Re: Maternal obesity during pregnancy and premature mortality from cardiovascular event in adult offspring: follow-up of 1 323 275 person years
The researchers found that children born to overweight and obese mothers were more likely to die from any cause during follow-up, and were specifically more likely to die before the age of 55. They were also at an increased risk of hospital admission for a cardiovascular disease event, such as a heart attack or stroke.
The relationship between maternal weight during pregnancy and their child’s health outcomes is likely to be complex and involve many factors.
There are obvious environmental factors to consider, for instance. Children brought up in a household where unhealthy eating patterns are the norm are more likely to adopt these patterns themselves.
There may also be many hereditary factors influencing the child’s tendency to be overweight or obese, as well as their risk of disease.
The idea that factors act during early critical windows such as intrauterine or early postnatal life to influence or "program" long-term health is now a major public health concern ( 1 ). For instance, a high birth weight has been suggested to program an increased risk of later obesity, as measured by body mass index (BMI; in kg/m 2 ) ( 2, 3 ). The association between birth weight and BMI, however, contradicts considerable evidence that a high birth weight programs less susceptibility rather than greater susceptibility to cardiovascular disease (CVD) risk factors ( 4, 5 ). One hypothesis that could partially explain this paradox is that low birth weight is associated with programming of greater abdominal or truncal fat mass ( 6 - 8 ), which would increase the metabolic risk of CVD, although the evidence for this is inconclusive ( 9 ). Another possibility is that, because BMI correlates strongly with both total lean mass and fat mass ( 10 ), positive associations between birth weight and later BMI represent an association of birth weight with lean rather than fat tissue.
Whatever the reasons for the association, this study reinforces the importance of women trying to achieve a healthy weight when planning to have a baby, as this may reduce the risk of complications in pregnancy.
1. Lucas A. Programming by early nutrition in man. In: Bock GR, Whelan J, eds. The childhood environment and adult disease. Ciba Found Symp 1991;156:38-55.
2. Dietz WH. Critical periods in childhood for the development of obesity. Am J Clin Nutr 1994;59:955-9.
3. Parsons TJ, Power C, Logan S, Summerbell CD. Childhood predictors of adult obesity: a systematic review. Int J Obes Relat Metabol Disord 1999;23:S1-107.
4. Barker DJP, Gluckman PD, Godfrey KM, Harding JE, Owens JA, Robinson JS. Fetal nutrition and cardiovascular disease in adult life. Lancet 1993;341:938-41.
5. Barker DJP. Fetal origins of coronary heart disease. BMJ 1995;311:171-4
6. Law CM, Barker DJP, Osmond C, Fall CHD, Simmonds SJ. Early growth and abdominal fatness in adult life. J Epidemiol Community Health 1992;46:184-6.
7. Barker M, Robinson S, Osmond C, Barker DJP. Birth weight and body fat distribution in adolescent girls. Arch Dis Child 1997;77:381-3.
8. Malina RM, Katzmarzyk PT, Beunen G. Birth weight and its relationship to size attained and relative fat distribution at 7 to 12 years of age. Obes Res 1996;4:385-90.
9. Choi CS, Kim CH, Lee WJ, et al. Association between birth weight and insulin sensitivity in healthy young men in Korea: role of visceral adiposity. Diabetes Res 2000;49:53-9.
10. Wells JC. A Hattori chart analysis of body mass index in infants and children. Int J Obes Relat Metab Disord 2000;24:325-9.
Rapid Response:
Re: Maternal obesity during pregnancy and premature mortality from cardiovascular event in adult offspring: follow-up of 1 323 275 person years
The researchers found that children born to overweight and obese mothers were more likely to die from any cause during follow-up, and were specifically more likely to die before the age of 55. They were also at an increased risk of hospital admission for a cardiovascular disease event, such as a heart attack or stroke.
The relationship between maternal weight during pregnancy and their child’s health outcomes is likely to be complex and involve many factors.
There are obvious environmental factors to consider, for instance. Children brought up in a household where unhealthy eating patterns are the norm are more likely to adopt these patterns themselves.
There may also be many hereditary factors influencing the child’s tendency to be overweight or obese, as well as their risk of disease.
The idea that factors act during early critical windows such as intrauterine or early postnatal life to influence or "program" long-term health is now a major public health concern ( 1 ). For instance, a high birth weight has been suggested to program an increased risk of later obesity, as measured by body mass index (BMI; in kg/m 2 ) ( 2, 3 ). The association between birth weight and BMI, however, contradicts considerable evidence that a high birth weight programs less susceptibility rather than greater susceptibility to cardiovascular disease (CVD) risk factors ( 4, 5 ). One hypothesis that could partially explain this paradox is that low birth weight is associated with programming of greater abdominal or truncal fat mass ( 6 - 8 ), which would increase the metabolic risk of CVD, although the evidence for this is inconclusive ( 9 ). Another possibility is that, because BMI correlates strongly with both total lean mass and fat mass ( 10 ), positive associations between birth weight and later BMI represent an association of birth weight with lean rather than fat tissue.
Whatever the reasons for the association, this study reinforces the importance of women trying to achieve a healthy weight when planning to have a baby, as this may reduce the risk of complications in pregnancy.
1. Lucas A. Programming by early nutrition in man. In: Bock GR, Whelan J, eds. The childhood environment and adult disease. Ciba Found Symp 1991;156:38-55.
2. Dietz WH. Critical periods in childhood for the development of obesity. Am J Clin Nutr 1994;59:955-9.
3. Parsons TJ, Power C, Logan S, Summerbell CD. Childhood predictors of adult obesity: a systematic review. Int J Obes Relat Metabol Disord 1999;23:S1-107.
4. Barker DJP, Gluckman PD, Godfrey KM, Harding JE, Owens JA, Robinson JS. Fetal nutrition and cardiovascular disease in adult life. Lancet 1993;341:938-41.
5. Barker DJP. Fetal origins of coronary heart disease. BMJ 1995;311:171-4
6. Law CM, Barker DJP, Osmond C, Fall CHD, Simmonds SJ. Early growth and abdominal fatness in adult life. J Epidemiol Community Health 1992;46:184-6.
7. Barker M, Robinson S, Osmond C, Barker DJP. Birth weight and body fat distribution in adolescent girls. Arch Dis Child 1997;77:381-3.
8. Malina RM, Katzmarzyk PT, Beunen G. Birth weight and its relationship to size attained and relative fat distribution at 7 to 12 years of age. Obes Res 1996;4:385-90.
9. Choi CS, Kim CH, Lee WJ, et al. Association between birth weight and insulin sensitivity in healthy young men in Korea: role of visceral adiposity. Diabetes Res 2000;49:53-9.
10. Wells JC. A Hattori chart analysis of body mass index in infants and children. Int J Obes Relat Metab Disord 2000;24:325-9.
Competing interests: No competing interests