Prenatal weight gain and children's weight trajectories

The Pattern and Timing of Weight Changes in Pregnancy Impact Child Growth and Weight Trajectories for Girls but not Boys

Elizabeth M. Widen, Natalie Burns, Michael Daniels, Grant Backlund, Rachel Rickman, Saralyn Foster, Amy R. Nichols, Lori A. Hoepner, Eliza W. Kinsey, Judyth Ramirez-Carvey, Abeer Hassoun, Frederica P. Perera, Radek Bukowski, and Andrew G. Rundle

Introduction

Obesity in the United States has increased substantially over the past several decades among children, adolescents, and adults. Current obesity prevalence in the U.S. is 14% among preschool aged children, 18% among school aged children, 21% among adolescents, and 40% among adults. Moreover, a higher percentage of non-Hispanic Black children and adults and Latinx children and adults experience obesity compared to non-Hispanic White children and adults.

Pregnancy is a critical period that can shape later health and obesity risk for both the woman carrying the pregnancy and the eventual child. The U.S. Institute of Medicine has developed guidelines for weight gain during pregnancy – also known as prenatal weight gain – to optimize maternal and child health outcomes. However, over half of pregnant women in the U.S. gain more weight than recommended. In addition, women with overweight or obesity are more likely than women with normal weight to gain above recommendations.

Substantial research has shown that women who have excessive prenatal weight gain are more likely than women who gained within the recommended guidelines during pregnancy to have newborns with higher adiposity – which means the babies have too much body fat relative to their body size. Longer-term effects of excessive prenatal weight gain have been linked to childhood overweight, obesity, and unfavorable body composition such as a high percentage of body fat. Excessive weight gain during pregnancy has also been linked to children having higher levels of cholesterol and other measures that may increase a person’s future risk for heart disease, diabetes, and stroke. These risk factors are also known as adverse cardiometabolic outcomes.

The Institute of Medicine recommends that researchers explore how the pattern of prenatal weight gain, rather than total prenatal weight gain, impacts children’s health outcomes, including by focusing on children’s longer-term growth and development.

Responding to this call, the authors designed a study to understand how patterns of weight change over the course of pregnancy are linked to body composition and growth patterns of the children born of these pregnancies. After enrolling Black and Latinx pregnant women in New York City during pregnancy, the authors followed the children from ages 5 to 14. They measured each woman’s prenatal weight gain over the course of pregnancy, as well as her child’s body mass index (BMI), body fat percentage, waist circumference, cholesterol, and other cardiometabolic measures.

Key Findings

• Women’s prenatal weight changes affected their daughters’ growth and body fat changes across childhood and early adolescence, but not their sons’. See Figure
• Girls who were exposed to rapid prenatal weight gain early and moderate weight gain late in pregnancy had the highest BMIs, largest waist circumferences and highest body fat percentages from ages 5 to 14. See Figure

Note: BMI = body mass index

Policy Implications

This work provides more evidence on how the prenatal period shapes the health of children as they age. The authors found that, unlike boys, girls exposed to high prenatal weight changes are likely more vulnerable to excess body fat across childhood and into early adolescence. This work and similar research from the authors conducted with different groups of people will very likely be included in future Institute of Medicine recommendations for healthy weight changes throughout pregnancy. The focus should include the pattern and timing of weight changes during pregnancy, rather than simply a total amount gained.

This work also provides evidence to support tailoring interventions for pregnant people and children. These findings highlight the need to develop personalized interventions and policies to prevent obesity. In particular, they point to the need for obesity prevention for the children, especially girls, of mothers who experience unfavorable weight change patterns during pregnancy.

Reference

Widen E.M., Burns, N., Daniels, M., Backlund, G., Rickman, R., Foster, S., Nichols, A.R, Hoepner, L.A., Kinsey, E.W., Ramirez-Carvey, J., Hassoun, A., Perera, F.P., Bukowski, R. & Rundle, A.G. (2022). Gestational weight change and childhood body composition trajectories from pregnancy to early adolescence. Obesity 93(1):e87-e102. https://onlinelibrary.wiley.com/doi/10.1002/oby.23367

Suggested Citation

Widen E.M., Burns, N., Daniels, M., Backlund, G., Rickman, R., Foster, S., Nichols, A.R, Hoepner, L.A., Kinsey, E.W., Ramirez-Carvey, J., Hassoun, A., Perera, F.P., Bukowski, R. & Rundle, A.G. (2022). The pattern and timing of weight changes in pregnancy impact child growth and weight trajectories, especially for girls. PRC Research Brief 7(3). http://dx.doi.org/10.26153/tsw/40217

About the Authors

Elizabeth M. Widen (elizabeth.widen@austin.utexas.edu) is an assistant professor in the Department of Nutritional Sciences, faculty at Dell Pediatric Research Institute, affiliate faculty in the Departments of Women’s Health and Pediatrics at Dell Medical School and a faculty scholar in the Population Research Center at The University of Texas at Austin; Natalie Burns is a doctoral student, Michael Daniels is a professor and Andrew Banks Family Endowed Chair, and Grant Backlund is a doctoral student in the Department of Statistics at the University of Florida; Rachel Rickman is a PhD candidate in the Department of Nutritional Sciences and Dell Pediatric Research Institute at UT Austin; Saralyn Foster and Amy R. Nichols are PhD candidates in the Department of Nutritional Sciences and Dell Pediatric Research Institute at UT Austin; Lori A. Hoepner is an assistant professor in the Department of Environmental and Occupational Health Sciences at SUNY Downstate Health Sciences University and a deputy director of organizational and analytical data management at the Columbia Center for Children’s Environmental Health; Eliza W. Kinsey is an assistant professor at the University of Pennsylvania Perelman School of Medicine; Judyth Ramirez-Carvey is project coordinator at the Columbia Center for Children’s Environmental Health, Mailman School of Public Health, Columbia University Medical Center; Abeer Hassoun is an assistant professor of clinical pediatrics at Columbia University Vagelos College of Physicians and Surgeons; Frederica P. Perera is a professor of environmental health sciences and director of translational research at the Columbia Center for Children's Environmental Health, Columbia University; Radek Bukowski is associate chair for Investigation and Discovery and professor in the Department of Women's Health at Dell Medical School, UT Austin; and Andrew G. Rundle is a professor epidemiology and an investigator at research at the Columbia Center for Children's Environmental Health, Columbia University.

Acknowledgements

This work was supported with grants from the Eunice Kennedy Shriver National Institute of Child Health & Human Development to the University of Texas at Austin (P2C HD042849) and Columbia University (NIH K99/ R00 HD086304). The Columbia Center for Children’s Environmental Health (CCCEH) and the study were also supported by grants from the National Institute of Environmental Health Sciences (NIEHS) and the US Environmental Protection Agency (EPA) Children’s Environmental Health and Disease Prevention Research Centers (NIEHS/EPA P01ES09600/ R82702701, NIEHS/EPA P01ES09600/ RD832141, NIEHS/EPA P01ES09600/ RD834509), Irving General Clinical Research Center (RR00645), Educational Foundation of America, John and Wendy Neu Family Foundation, New York Community Trust, and the Trustees of the Blanchette Hooker Rockefeller Fund.