title: Maternal weight gain in excess of pregnancy guidelines is related to daughters being overweight 40 years later.
abstract: Exceeding the Institute of Medicine guidelines for pregnancy weight gain increases childhood and adolescent obesity. However, it is unknown if these effects extend to midlife.
  
  
  
  We sought to determine if exceeding the Institute of Medicine guidelines for pregnancy weight gain increases risk of overweight/obesity in daughters 40 years later.
  
  
  
  This cohort study is based on adult offspring in the Child Health and Development Studies and the Collaborative Perinatal Project pregnancy cohorts originally enrolled in the 1960s. In 2005 through 2008, 1035 daughters in their 40s were recruited to the Early Determinants of Mammographic Density study. We classified maternal pregnancy weight gain as greater than vs less than or equal to the 2009 clinical guidelines. We used logistic regression to compare the odds ratios of daughters being overweight/obese (body mass index [BMI] ≥25) at a mean age of 44 years between mothers who did not gain or gained more than pregnancy weight gain guidelines, accounting for maternal prepregnant BMI, and daughter body size at birth and childhood. We also examined potential family related confounding through a comparison of sisters using generalized estimating equations, clustered on sibling units and adjusted for maternal age and race.
  
  
  
  Mothers who exceeded guidelines for weight gain in pregnancy were more likely to have daughters who were overweight/obese in their 40s (odds ratio [OR], 3.4; 95% confidence interval {CI}, 2.0-5.7). This magnitude of association translates to a relative risk (RR) increase of 50% (RR = 1.5; 95% CI, 1.3-1.6). The association was of the same magnitude when examining only the siblings whose mother exceeded guidelines in 1 pregnancy and did not exceed the guidelines in the other pregnancy. The association was stronger with increasing maternal prepregnancy BMI (P trend < .001). Compared to mothers with BMI <25 who did not exceed guidelines, the relative risks (RR) for having an overweight/obese adult daughter were 1.3 (95% CI, 1.1-1.7), 1.7 (95% CI, 1.4-2.1) and 1.8 (95% CI, 1.5-2.1), respectively, if mothers exceeded guidelines and their prepregnancy BMI was <25, overweight (BMI 25-<30), or obese (BMI >30). This pattern held irrespective of daughters' weight status at birth, at age 4 years, or at age 20 years.
  
  
  
  Our findings support that obesity prevention before pregnancy and strategies to maintain weight gain during pregnancy within the IOM guidelines might reduce the risk of being overweight in midlife for the offspring.
authors.affiliation: Department of Epidemiology, Columbia University, Mailman School of Public Health, 722W 168th Street, New York, NY 10032, USA.
authors.forename: L C
authors.initials: LC
authors.lastname: Houghton
authors.affiliation: Department of Epidemiology, Columbia University, Mailman School of Public Health, 722W 168th Street, New York, NY 10032, USA.|Parnassia Psychiatric Institute, Kiwistraat 43, 2552 DH, The Hague, The Netherlands.
authors.forename: W A
authors.initials: WA
authors.lastname: Ester
authors.affiliation: Department of Epidemiology, Columbia University, Mailman School of Public Health, 722W 168th Street, New York, NY 10032, USA.|Herbert Irving Comprehensive Cancer Center, Columbia Medical Center, New York, NY, USA.
authors.forename: L H
authors.initials: LH
authors.lastname: Lumey
authors.affiliation: Obstetrics, and Gynecology Epidemiology Center, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.|Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.|Institute for Prevention and Cancer Epidemiology, University Medical Center Freiburg, University of Freiburg, Germany.
authors.forename: K B
authors.initials: KB
authors.lastname: Michels
authors.affiliation: Department of Biostatistics, Columbia University, Mailman School of Public Health, Street, New York, NY 10032, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Wei
authors.affiliation: The Center for Research on Women and Children's Health, The Child Health and Development Studies, Public Health Institute, Berkeley, CA, USA.
authors.forename: B A
authors.initials: BA
authors.lastname: Cohn
authors.affiliation: Department of Epidemiology, Columbia University, Mailman School of Public Health, 722W 168th Street, New York, NY 10032, USA.|New York State Psychiatric Institute, New York, NY, USA.
authors.forename: E
authors.initials: E
authors.lastname: Susser
authors.affiliation: Department of Epidemiology, Columbia University, Mailman School of Public Health, 722W 168th Street, New York, NY 10032, USA.|Herbert Irving Comprehensive Cancer Center, Columbia Medical Center, New York, NY, USA.
authors.forename: M B
authors.initials: MB
authors.lastname: Terry
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D006801:Humans; D039382:Maternal Nutritional Physiological Phenomena / Q000502:physiology*; D009035:Mothers; D009679:Nuclear Family; D050177:Overweight / Q000209:etiology* / Q000503:physiopathology; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000503:physiopathology*; D012307:Risk Factors; D015430:Weight Gain / Q000502:physiology*
keywords: gestational weight gain; life course; obesity