title: Maternal BMI, gestational diabetes, and weight gain in relation to childhood obesity: The mediation effect of placental weight.
abstract: OBJECTIVE
  High prepregnancy body mass index (BMI), excessive gestational weight gain (GWG), and gestational diabetes mellitus (GDM) are associated with the risk of childhood obesity. This study aims to examine the extent to which these effects may be mediated through the placenta.
  
  
  METHODS
  Data included 33,893 mothers and their singleton infants from birth to 7 years old (total 154,590 visits) in the Collaborative Perinatal Project, a U.S. multicenter prospective cohort study from 1959 to 1976. The placentas were weighed after removing cord and membranes. We performed sequential generalized estimating equation-linear models excluding and including placental weight to evaluate its mediation effect.
  
  
  RESULTS
  In this population, 21.7% of mothers had overweight or obesity, 17.3% had excessive GWG, and 350 (1%) had diagnosed GDM; in addition, 7.2% children had obesity. After adjustment for prepregnancy BMI and other covariates, childhood BMI was 0.23 (95% CI: 0.05, 0.40) kg/m(2) higher for children born to mothers with GDM versus those without GDM. Inclusion of placental weight in the model attenuated the association by 52% to 0.11 (95% CI: -0.06, 0.28) and similarly attenuated the associations with childhood BMI for GWG by 25% and maternal prepregnancy BMI by 17%.
  
  
  CONCLUSIONS
  Placental weight partly mediates the effects of prepregnancy BMI, excessive GWG, and GDM on childhood BMI.
authors: MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
authors: Fengxiu
authors: F
authors: Ouyang
authors: Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
authors: Margaret G
authors: MG
authors: Parker
authors: MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.|Department of Obstetrics and Gynecology, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, Canada.
authors: Zhong-Cheng
authors: ZC
authors: Luo
authors: MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
authors: Xia
authors: X
authors: Wang
authors: Department of Pathology, The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, Shanghai, China.|Department of Bio-Bank, The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, Shanghai, China.
authors: Hui-Juan
authors: HJ
authors: Zhang
authors: MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.|Department of Developmental and Behavioral Pediatrics, Shanghai Pediatric Transitional Institution, Shanghai Children's Medical Center Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors: Fan
authors: F
authors: Jiang
authors: Division of General Pediatrics & Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.|Center on Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors: Xiaobin
authors: X
authors: Wang
authors: Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
authors: Matthew W
authors: MW
authors: Gillman
authors: MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
authors: Jun
authors: J
authors: Zhang
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D016640:Diabetes, Gestational / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D039382:Maternal Nutritional Physiological Phenomena; D009035:Mothers; D009929:Organ Size; D050177:Overweight / Q000453:epidemiology / Q000503:physiopathology; D063766:Pediatric Obesity / Q000453:epidemiology / Q000209:etiology*; D010920:Placenta / Q000033:anatomy & histology*; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D015430:Weight Gain