title: Independent relation of maternal prenatal factors to early childhood obesity in the offspring.
abstract: OBJECTIVE
  To examine the independent contribution of risk factors developing during pregnancy to subsequent risk of obesity in young children.
  
  
  METHODS
  We conducted a historical cohort study using data from electronic medical records of mothers and their 3,302 singleton offspring born between 2004 and 2007 at a community-based obstetric facility who attended a 4-year well visit at a pediatric practice network. The child's body mass index (BMI) z score at age 4 years was studied in relation to the mother's gestational weight gain, gestational diabetes mellitus, gestational hypertension or preeclampsia, and prenatal tobacco use. Institute of Medicine categories defined excess and inadequate gestational weight gain at term. Analysis of variance and multiple linear regression were used to test their independent relation to BMI.
  
  
  RESULTS
  Mothers were white (39%), African American (46%), and of Hispanic ethnicity (11%); 46% were privately insured. The association of net gestational weight gain with the child's BMI z score was significant after adjustment for prepregnancy maternal factors (P<.001); gestational diabetes mellitus, gestational hypertension, and tobacco use were not significant in adjusted models. Children of mothers with excess gestational weight gain had a higher mean BMI z score (P<.001) but a significant association was observed only for inadequate gestational weight gain after adjusting for prepregnancy BMI and other covariates. Prepregnancy BMI (P<.001), Hispanic ethnicity (P<.001), and being married (P<.05) were independently associated with increasing BMI z score of the offspring.
  
  
  CONCLUSIONS
  Preconception maternal factors had a greater influence on child obesity than prenatal factors. The gestational weight gain category was independently related to BMI z score of 4 year olds, but this association was significant only for mothers with inadequate gestational weight gain.
  
  
  METHODS
  II.
authors.affiliation: Christiana Care Health System, Newark, DE 19718, USA. Dehrenthal@Christianacare.org
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Ehrenthal
authors.forename: Kristin
authors.initials: K
authors.lastname: Maiden
authors.forename: Ashwani
authors.initials: A
authors.lastname: Rao
authors.forename: David W
authors.initials: DW
authors.lastname: West
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Gidding
authors.forename: Louis
authors.initials: L
authors.lastname: Bartoshesky
authors.forename: Ben
authors.initials: B
authors.lastname: Carterette
authors.forename: Judith
authors.initials: J
authors.lastname: Ross
authors.forename: Donna
authors.initials: D
authors.lastname: Strobino
mesh_terms: D000328:Adult; D044383:Black People / Q000706:statistics & numerical data; D015992:Body Mass Index; D002675:Child, Preschool; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000453:epidemiology* / Q000208:ethnology; D057286:Electronic Health Records; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology* / Q000208:ethnology; D008297:Male; D008954:Models, Biological; D009765:Obesity / Q000453:epidemiology* / Q000208:ethnology; D011225:Pre-Eclampsia / Q000453:epidemiology* / Q000208:ethnology; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology*; D015995:Prevalence; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology / Q000208:ethnology; D015430:Weight Gain; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult; D001741:Black or African American