Prenatal programming of childhood overweight and obesity.
OBJECTIVE
To review the scientific evidence for prenatal programming of childhood overweight and obesity, and discuss its implications for MCH research, practice, and policy.


METHODS
A systematic review of observational studies examining the relationship between prenatal exposures and childhood overweight and obesity was conducted using MOOSE guidelines. The review included literature posted on PubMed and MDConsult and published between January 1975 and December 2005. Prenatal exposures to maternal diabetes, malnutrition, and cigarette smoking were examined, and primary study outcome was childhood overweight or obesity as measured by body mass index (BMI) for children ages 5 to 21.


RESULTS
Four of six included studies of prenatal exposure to maternal diabetes found higher prevalence of childhood overweight or obesity among offspring of diabetic mothers, with the highest quality study reporting an odds ratio of adolescent overweight of 1.4 (95% CI 1.0-1.9). The Dutch famine study found that exposure to maternal malnutrition in early, but not late, gestation was associated with increased odds of childhood obesity (OR 1.9, 95% CI 1.5-2.4). All eight included studies of prenatal exposure to maternal smoking showed significantly increased odds of childhood overweight and obesity, with most odds ratios clustering around 1.5 to 2.0. The biological mechanisms mediating these relationships are unknown but may be partially related to programming of insulin, leptin, and glucocorticoid resistance in utero.


CONCLUSIONS
Our review supports prenatal programming of childhood overweight and obesity. MCH research, practice, and policy need to consider the prenatal period a window of opportunity for obesity prevention.
Huang
Jennifer S
JS
Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Lee
Tiffany A
TA
Lu
Michael C
MC
D000293:Adolescent; D000328:Adult; D000886:Anthropometry; D001724:Birth Weight; D001824:Body Constitution; D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D008429:Maternal Welfare; D009752:Nutritional Status; D009765:Obesity / Q000453:epidemiology* / Q000517:prevention & control; D050177:Overweight; D011247:Pregnancy; D011295:Prenatal Care; D015995:Prevalence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology