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Relation of maternal prepregnancy body mass index with offspring bone mass in childhood: is there evidence for an intrauterine effect?

ABSTRACT: Evidence indicates that intrauterine skeletal development has implications for bone mass in later life and that maternal fat stores in pregnancy are important for fetal bone mineral accrual.We investigated whether childhood bone mass is influenced by maternal body mass index (BMI) via an intrauterine mechanism by comparing parental associations.We conducted a multivariable regression analysis of 7121 children in the Avon Longitudinal Study of Parents and Children. Total body less head (TBLH) and spine bone measures were derived from dual-energy X-ray absorptiometry scans at a mean age of 9.9 y. Maternal and paternal BMI values were derived from self-reported weight and height during pregnancy.Maternal prepregnancy BMI (SD score) was positively associated with offspring TBLH bone mineral content and bone mineral density (SD scores) [mean difference (95% CI): boys, 0.19 (0.16, 0.23) and 0.15 (0.12, 0.19), respectively; girls, 0.23 (0.19, 0.26) and 0.19 (0.16, 0.23), respectively] and spine bone mineral content and bone mineral density [boys, 0.20 (0.16, 0.24) and 0.18 (0.14, 0.22), respectively; girls, 0.22 (0.18, 0.26) and 0.21 (0.17, 0.25), respectively] and with TBLH and spine bone area-and spine area-adjusted bone mineral content. Associations of paternal BMI with these outcomes were similar, with no statistical evidence of a difference between maternal and paternal effects. Maternal associations were partly explained by offspring birth weight and gestational age and attenuated to the null after adjustment for offspring height and weight.The positive relation between maternal prepregnancy BMI and offspring bone mass is likely due to shared familial, genetic, and environmental characteristics rather than to an intrauterine mechanism.

SUBMITTER: Macdonald-Wallis C

PROVIDER: S-EPMC2937586 | biostudies-literature | 2010 Oct

REPOSITORIES: biostudies-literature

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Relation of maternal prepregnancy body mass index with offspring bone mass in childhood: is there evidence for an intrauterine effect?

Macdonald-Wallis Corrie C Tobias Jon H JH Smith George Davey GD Lawlor Debbie A DA

The American journal of clinical nutrition 20100728 4

<h4>Background</h4>Evidence indicates that intrauterine skeletal development has implications for bone mass in later life and that maternal fat stores in pregnancy are important for fetal bone mineral accrual.<h4>Objective</h4>We investigated whether childhood bone mass is influenced by maternal body mass index (BMI) via an intrauterine mechanism by comparing parental associations.<h4>Design</h4>We conducted a multivariable regression analysis of 7121 children in the Avon Longitudinal Study of P ...[more]

PMID: 20668048

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Project description:ImportanceAlthough high body mass index (BMI) is associated with adverse birth outcomes, the association with severe maternal morbidity is unclear.ObjectiveTo examine the association between prepregnancy BMI and severe maternal morbidity.Design, setting, and participantsRetrospective population-based cohort study including all singleton hospital births in Washington State, 2004-2013. Demographic data and morbidity diagnoses were obtained from linked birth certificates and hospitalization files.ExposuresPrepregnancy BMI (weight in kilograms divided by height in meters squared) categories included underweight (<18.5), normal BMI (18.5-24.9), overweight (25.0-29.9), obesity class 1 (30.0-34.9), obesity class 2 (35.0-39.9), and obesity class 3 (≥40).Main outcomes and measuresComposite severe maternal morbidity or mortality included life-threatening conditions and conditions leading to serious sequelae (eg, amniotic fluid embolism, hysterectomy), complications requiring intensive care unit admission, and maternal death. Logistic regression was used to obtain adjusted odds ratios (ORs) and adjusted rate differences with 95% confidence intervals, adjusted for confounders (eg, maternal age and parity).ResultsOverall, 743 630 women were included in the study (mean age, 28.1 [SD, 6.0] years; 41.4% nulliparous). Prepregnancy BMI was distributed as follows: underweight, 3.2%; normal weight, 47.5%; overweight, 25.8%; obesity class 1, 13.1%; obesity class 2, 6.2%; and obesity class 3, 4.2%. Rates of severe maternal morbidity or mortality were 171.5, 143.2, 160.4, 167.9, 178.3 and 202.9 per 10 000 women, respectively. Adjusted ORs were 1.2 (95% CI, 1.0-1.3) for underweight women; 1.1 (95% CI, 1.1-1.2) for overweight women; 1.1 (95% CI, 1.1-1.2) for women with class 1 obesity; 1.2 (95% CI, 1.1-1.3) for women with class 2 obesity; and 1.4 (95% CI, 1.3-1.5) for women with class 3 obesity compared with women with normal BMI. Absolute risk increases (adjusted rate differences per 10 000 women, compared with women with normal BMI) were 28.8 (95% CI, 12.2-47.2) for underweight women, 17.6 (95% CI, 10.5-25.1) for overweight women, 24.9 (95% CI, 15.7-34.6) for women with class 1 obesity, 35.8 (95% CI, 23.1-49.5) for women with class 2 obesity, and 61.1 (95% CI, 44.8-78.9) for women with class 3 obesity.Conclusions and relevanceAmong pregnant women in Washington State, low and high prepregnancy BMI, compared with normal BMI, were associated with a statistically significant but small absolute increase in severe maternal morbidity or mortality.

Project description:BackgroundAn association between prepregnancy body mass index (BMI) and severe maternal morbidity (SMM) has been reported, but evidence has been mixed and potential explanations have not been examined.ObjectiveTo evaluate the association between prepregnancy BMI and SMM in a large, diverse birth cohort and assess potential mediation by obesity-related co-morbidities and caesarean birth.MethodsThis cohort study used linked birth certificate and hospitalisation discharge records from Californian births during 2007-2012. We assessed associations between prepregnancy BMI and SMM, and used inverse probability weighting for multiple mediators to estimate relative and absolute natural direct and indirect effects accounting for mediation by co-morbidities (hypertensive conditions, diabetes, asthma) and caesarean birth.ResultsAmong 2 650 182 births, the prevalence of SMM was 1.42%. Adjusted risk ratios for the total association between prepregnancy BMI category and SMM were 1.12 (95% confidence interval [CI] 1.07, 1.18) for underweight, 1.02 (95% CI 0.99, 1.04) for overweight, 1.04 (95% CI 1.00, 1.07) for obesity class 1, 1.14 (95% CI 1.09, 1.20) for obesity class 2, and 1.28 (95% CI 1.22, 1.36) for obesity class 3 compared to women with normal weight. After accounting for mediation by co-morbidity and caesarean birth, the risk ratios were 1.19 (95% CI 1.14, 1.26) for underweight, 0.91 (95% CI 0.89, 0.94) for overweight, 0.86 (95% CI 0.84, 0.89) for obesity class 1, 0.88 (95% CI 0.84, 0.92) for obesity class 2, and 0.89 (95% CI 0.83, 0.95) for obesity class 3.ConclusionsCo-morbidities and caesarean birth explained an association between high prepregnancy BMI and SMM. These findings suggest that promotion of healthy prepregnancy weight, along with management of co-morbidities and support of vaginal birth in pregnant women with high BMI, could reduce the risk of SMM. However, these mediators did not reduce the elevated risk of SMM observed in women with low BMI.

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Relation of maternal prepregnancy body mass index with offspring bone mass in childhood: is there evidence for an intrauterine effect?

Publications

Relation of maternal prepregnancy body mass index with offspring bone mass in childhood: is there evidence for an intrauterine effect?

Similar Datasets

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