Original Article

Association of Prepregnancy BMI, Gestational Weight Gain, and Child Birth Weight with Metabolic Dysfunction in Children and Adolescents with Obesity

Authors: Kelsey Pearson, MS, RD, Kristine C. Jordan, PhD, MPH, Julie Metos, PhD, MPH, Richard Holubkov, PhD, M. Nazeem Nanjee, PhD, Nicole L. Mihalopoulos, MD, MPH


Objectives: Previous studies have reported that maternal prepregnancy body mass index (BMI), gestational weight gain (GWG), and child birth weight are positively associated with metabolic dysfunction (a broader term than metabolic syndrome) in children and adolescents. Physical activity habits may play a role in reducing these risk factors. The objectives of this study were to investigate the association of prepregnancy BMI, GWG, child birth weight, physical activity, and sedentary time with metabolic dysfunction in a cohort of children and adolescents with obesity.

Methods: Participants (N = 117; 53% Hispanic) were children and adolescents, aged 8 to 17 years, with obesity. Fasting serum glucose, insulin, and a complete lipid profile were obtained. Body weight, height, waist circumference, and blood pressure were measured. A self-reported survey assessed prepregnancy BMI, GWG, child birth weight, physical activity, and sedentary time. The χ2 test and the Mantel-Haenzel test statistic were used to examine the differences in proportions for the outcome of metabolic dysfunction.

Results: In this sample, 76.9% of children and adolescents had metabolic dysfunction. Prepregnancy BMI and GWG were not associated with metabolic dysfunction. Child birth weight and sedentary behavior were positively correlated (P = 0.033 and P = 0.015, respectively) with a diagnosis of metabolic dysfunction. Physical activity levels were not associated with metabolic dysfunction. Hispanic and non-Hispanic youth were similar for all risk factors.

Conclusions: Contrary to previous studies, prepregnancy BMI and GWG were not correlated with metabolic dysfunction. These findings support the need for lifestyle interventions, particularly in reducing sedentary behaviors, in obese children and adolescents.
Posted in: Pregnancy16

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Rasmussen KM, Yaktine AL, eds. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press; 2009. 2. Gaillard R. Maternal obesity during pregnancy and cardiovascular development and disease in the offspring. Eur J Epidemiol. 2015;30:1141–1152. 3. Gaillard R, Steegers EAP, Franco OH, et al. Maternal weight gain in different periods of pregnancy and childhood cardio-metabolic outcomes. The Generation R Study. Int J Obes (Lond). 2015;39:677–685. 4. Gaillard R, Welten M, Oddy WH, et al. Associations of maternal prepregnancy body mass index and gestational weight gain with cardio-metabolic risk factors in adolescent offspring: a prospective cohort study. BJOG 2016;123:207–216. 5. Toemen L, Gishti O, van Osch-Gevers L, et al. Maternal obesity, gestational weight gain and childhood cardiac outcomes: role of childhood body mass index. Int J Obes (Lond) 2016;40:1070-1078. 6. Vidakovic AJ, Jaddoe VWV, Gishti O, et al. Body mass index, gestational weight gain and fatty acid concentrations during pregnancy: the Generation R Study. Eur J Epidemiol 2015;30:1175–1185. 7. Huda SS, Brodie LE, Sattar N. Obesity in pregnancy: prevalence and metabolic consequences. Semin Fetal Neonatal Med 2010;15:70–76. 8. Nehring I, Lehmann S, von Kries R. Gestational weight gain in accordance to the IOM/NRC criteria and the risk for childhood overweight: a meta-analysis. Pediatr Obes 2013;8:218–224. 9. Carolan-OlahM, Duarte-GardeaM, Lechuga J. A critical review: early life nutrition and prenatal programming for adult disease. J Clin Nurs 2015;24:3716–3729. 10. Lillycrop KA, Burdge GC. Maternal diet as a modifier of offspring epigenetics. J Dev Orig Health Dis 2015;6:88–95. 11. Battaglia FC, Lubchenco LO. A practical classification of newborn infantsby weight and gestational age. J Pediatr 1967;71:159–163. 12. Curhan GC, Chertow GM, Willett WC, et al. Birth weight and adult hypertension and obesity in women. Circulation 1996;94:1310–1315. 13. McCance DR, Pettitt DJ, Hanson RL, et al. Birth weight and non-insulin dependent diabetes: thrifty genotype, thrifty phenotype, or surviving small baby genotype? BMJ 1994;308:942–945. 14. Curhan GC, Willett WC, Rimm EB, et al. Birth weight and adult hypertension, diabetes mellitus, and obesity in US men. Circulation 1996;94:3246–3250. 15. Sehgal A, Skilton MR, Crispi F. Human fetal growth restriction: a cardiovascular journey through to adolescence. J Dev Orig Health Dis 2016;7:626–635. 16. Khandelwal P, Jain V, Gupta AK, et al. Association of early postnatal growth trajectory with body composition in term low birth weight infants. J Dev Orig Health Dis 2014;5:189–196. 17. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: summary report. Pediatrics 2011;128(suppl 5):S213–S256. 18. Maffeis C, Banzato C, Talamini G, et al. Waist-to-height ratio, a useful index to identify high metabolic risk in overweight children. J Pediatr 2008;152:207–213. 19. Ensenauer R, Chmitorz A, Riedel C, et al. Effects of suboptimal or excessive gestational weight gain on childhood overweight and abdominal adiposity: results from a retrospective cohort study. Int J Obes (Lond) 2013;37:505–512. 20. Daniels SR, Hassink SG, Abrams SA, et al. The Role of the pediatrician in primary prevention of obesity. Pediatrics 2015;136:e275–e292. 21. US Department of Health and Human Services. 2008 physical activity guidelines for Americans. https://health.gov/sites/default/files/2019-09/paguide.pdf. Published 2008. Accessed August 13, 2020. 22. Duncan PM, Shaw JS, Hagan JF. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. Itasca, IL:American Academy of Pediatrics; 2008. 23. Peplies J, Bornhorst C, Gunther K, et al. Longitudinal associations of lifestyle factors and weight status with insulin resistance (HOMA-IR) in preadolescent children: the large prospective cohort study IDEFICS. Int J Behav Nutr Phys Act 2016;13:97. 24. Robinson TN. Reducing children’s television viewing to prevent obesity: a randomized controlled trial. JAMA 1999;282:1561–1567. 25. Mamun AA, O’Callaghan MJ, Williams G, et al. Television watching from adolescence to adulthood and its association with BMI, waist circumference, waist-to-hip ratio and obesity: a longitudinal study. Public Health Nutr 2012;16:54–64. 26. Warnick GR, Benderson J, Albers JJ. Dextran sulfate-Mg2+ precipitation procedure for quantitation of high-density-lipoprotein cholesterol. Clin Chem 1982;28:1379–1388. 27. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18:499–502. 28. Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412–419. 29. Alberti G, Zimmet P, Kaufman F, et al.The IDFConsensus Definition of the Metabolic Syndrome in Children and Adolescents. Brussels: IDF Communications; 2007. 30. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Questionnaire. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2003–2004. https://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/questionnaires.aspx?BeginYear=2003. Accessed September 5, 2020. 31. Kowalski K, Crocker P, Donen R. The Physical Activity Questionnaire for Older Children (PAQ-C) and Adolescents (PAQ-A) Manual. https://www.prismsports.org/UserFiles/file/PAQ_manual_ScoringandPDF.pdf. Published 2004. Accessed August 13, 2020. 32. World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation on Obesity. Geneva: WHO; 1997. 33. Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–381. 34. Friend A, Craig L, Turner S. The prevalence of metabolic syndrome in children: a systematic review of the literature. Metab Syndr Relat Disord 2013;11:71–80. 35. Godfrey KM, Barker DJP. Fetal programming and adult health. Public Health Nutr 2001;4:611–624. 36. Sehgal A, Skilton MR, Crispi F. Human fetal growth restriction: a cardiovascular journey through to adolescence. J Dev Orig Health Dis 2016;7:626–635. 37. Curhan GC, Chertow GM, Willett WC, et al. Birth weight and adult hypertension and obesity in women. Circulation 1996;94:1310–1315. 38. Faienza MF, Wang DQ, Fruhbeck G, et al. The dangerous link between childhood and adulthood predictors of obesity and metabolic syndrome. Intern Emerg Med 2016;11:175–182. 39. Hull HR, Thornton J, Paley C, et al. Maternal obesity influences the relationship between location of neonate fat mass and total fat mass. Pediatr Obes 2015;10:245–251. 40. Owen N, Healy GN, Matthews CE, et al. Too much sitting: the population health science of sedentary behavior. Exerc Sport Sci Rev 2010;38:105–113. 41. Warren TY, Barry V, Hooker SP, et al. Sedentary behaviors increase risk of cardiovascular disease mortality in men. Med Sci Sports Exerc 2010;42:879–885. 42. Epstein LH, Valoski AM, Vara LS, et al. Effects of decreasing sedentary behavior and increasing activity on weight change in obese children. Health Psychol 1995;14:109–115.