Quantifying the effect of interpregnancy maternal weight and smoking status changes on childhood overweight and obesity in a UK population-based cohort

Abstract

Background Maternal preconception and pregnancy exposures have been linked to offspring adiposity. We aimed to quantify the effect of changes in maternal weight and smoking status between pregnancies on childhood overweight/obesity (≥ 85th centile) and obesity (≥ 95th centile) rates in second children. Methods Records for 5612 women were drawn from a population-based cohort of routinely collected antenatal healthcare records (2003–2014) linked to measured child body mass index (BMI) age 4–5 years. We applied the parametric G-formula to estimate the effect of hypothetical changes between pregnancy-1 and pregnancy-2 compared to the natural course scenario (without change) on child-2 BMI. Results Observed overweight/obesity and obesity in child-2 at age 4–5 years were 22.2% and 8·5%, respectively. We estimated that if all mothers started pregnancy-2 with BMI 18·5–24·9 kg/m² and all smokers stopped smoking, then child-2 overweight/obesity and obesity natural course estimates of 22.3% (95% CI 21.2–23.5) and 8·3% (7·6–9·1), would be reduced to 18.5% (17.4–19.9) and 6.2% (5.5–7.0), respectively. For mothers who started pregnancy-1 with BMI 18·5–24·9 kg/m², if all smokers stopped smoking, child-2 overweight/obesity and obesity natural course estimates of 17.3% (16.0–18.6) and 5·9% (5·0–6·7) would be reduced to 16.0% (14.6–17.3) and 4·9% (4·1–5·7), respectively. For mothers who started pregnancy-1 with BMI ≥30 kg/m², if BMI was 18·5–24·9 kg/m² prior to pregnancy-2, child-2 overweight/obesity and obesity natural course estimates of 38.6% (34.7–42.3) and 17·7% (15·1–20·9) would be reduced to 31.3% (23.8–40.0) and 12.5 (8.3–17.4), respectively. If BMI was 25.0–29.9 kg/m² prior to pregnancy-2, these estimates would be 34.5% (29.4–40.4) and 14.6% (11.2–17.8), respectively. Conclusion Interventions supporting women to lose/maintain weight and quit smoking between pregnancies could help reduce rates of overweight/obesity and obesity in second children. The most effective interventions may vary by maternal BMI prior to the first pregnancy.