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Maternal interpregnancy weight change and childhood overweight and obesity: findings from a UK population-based cohort
Meeting Abstracts
Maternal interpregnancy weight change and childhood overweight and obesity: findings from a UK populationbased cohort Nida Ziauddeen, Nisreen A Alwan
Abstract
Background Maternal obesity is a major risk factor for childhood obesity. Given the relatively intensive contact with health and care professionals following birth, the interpregnancy period provides an excellent opportunity to focus on preconception and family health. We examined the association between maternal interpregnancy weight change and overweight/obesity in the second child. Methods We used a population-based anonymised linked cohort of antenatal and birth records registered at University Hospital Southampton, Hampshire, UK (August, 2004–August, 2014) and child health records. Change in maternal interpregnancy body-mass index (BMI) was calculated as the difference between BMI (using measured weight) at the first antenatal appointment of each pregnancy. Records of the first two singleton live pregnancies for 6358 women were analysed. Second child’s age-adjusted and sex-adjusted BMI at 4–5 years was used to define the outcome of overweight/obesity (≥85th centile). Generalised linear modelling was used to adjust for maternal age, ethnicity, educational qualification, infertility treatment, smoking, employment status, gestational diabetes, BMI at start of the first pregnancy, and interpregnancy interval, then adding second child’s birthweight. Findings 18·5% women (1175 of 6358) gained 3 kg/m² or more and 29·0% (1842 of 6358) gained 1–3 kg/m² between pregnancies. Unadjusted prevalence of second child overweight/obesity for mothers with 3 kg/m² or more gain was 27·9% (328 of 1175) compared with 18·6% (427 of 2287) for mothers whose weigh remained stable between pregnancies (–1 to 1 kg/m²). Interpregnancy gain of 3 kg/m² or more was associated with increased risk of childhood overweight/ obesity (adjusted relative risk [aRR] 1·15, 95% CI 1·01–1·32). The relationship was attenuated on adjusting for birthweight of child 2 (1·09, 0·95–1 ·25). This pattern was similar in the subgroup who were obese at the start of their first pregnancy (1·34, 1·00–1·78 and 1·27, 0·96–1·69, respectively). There was no evidence of an association between the other weight change categories and the outcome after adjustment.
Published Online November 29, 2019 School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK (N Ziauddeen MSc, N A Alwan PhD); and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK (N A Alwan) Correspondence to: Dr Nisreen A Alwan, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK [email protected]
Interpretation Many women gain a considerable amount of weight between their first and second pregnancies. Children of mothers who have started their second pregnancy with a considerably higher weight than their first were more likely to be overweight/obese at the start of primary school; however, this association was attenuated by accounting for birthweight, which may be on the causal pathway. Funding Academy of Medical Sciences and the Wellcome Trust (grant number AMS_HOP001\1060 to NAA). NAA is also in receipt of research support from and the National Institute for Health Research through the NIHR Southampton Biomedical Research Centre. Contributors NAA is the Principal Investigator of the SLOPE (Studying Lifecourse Obesity PrEdictors) study. Both authors conceived the research question and interpreted the data. NZ did the data analysis. NA Drafted the abstract; both authors revised the abstract for content before giving approval of the final version for submission. Declaration of interests Both authors declare no competing interests. Acknowledgments We thank David Cable (Electronic Patient Records Implementation and Service Manager) and Florina Borca (Senior Information Analyst R&D) at University Hospital Southampton NHS Foundation Trust for support in accessing the data used in this study.
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103
Maternal interpregnancy weight change and childhood overweight and obesity: findings from a UK populationbased cohort Nida Ziauddeen, Nisreen A Alwan
Abstract
Background Maternal obesity is a major risk factor for childhood obesity. Given the relatively intensive contact with health and care professionals following birth, the interpregnancy period provides an excellent opportunity to focus on preconception and family health. We examined the association between maternal interpregnancy weight change and overweight/obesity in the second child. Methods We used a population-based anonymised linked cohort of antenatal and birth records registered at University Hospital Southampton, Hampshire, UK (August, 2004–August, 2014) and child health records. Change in maternal interpregnancy body-mass index (BMI) was calculated as the difference between BMI (using measured weight) at the first antenatal appointment of each pregnancy. Records of the first two singleton live pregnancies for 6358 women were analysed. Second child’s age-adjusted and sex-adjusted BMI at 4–5 years was used to define the outcome of overweight/obesity (≥85th centile). Generalised linear modelling was used to adjust for maternal age, ethnicity, educational qualification, infertility treatment, smoking, employment status, gestational diabetes, BMI at start of the first pregnancy, and interpregnancy interval, then adding second child’s birthweight. Findings 18·5% women (1175 of 6358) gained 3 kg/m² or more and 29·0% (1842 of 6358) gained 1–3 kg/m² between pregnancies. Unadjusted prevalence of second child overweight/obesity for mothers with 3 kg/m² or more gain was 27·9% (328 of 1175) compared with 18·6% (427 of 2287) for mothers whose weigh remained stable between pregnancies (–1 to 1 kg/m²). Interpregnancy gain of 3 kg/m² or more was associated with increased risk of childhood overweight/ obesity (adjusted relative risk [aRR] 1·15, 95% CI 1·01–1·32). The relationship was attenuated on adjusting for birthweight of child 2 (1·09, 0·95–1 ·25). This pattern was similar in the subgroup who were obese at the start of their first pregnancy (1·34, 1·00–1·78 and 1·27, 0·96–1·69, respectively). There was no evidence of an association between the other weight change categories and the outcome after adjustment.
Published Online November 29, 2019 School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK (N Ziauddeen MSc, N A Alwan PhD); and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK (N A Alwan) Correspondence to: Dr Nisreen A Alwan, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK [email protected]
Interpretation Many women gain a considerable amount of weight between their first and second pregnancies. Children of mothers who have started their second pregnancy with a considerably higher weight than their first were more likely to be overweight/obese at the start of primary school; however, this association was attenuated by accounting for birthweight, which may be on the causal pathway. Funding Academy of Medical Sciences and the Wellcome Trust (grant number AMS_HOP001\1060 to NAA). NAA is also in receipt of research support from and the National Institute for Health Research through the NIHR Southampton Biomedical Research Centre. Contributors NAA is the Principal Investigator of the SLOPE (Studying Lifecourse Obesity PrEdictors) study. Both authors conceived the research question and interpreted the data. NZ did the data analysis. NA Drafted the abstract; both authors revised the abstract for content before giving approval of the final version for submission. Declaration of interests Both authors declare no competing interests. Acknowledgments We thank David Cable (Electronic Patient Records Implementation and Service Manager) and Florina Borca (Senior Information Analyst R&D) at University Hospital Southampton NHS Foundation Trust for support in accessing the data used in this study.
www.thelancet.com
103