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. Author manuscript; available in PMC: 2014 Jul 1.
Published in final edited form as: Pediatr Obes. 2013 Jan 3;8(2):e33–e36. doi: 10.1111/j.2047-6310.2012.00132.x

Excessive weight gain in women with a normal pre-pregnancy BMI is associated with increased neonatal adiposity

J L Josefson 1,2, J A Hoffmann 3, B E Metzger 4
PMCID: PMC4076951  NIHMSID: NIHMS599598  PMID: 23283756

Summary

Background

More than 40% of women with a normal pre-pregnancy body mass index (BMI) exceed the 2009 Institute of Medicine (IOM) guidelines’ recommended weight gain of 25–35 lb. Excessive gestational weight gain is one modifiable factor that may be contributing to childhood overweight and obesity.

Objective

The objective of this study was to evaluate differences in adiposity from neonates born to mothers with a normal pre-pregnancy BMI who either gained within or above IOM guidelines.

Methods

Neonatal adiposity was measured within 72 h of birth by the method of air displacement plethysmography.

Results

Compared with mothers who gained within IOM guidelines (N = 27), mothers with excessive gestational weight gain (N = 11) (mean 29.0 vs. 45.2 lb) had neonates with 50% more fat mass (348 vs. 525 g) and 3% greater body fat (10.7 vs. 13.9%).

Conclusions

Increased adiposity at birth may predispose these children to increased risk of obesity and highlight the importance that women avoid gaining excessive weight in pregnancy.

Keywords: Gestational weight gain, neonatal adiposity, newborn body composition


The Institute of Medicine (IOM) published revised guidelines for weight gain in pregnancy three years ago (1) in an effort to address post-partum weight retention and increased risk of offspring obesity. As more than 40% of women with a normal pre-pregnancy body mass index (BMI) exceed the IOM recommended amount of weight gain of 25–35 lb (2), excessive gestational weight gain (GWG) is one modifiable factor that may be contributing to childhood overweight and obesity (3,4). Several studies have demonstrated that offspring of women whose weight gain exceeded the IOM guidelines (1990 guidelines) are more likely to become overweight (57).

Most studies associating excessive GWG to childhood obesity have used childhood BMI as a correlate for obesity. However, BMI measurements include both fat and lean tissue mass (8) and a high proportion of either one leads to increased readings. Therefore, using BMI as a proxy for adiposity in children has major limitations (9). A few studies have reported associations of excessive GWG with increased offspring adiposity, both at birth and in early childhood (7,10,11). These studies either failed to adjust for maternal diabetes status during pregnancy (10), a known risk factor for offspring obesity (12), or used methodologies with high measurement variation, such as skinfold thickness, to measure fat mass (7). None of the aforementioned studies reported maternal glucose levels.

Preliminary data have been gathered through a pilot study on the impact of GWG on neonatal adiposity, using a new, validated method of air displacement plethysmography to measure newborn body fat (Pea Pod Infant Body Composition System, Cosmed, Rome, Italy) (13). The objective of this analysis was to evaluate differences in neonatal body fat and cord blood biomarkers in offspring of mothers with a normal pre-pregnancy BMI who either gained within or above IOM guidelines.

Pregnant women with a normal pre-pregnancy BMI (18–25 kg m−2) and a normal diabetes screening test result (14), planning to deliver at Northwestern Memorial Hospital were recruited. Participants in this study had singleton, term pregnancies (>37 weeks), and were not hypertensive. Participants presented to the clinical research unit at 36–38 weeks gestation for a fasting blood draw and measurement of height and weight. Measured height and self-reported pre-pregnancy weight, confirmed by chart review in most cases, was used to calculate pre-pregnancy BMI. GWG was calculated by subtracting the self-reported pre-pregnancy weight from the weight at the last prenatal visit before delivery. All subjects provided written informed consent and the study was approved by the Northwestern University Institutional Review Board.

Umbilical cord blood was collected at delivery and stored, along with maternal blood, at −70°C until assayed simultaneously. Plasma glucose was measured with Synchron CX Delta Systems instrumentation (Beckman Coulter, Inc., Brea, CA, USA) employing an oxygen rate method using a glucose oxygen electrode and had an inter-assay coefficient of variation of 2.0–2.3%. Concentrations of C-peptide, leptin and adiponectin were assayed using radioimmunoassay kits from Millipore Corporation (Billerica, MA, USA). The intra- and inter-assay coefficients of variation ranged from 2.1 to 4.4% and 2.9 to 5.9%, respectively. All biochemical assays were performed in duplicate.

Neonatal anthropometric measurements were obtained within 72 h following birth. Infant length was obtained using a hard-surface measuring board. Abdominal circumference was measured at the level of the umbilicus. Measurements were recorded to the nearest 0.1 cm, performed in duplicate, and the results averaged. Infant weight and volume were measured by air displacement plethysmography with the Pea Pod Infant Body Composition System (Cosmed), which has been previously described (15). Briefly, the machine was calibrated according to manufacturer's guidelines, the infant placed naked on the scale, weighed to the nearest 0.0001 kg and, lastly, placed inside the Pea Pod chamber for the 2-min volume measurement. Using pressure–volume equations, body composition, including fat mass and fat-free mass, was calculated to provide % body fat.

For statistical analyses, Fisher's exact tests were used to compare categorical characteristics, and independent sample t-tests were used to compare means. A P-value < 0.05 was considered statistically significant. All statistical analyses were conducted using SAS 9.2 software (SAS Institute Inc., Cary, NC, USA).

There were 38 participants, 27 who gained within guidelines and 11 with excessive GWG. Maternal demographic characteristics and metabolic measurements are shown in Table 1. Women with excessive GWG had a similar pre-pregnancy BMI, age, glucose results on diabetes screening test and fasting glucose, compared with women who gained within guidelines. Women with excessive GWG had significantly higher-fasting C-peptide and leptin levels, and lower adiponectin levels, compared with women who gained within guidelines.

Table 1.

Maternal characteristics and metabolic measurements

Weight gain within
guidelines (N = 27)
Excessive weight
gain (N = 11)
P-value
Gestational weight gain (lb) 29.0 ± 3.2 45.2 ± 9.9 0.0003
Pre-pregnancy body mass index (kg m−2) 21.7 ± 1.7 22.6 ± 1.8 NS
Age 33.2 ± 4.8 31.7 ± 8.1 NS
Race (% white) 74% 64% NS
Delivery type (% C/S) 26% 27% NS
Maternal blood sample at 24–28 weeks
Glucose (mg dL−1) post-1 h 50 g glucose challenge test 97.9 ± 14.7 99.6 ± 13.9 NS
Maternal fasting blood sample at 36–38 weeks
Glucose (mg dL−1) 79.6 ± 5.5 83.5 ± 7.7 NS
C-peptide (ng mL−1) 2.0 ± 1.7 3.1 ± 2.3 0.01
Leptin (ng mL−1) 20.5 ± 16.2 33.9 ± 13.6 0.01
Adiponectin (µg mL−1) 11.9 ± 4.2 8.7 ± 4.0 0.04

Data are displayed as mean ± standard deviation or percent.

NS, not significant.

Cord blood was obtained from 35 of the 38 participants. The neonatal anthropometric characteristics and cord blood hormone levels of the neonates are shown in Table 2. At 1–3 d of life, neonates born to women with excessive GWG had a higher mean weight, length, fat mass and percent body fat compared with neonates born to women who gained within guidelines. Cord blood levels of leptin were significantly higher in the neonates born to women who gained excessively.

Table 2.

Neonatal characteristics

Weight gain within
guidelines (N = 27)
Excessive weight
gain (N = 11)
P-value
Gestational age 39.8 ± 1.0 40.0 ± 1.2 NS
Gender (% female) 64% 67% NS
Birth weight (g) 3389 ± 387 3832 ± 552 0.029
Pea pod weight (g) 3250 ± 370 3700 ± 560 0.028
Length (cm) 50.1 ± 1.6 51.7 ± 2.4 0.026
Fat mass (g) 348 ± 103 525 ± 178 0.009
Fat-free mass (g) 2898 ± 327 3174 ± 415 NS
Body fat % 10.7 ± 2.8 13.9 ± 3.3 0.012
Abdominal circumference (cm) 29.9 ± 2.3 31.2 ± 2.3 NS
Neonatal cord blood N = 25 N = 10
Glucose (mg dL−1) 78.0 ± 17.8 87.3 ± 28.4 NS
C-peptide (ng mL−1) 0.83 ± 0.32 1.0 ± 0.33 NS
Leptin (ng mL−1) 8.2 ± 4.9 13.4 ± 6.8 0.046
Adiponectin (µg mL−1) 35.5 ± 5.0 38.1 ± 9.1 NS

Data are displayed as mean ± standard deviation or percent.

NS, not significant.

The women in this study had a similar pre-pregnancy BMI of 22 kg m−2 in the normal weight category. However, the women who gained in excess of IOM recommendations had a metabolic profile of an obese woman by the end of pregnancy, as evidenced by higher serum C-peptide and leptin levels, slightly higher fasting glucose levels, and lower adiponectin levels (16,17). Neonates born to women who gained excessively were not, on average, considered large for gestational age, defined by a birth weight greater than 4 kg. However, these neonates were significantly larger in weight and length, and had a 50% increase in fat mass, leading to a 3% fat unit increase in total body fat. These preliminary results highlight the importance of women avoiding gaining excessive weight in pregnancy.

The timing of excessive weight gain in participants of this study is not known, although that information would further our understanding of neonatal adipose tissue development. In this study, self-reported pre-pregnancy weight was used to calculate GWG, rather than documented weight at the first prenatal visit, in order to capture weight gained prior to the first prenatal visit. Previous studies report American women with a normal BMI to be very accurate in their reporting of pre-pregnancy weight (18).

In conclusion, GWG above the IOM guidelines for weight gain in pregnancy in women with a normal pre-pregnancy BMI was associated with increased newborn body fat content. These neonates had, on average, 175 g more fat mass, and a 3% increase in total body fat. This higher amount of body fat at birth may predispose these children to increased risk of obesity later in life.

Acknowledgement

This study was funded in part by the Eleanor Wood Prince Grant Initiative, a project of the Women's Board of Northwestern Memorial Hospital.

Footnotes

Conflicts of Interest Statement

The authors have no conflicts of interest to disclose.

References

  • 1.Institute of Medicine. Weight Gain during Pregnancy: Reexamining the Guidelines. Washington D.C.: National Academies Press; 2009. [PubMed] [Google Scholar]
  • 2.Chu SY, Callaghan WM, Bish CL, D'Angelo D. Gestational weight gain by body mass index among US women delivering live births, 2004–2005: fueling future obesity. Am J Obstet Gynecol. 2009;200:271e1–271e7. doi: 10.1016/j.ajog.2008.09.879. [DOI] [PubMed] [Google Scholar]
  • 3.von Kries R, Ensenauer R, Beyerlein A, Amann-Gassner U, Hauner H, Rosario AS. Gestational weight gain and overweight in children: results from the cross-sectional German KiGGS study. Int J Pediatr Obes. 2011;6:45–52. doi: 10.3109/17477161003792564. [DOI] [PubMed] [Google Scholar]
  • 4.Oken E, Rifas-Shiman SL, Field AE, Frazier AL, Gillman MW. Maternal gestational weight gain and offspring weight in adolescence. Obstet Gynecol. 2008;112:999–1006. doi: 10.1097/AOG.0b013e31818a5d50. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Olson CM, Strawderman MS, Dennison BA. Maternal weight gain during pregnancy and child weight at age 3 years. Matern Child Health J. 2009;13:839–846. doi: 10.1007/s10995-008-0413-6. [DOI] [PubMed] [Google Scholar]
  • 6.Wrotniak BH, Shults J, Butts S, Stettler N. Gestational weight gain and risk of overweight in the offspring at age 7 y in a multicenter, multiethnic cohort study. Am J Clin Nutr. 2008;87:1818–1824. doi: 10.1093/ajcn/87.6.1818. [DOI] [PubMed] [Google Scholar]
  • 7.Oken E, Taveras EM, Kleinman KP, Rich-Edwards JW, Gillman MW. Gestational weight gain and child adiposity at age 3 years. Am J Obstet Gynecol. 2007;196:322e1–322e8. doi: 10.1016/j.ajog.2006.11.027. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Zimmermann MB, Gubeli C, Puntener C, Molinari L. Detection of overweight and obesity in a national sample of 6–12-y-old Swiss children: accuracy and validity of reference values for body mass index from the US Centers for Disease Control and Prevention and the International Obesity Task Force. Am J Clin Nutr. 2004;79:838–843. doi: 10.1093/ajcn/79.5.838. [DOI] [PubMed] [Google Scholar]
  • 9.Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000;320:1240–1243. doi: 10.1136/bmj.320.7244.1240. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Crozier SR, Inskip HM, Godfrey KM, et al. Weight gain in pregnancy and childhood body composition: findings from the Southampton Women's Survey. Am J Clin Nutr. 2010;91:1745–1751. doi: 10.3945/ajcn.2009.29128. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Hull HR, Thornton JC, Ji Y, et al. Higher infant body fat with excessive gestational weight gain in overweight women. Am J Obstet Gynecol. 2011;205:211e1–211e7. doi: 10.1016/j.ajog.2011.04.004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Silverman BL, Rizzo TA, Cho NH, Metzger BE. Long-term effects of the intrauterine environment. The Northwestern University Diabetes in Pregnancy Center. Diabetes Care. 1998;21(Suppl. 2):B142–B149. [PubMed] [Google Scholar]
  • 13.Ellis KJ, Yao M, Shypailo RJ, Urlando A, Wong WW, Heird WC. Body-composition assessment in infancy: air-displacement plethysmography compared with a reference 4-compartment model. Am J Clin Nutr. 2007;85:90–95. doi: 10.1093/ajcn/85.1.90. [DOI] [PubMed] [Google Scholar]
  • 14.Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol. 1982;144:768–773. doi: 10.1016/0002-9378(82)90349-0. [DOI] [PubMed] [Google Scholar]
  • 15.Urlando A, Dempster P, Aitkens S. A new air displacement plethysmograph for the measurement of body composition in infants. Pediatr Res. 2003;53:486–492. doi: 10.1203/01.PDR.0000049669.74793.E3. [DOI] [PubMed] [Google Scholar]
  • 16.Ramsay JE, Ferrell WR, Crawford L, Wallace AM, Greer IA, Sattar N. Maternal obesity is associated with dysregulation of metabolic, vascular, and inflammatory pathways. J Clin Endocrinol Metab. 2002;87:4231–4237. doi: 10.1210/jc.2002-020311. [DOI] [PubMed] [Google Scholar]
  • 17.Luo ZC, Nuyt AM, Delvin E, et al. Maternal and fetal leptin, adiponectin levels and associations with fetal insulin sensitivity. Obesity. 2012 doi: 10.1002/oby.20250. [epub ahead of print]. [DOI] [PubMed] [Google Scholar]
  • 18.Mandujano A, Huston-Presley L, Waters TP, Catalano PM. Women's reported weight: is there a discrepancy? J Matern Fetal Neonatal Med. 2012;25:1395–1398. doi: 10.3109/14767058.2011.636099. [DOI] [PubMed] [Google Scholar]

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