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Mediation of the association between maternal pre-pregnancy overweight/obesity and childhood overweight/obesity by birth anthropometry

Published online by Cambridge University Press:  20 February 2020

Danielle R. Stevens
Affiliation:
Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
Brian Neelon
Affiliation:
Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
James R. Roberts
Affiliation:
Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA
Sarah N. Taylor
Affiliation:
Department of Pediatrics, Yale School of Medicine, New Haven, CT 06520, USA
Roger B. Newman
Affiliation:
Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC 29425, USA
John E. Vena
Affiliation:
Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
Kelly J. Hunt
Affiliation:
Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
Corresponding
E-mail address:

Abstract

The mechanism through which developmental programming of offspring overweight/obesity following in utero exposure to maternal overweight/obesity operates is unknown but may operate through biologic pathways involving offspring anthropometry at birth. Thus, we sought to examine to what extent the association between in utero exposure to maternal overweight/obesity and childhood overweight/obesity is mediated by birth anthropometry. Analyses were conducted on a retrospective cohort with data obtained from one hospital system. A natural effects model framework was used to estimate the natural direct effect and natural indirect effect of birth anthropometry (weight, length, head circumference, ponderal index, and small-for-gestational age [SGA] or large-for-gestational age [LGA]) for the association between pre-pregnancy maternal body mass index (BMI) category (overweight/obese vs normal weight) and offspring overweight/obesity in childhood. Models were adjusted for maternal and child socio-demographics. Three thousand nine hundred and fifty mother–child dyads were included in analyses (1467 [57.8%] of mothers and 913 [34.4%] of children were overweight/obese). Results suggest that a small percentage of the effect of maternal pre-pregnancy BMI overweight/obesity on offspring overweight/obesity operated through offspring anthropometry at birth (weight: 15.5%, length: 5.2%, head circumference: 8.5%, ponderal index: 2.2%, SGA: 2.9%, and LGA: 4.2%). There was a small increase in the percentage mediated when gestational diabetes or hypertensive disorders were added to the models. Our study suggests that some measures of birth anthropometry mediate the association between maternal pre-pregnancy overweight/obesity and offspring overweight/obesity in childhood and that the size of this mediated effect is small.

Type
Original Article
Copyright
© The Author(s) 2020. Published by Cambridge University Press and the International Society for Developmental Origins of Health and Disease

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