Predicting the earliest deviation in weight gain in the course towards manifest overweight in offspring exposed to obesity in pregnancy: a longitudinal cohort study

Abstract

Background Obesity in pregnancy and related early-life factors place the offspring at the highest risk of being overweight. Despite convincing evidence on these associations, there is an unmet public health need to identify “high-risk” offspring by predicting very early deviations in weight gain patterns as a subclinical stage towards overweight. However, data and methods for individual risk prediction are lacking. We aimed to identify those infants exposed to obesity in pregnancy at ages 3 months, 1 year, and 2 years who likely will follow a higher-than-normal body mass index (BMI) growth trajectory towards manifest overweight by developing an early-risk quantification system. Methods This study uses data from the prospective mother-child cohort study Programming of Enhanced Adiposity Risk in CHildhood–Early Screening (PEACHES) comprising 1671 mothers with pre-conception obesity and without (controls) and their offspring. Exposures were pre- and postnatal risks documented in patient-held maternal and child health records. The main outcome was a “higher-than-normal BMI growth pattern” preceding overweight, defined as BMI z-score >1 SD (i.e., World Health Organization [WHO] cut-off “at risk of overweight”) at least twice during consecutive offspring growth periods between age 6 months and 5 years. The independent cohort PErinatal Prevention of Obesity (PEPO) comprising 11,730 mother-child pairs recruited close to school entry (around age 6 years) was available for data validation. Cluster analysis and sequential prediction modelling were performed. Results Data of 1557 PEACHES mother-child pairs and the validation cohort were analyzed comprising more than 50,000 offspring BMI measurements. More than 1-in-5 offspring exposed to obesity in pregnancy belonged to an upper BMI z-score cluster as a distinct pattern of BMI development (above the cut-off of 1 SD) from the first months of life onwards resulting in preschool overweight/obesity (age 5 years: odds ratio [OR] 16.13; 95% confidence interval [CI] 9.98–26.05). Contributing early-life factors including excessive weight gain (OR 2.08; 95% CI 1.25–3.45) and smoking (OR 1.94; 95% CI 1.27–2.95) in pregnancy were instrumental in predicting a “higher-than-normal BMI growth pattern” at age 3 months and re-evaluating the risk at ages 1 year and 2 years (area under the receiver operating characteristic [AUROC] 0.69–0.79, sensitivity 70.7–76.0%, specificity 64.7–78.1%). External validation of prediction models demonstrated adequate predictive performances. Conclusions We devised a novel sequential strategy of individual prediction and re-evaluation of a higher-than-normal weight gain in “high-risk” infants well before developing overweight to guide decision-making. The strategy holds promise to elaborate interventions in an early preventive manner for integration in systems of well-child care.

Basal Blood Morphology, Serum Biochemistry, and the Liver and Muscle Structure of Weaned Wistar Rats Prenatally Exposed to Fumonisins

“…Moreover, the final body weight and the disproportional organ development, as well as the serum insulin and the glucose concentrations, could indicate obesity and the risk of diabetes mellitus, which can occur particularly in female offspring, where at a similar insulin concentration to the male offspring, they had a higher glucose concentration. These findings could be in agreement with the Developmental Origin of Health and Disease (DOHaD) theory, which speaks of disturbances in the intrauterine environment that can increase the risk of the development of many diseases (such as diabetes and obesity) later on in life [ 39 ]. This risk can be strengthened by the phenomenon known as catch-up growth, which is accelerated growth that occurs between birth and the first few months of neonatal life.…”

Adipositasprävention in den ersten 1000 Tagen

“…Außerdem gibt es Hinweise darauf, dass Rauchen das Risiko für späteres Übergewicht und Adipositas erhöht [25]. Aktuelle Daten aus der deutschen "Programming of Enhanced Adiposity Risk in CHildhood -Early Screening" (PEACHES)-Studie zeigen, dass Rauchen während der Schwangerschaft mit einer überdurchschnittlichen Gewichtszunahme der Kinder assoziiert ist [26]. Trotz verschiedener Aufklärungsinitiativen gaben im Rahmen der deutschen "Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland" (KiGGS)-Studie 10,9 % der Frauen an, in der Schwangerschaft zu rauchen [27].…”

“…Es wird diskutiert, dass das Stillen einem postnatalen Gewichtsbehalt entgegenwirkt [10]. Ungünstig ist, dass vor allem Frauen mit Übergewicht und Adipositas weniger häufig und kürzer stillen [26,31]. Für den Säugling gilt Muttermilch aufgrund der zahlreichen positiven gesundheitlichen Effekte als die optimale Ernährung in den ersten Lebensmonaten.…”

Cannabidiol treatment improves metabolic profile and decreases hypothalamic inflammation caused by maternal obesity

“…Other than that, the increased insulin resistance, glucose levels, and lipids, with a potentially elevated supply of nutrients to the developing fetus, contribute to setting persistent changes in the offspring’s energy balance, appetite regulation, lipid and glucose homeostasis, and gut dysbiosis. Overall, as a result, maternal obesity substantially raises the risk of offspring obesity, insulin resistance, type 2 diabetes, high blood pressure, and adverse lipid profile ( 7 , 10 , 13 ).…”