obesity: public-health crisis, common sense cure
Lancet
(2002) - et al.
Role of the prenatal environment in the development of obesity
J Pediatr
(1998) - et al.
Maternal body size and birth weight: can insulin or adipokines do better?
Metabolism
(2006) - et al.
The reliability and validity of birth certificates
J Obstet Gynecol Neonatal Nurs
(2006) Hormones and insulin resistance during pregnancy
Lancet
(2003)- et al.
Maternal hormones linking maternal body mass index and dietary intake to birth weight
Am J Clin Nutr
(2008) - et al.
Pregnancy outcomes related to gestational weight gain in women defined by their body mass index, parity, height, and smoking status
Am J Clin Nutr
(2009) - et al.
Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesis
Diabetologia
(1992) - et al.
Trajectories of growth among children who have coronary events as adults
N Engl J Med
(2005)
Obesity and early life
Obes Rev
Size at birth, childhood growth and obesity in adult life
Int J Obes Relat Metab Disord
Fetal origins of obesity
Obes Res
Birth weight as a predictor of type 2 diabetes mellitus: the U-shaped curve
Curr Diab Rep
Gestational obesity accentuates obesity in obesity-prone progeny
Am J Physiol
Parental obesity and overweight affect the body-fat accumulation in the offspring: the possible effect of a high-fat diet through epigenetic inheritance
Obes Rev
Effect of birth size and proportionality on BMI and skinfold thickness in early adolescence: prospective birth cohort study
Eur J Clin Nutr
The impact of birth weight on prostate cancer incidence and mortality in a population-based study of men born in 1913 and followed up from 50 to 85 years of age
Prostate
Maternal gestational diabetes, birth weight, and adolescent obesity
Pediatrics
Birth weight and subsequent risk of childhood primary brain tumors: a meta-analysis
Am J Epidemiol
Birth weight as a risk factor for childhood leukemia: a meta-analysis of 18 epidemiologic studies
Am J Epidemiol
Early life risk factors in cancer: the relation of birth weight to adult obesity
Int J Cancer
Childhood predictors of adult obesity: a systematic review
Int J Obes Relat Metab Disord
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2021, Journal of Reproductive ImmunologyCitation Excerpt :These authors concluded that these differences in birthweights (BW) were associated with maternal weight and gestational weight gain (GWG). Since then, many epidemiological studies have confirmed this phenomenon of lighter babies in nulliparous women vs multiparas (Ludwig and Currie, 2010; Shah, 2010; Hinkle et al., 2014; Kozuki et al., 2013; Terán et al., 2017; Meller et al., 2018; Falcão et al., 2020; Garces et al., 2020). Bohn et al. (2020) conducted in a recent study in Germany that birth order is an independent factor of heavier birthweights in second and third siblings.