title: Ethnic Differences in Effects of Maternal Pre-Pregnancy and Pregnancy Adiposity on Offspring Size and Adiposity.
abstract: BACKGROUND
  Maternal adiposity and overnutrition, both before and during pregnancy, plays a key role in the subsequent development of obesity and metabolic outcomes in offspring.
  
  
  OBJECTIVE
  We explored the hypothesis that maternal adiposity (pre-pregnancy and at 26-28 weeks' gestation) and mid-pregnancy gestational weight gain (GWG) are independently associated with offspring size and adiposity in early childhood, and determined whether these effects are ethnicity dependent.
  
  
  METHODS
  In a prospective mother-offspring cohort study (N = 976, 56% Chinese, 26% Malay, and 18% Indian), we assessed the associations of offspring size (weight, length) and adiposity (subscapular and triceps skinfolds), measured at birth and age 6, 12, 18, and 24 mo, with maternal pre-pregnancy body mass index (ppBMI), mid-pregnancy GWG, and mid-pregnancy four-site skinfold thicknesses (triceps, biceps, subscapular, suprailiac).
  
  
  RESULTS
  ppBMI and mid-pregnancy GWG were independently associated with postnatal weight up to 2 y and skinfold thickness at birth. Weight and subscapular and triceps skinfolds at birth increased by 2.56% (95% confidence interval, 1.68-3.45%), 3.85% (2.16-5.57%), and 2.14% (0.54-3.75%), respectively for every SD increase in ppBMI. Similarly, a one-SD increase in GWG increased weight and subscapular and triceps skinfolds at birth by 2.44% (1.66-3.23%), 3.28% (1.75-4.84%), and 3.23% (1.65-4.84%), respectively. ppBMI and mid-pregnancy suprailiac skinfold independently predicted postnatal skinfold adiposity up to 2 years of age, whereas only GWG predicted postnatal length. The associations of GWG with postnatal weight and length were present only among Chinese and Indians, but not Malays (P < .05 for interaction).
  
  
  CONCLUSIONS
  ppBMI and GWG are independent modifiable factors for child size and adiposity up to 2 years of age. The associations are ethnic-dependent, and underscore the importance of ethnic specific studies before generalizing the applicability of risk factors reported in other populations.
authors.affiliation: Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore.
authors.forename: Xinyi
authors.initials: X
authors.lastname: Lin
authors.affiliation: Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore.
authors.forename: Izzuddin M
authors.initials: IM
authors.lastname: Aris
authors.affiliation: Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore.
authors.forename: Mya Thway
authors.initials: MT
authors.lastname: Tint
authors.affiliation: Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore.
authors.forename: Shu E
authors.initials: SE
authors.lastname: Soh
authors.affiliation: Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Godfrey
authors.affiliation: Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore.
authors.forename: George Seow-Heong
authors.initials: GS
authors.lastname: Yeo
authors.affiliation: Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Kwek
authors.affiliation: Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore.
authors.forename: Jerry Kok-Yen
authors.initials: JK
authors.lastname: Chan
authors.affiliation: Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Gluckman
authors.affiliation: Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore.
authors.forename: Yap Seng
authors.initials: YS
authors.lastname: Chong
authors.affiliation: Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore.
authors.forename: Fabian
authors.initials: F
authors.lastname: Yap
authors.affiliation: Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore.
authors.forename: Joanna D
authors.initials: JD
authors.lastname: Holbrook
authors.affiliation: Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (X.L., P.D.G., Y.S.C., J.D.H., Y.S.L.), 117609 Singapore; Department of Paediatrics (I.M.A., S.E.S., Y.S.L.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Department of Obstetrics and Gynaecology (M.T.T., Y.S.C.), Yong Loo Lin School of Medicine, National University of Singapore, 119228 Singapore; Saw Swee Hock School of Public Health (S.E.S.), National University of Singapore, 117597 Singapore; MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre (K.M.G.), University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD United Kingdom; Department of Maternal Fetal Medicine (G.S.-H.Y., K.K.), KK Women's and Children's Hospital, 229899 Singapore; Department of Reproductive Medicine (J.K.-Y.C.), KK Women's and Children's Hospital, 229899 Singapore; Centre for Human Evolution, Adaptation and Disease (P.D.G.), Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Paediatrics (F.Y.), KK Women's and Children's Hospital, 229899 Singapore; Department of Biochemistry (J.D.H.), National University of Singapore, 117596 Singapore; and Division of Paediatric Endocrinology and Diabetes (Y.S.L.), Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, 119228 Singapore.
authors.forename: Yung Seng
authors.initials: YS
authors.lastname: Lee
mesh_terms: D050154:Adiposity / Q000208:ethnology*; D000328:Adult; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D039382:Maternal Nutritional Physiological Phenomena / Q000208:ethnology*; D063766:Pediatric Obesity / Q000208:ethnology*; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000208:ethnology*; D011446:Prospective Studies; D015430:Weight Gain