title: Associations of maternal weight status prior and during pregnancy with neonatal cardiometabolic markers at birth: the Healthy Start study.
abstract: BACKGROUND
  Maternal obesity increases adult offspring risk for cardiovascular disease; however, the role of offspring adiposity in mediating this association remains poorly characterized.
  
  
  OBJECTIVE
  To investigate the associations of maternal pre-pregnant body mass index (maternal BMI) and gestational weight gain (GWG) with neonatal cardiometabolic markers independent of fetal growth and neonatal adiposity.
  
  
  METHODS
  A total of 753 maternal-infant pairs from the Healthy Start study, a large multiethnic pre-birth observational cohort were used. Neonatal cardiometabolic markers included cord blood glucose, insulin, glucose-to-insulin ratio (Glu/Ins), total and high-density lipoprotein cholesterol (HDL-c), triglycerides, free fatty acids and leptin. Maternal BMI was abstracted from medical records or self-reported. GWG was calculated as the difference between the first pre-pregnant weight and the last weight measurement before delivery. Neonatal adiposity (percent fat mass) was measured within 72 h of delivery using whole-body air-displacement plethysmography.
  
  
  RESULTS
  In covariate adjusted models, maternal BMI was positively associated with cord blood insulin (P=0.01) and leptin (P<0.001) levels, and inversely associated with cord blood HDL-c (P=0.05) and Glu/Ins (P=0.003). Adjustment for fetal growth or neonatal adiposity attenuated the effect of maternal BMI on neonatal insulin, rendering the association nonsignificant. However, maternal BMI remained associated with higher leptin (P<0.0011), lower HDL-c (P=0.02) and Glu/Ins (P=0.05), independent of neonatal adiposity. GWG was positively associated with neonatal insulin (P=0.02), glucose (P=0.03) and leptin levels (P<0.001) and negatively associated with Glu/Ins (P=0.006). After adjusting for neonatal adiposity, GWG remained associated with higher neonatal glucose (P=0.02) and leptin levels (P=0.02) and lower Glu/Ins (P=0.048).
  
  
  CONCLUSIONS
  Maternal weight prior and/or during pregnancy is associated with neonatal cardiometabolic makers including leptin, glucose and HDL-c at delivery, independent of neonatal adiposity. Our results suggest that intrauterine exposure to maternal obesity influences metabolic processes beyond fetal growth and fat accretion.
authors.affiliation: Department of Pediatrics, Section of Neonatology, University of Colorado Denver, Aurora, CO, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Lemas
authors.affiliation: Department of Medicine, University of Colorado Denver, Denver, CO, USA.
authors.forename: J T
authors.initials: JT
authors.lastname: Brinton
authors.affiliation: Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA.
authors.forename: A L B
authors.initials: AL
authors.lastname: Shapiro
authors.affiliation: Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA.
authors.forename: D H
authors.initials: DH
authors.lastname: Glueck
authors.affiliation: Department of Pediatrics, Section of Neonatology, University of Colorado Denver, Aurora, CO, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Friedman
authors.affiliation: Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA.
authors.forename: D
authors.initials: D
authors.lastname: Dabelea
mesh_terms: D050154:Adiposity; D000328:Adult; D001724:Birth Weight; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D003120:Colorado / Q000453:epidemiology; D005260:Female; D047109:Fetal Development; D006801:Humans; D007231:Infant, Newborn; D007328:Insulin / Q000097:blood; D020738:Leptin / Q000097:blood; D008075:Lipoproteins, HDL / Q000097:blood; D008137:Longitudinal Studies; D009765:Obesity / Q000097:blood / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control; D010991:Plethysmography / Q000379:methods*; D011247:Pregnancy; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D015430:Weight Gain
chemical_list: D001786:Blood Glucose; D007328:Insulin; D020738:Leptin; D008075:Lipoproteins, HDL; D014280:Triglycerides