Second Trimester Estimated Fetal Weight and Fetal Weight Gain Predict Childhood Obesity

doi:10.1016/j.jpeds.2012.04.065

The Journal of Pediatrics

Volume 161, Issue 5, November 2012, Pages 864-870.e1

https://doi.org/10.1016/j.jpeds.2012.04.065 Get rights and content

Objective

To determine the extent to which fetal weight during mid-pregnancy and fetal weight gain from mid-pregnancy to birth predict adiposity and blood pressure (BP) at age 3 years.

Study design

Among 438 children in the Project Viva cohort, we estimated fetal weight at 16-20 (median 18) weeks' gestation using ultrasound biometry measures. We analyzed fetal weight gain as change in quartile of weight from the second trimester until birth, and we measured height, weight, subscapular and triceps skinfold thicknesses, and BP at age 3.

Results

Mean (SD) estimated weight at 16-20 weeks was 234 (30) g and birth weight was 3518 (420) g. In adjusted models, weight estimated during the second trimester and at birth were associated with higher body mass index (BMI) z-scores at age 3 years (0.32 unit [95% CI, 0.04-0.60 unit] and 0.53 unit [95% CI, 0.24-0.81 unit] for the highest vs lowest quartile of weight). Infants with more rapid fetal weight gain and those who remained large from mid-pregnancy to birth had higher BMI z-scores (0.85 unit [95% CI, 0.30-1.39 unit] and 0.63 unit [95% CI, 0.17-1.09 unit], respectively) at age 3 than did infants who remained small during fetal life. We did not find associations between our main predictors and sum or ratio of subscapular and triceps skinfold thicknesses or systolic BP.

Conclusion

More rapid fetal weight gain and persistently high fetal weight during the second half of gestation predicted higher BMI z-score at age 3 years. The rate of fetal weight gain throughout pregnancy may be important for future risk of adiposity in childhood.

Section snippets

Methods

We studied participants in Project Viva, a prospective, observational, cohort study of gestational diet, pregnancy outcomes, and offspring health.⁹ The details of recruitment and retention procedures are available elsewhere.⁹ All mothers provided written informed consent. The human subjects committees of Harvard Pilgrim Health Care, Brigham and Women's Hospital, and Beth Israel Deaconess Medical Center approved the study protocols. Of the 2128 women who delivered a live infant, we excluded 45

Results

The mean (SD) gestational age at the second trimester 16-to 20-week ultrasound was 18.2 (0.7) weeks (Table I). Fetal biometry measures were 124.9 (11.4) mm for AC, 41.4 (2.3) mm for BPD, and 26.9 (2.0) mm for FL. EFW at 16-20 weeks adjusted for gestational age was 234 (30) g and birth weight adjusted for gestational age was 3518 (420) g. At age 3 years, mean (SD) BMI was 16.5 (1.4) kg/m² and BMI z-score was 0.43 (0.99) unit. Nine percent of the children had BMI ≥95th percentile for age and sex.

Discussion

Our findings differ from those of Durmus et al of the Generation R cohort in the Netherlands who found an inverse relationship between second trimester fetal weight and ultrasound-measured abdominal fat mass in the preperitoneal area, representing visceral abdominal fat at age 2, but did not find associations between fetal weight, fetal weight gain, and other ultrasound measures of central adiposity that are related to adverse metabolic outcomes.⁷ We found positive associations between second

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Cited by (18)

The Maternal Nutritional Milieu and Neonatal Outcomes: Connecting the Dots
2018, Journal of Pediatrics
Risk Factors for Childhood Obesity in the First 1,000 Days: A Systematic Review
2016, American Journal of Preventive Medicine
Citation Excerpt :
Twenty-eight studies40,42,53,62,68,69,78,79,90,98,163,168–184 examined the association between birth weight and later child overweight. Higher birth weight was consistently associated with later childhood overweight, with 24 studies40,42,53,68,69,78,79,90,98,163,168–175,177–181,184 identifying an association between higher birth weight and later overweight. Studies defined birth weight as a continuous measure, as categorical absolute weight (e.g., macrosomia), or in reference to gestational age (e.g., large for gestational age).
Mounting evidence suggests that the origins of childhood obesity and related disparities can be found as early as the “first 1,000 days”—the period from conception to age 2 years. The main goal of this study is to systematically review existing evidence for modifiable childhood obesity risk factors present from conception to age 2 years.
PubMed, Embase, and Web of Science were searched for studies published between January 1, 1980, and December 12, 2014, of childhood obesity risk factors present during the first 1,000 days. Prospective, original human subject, English-language research with exposure occurrence during the first 1,000 days and with the outcome of childhood overweight or obesity (BMI ≥85th percentile for age and sex) collected between age 6 months and 18 years were analyzed between December 13, 2014, and March 15, 2015.
Of 5,952 identified citations, 282 studies met inclusion criteria. Several risk factors during the first 1,000 days were consistently associated with later childhood obesity. These included higher maternal pre-pregnancy BMI, prenatal tobacco exposure, maternal excess gestational weight gain, high infant birth weight, and accelerated infant weight gain. Fewer studies also supported gestational diabetes, child care attendance, low strength of maternal–infant relationship, low SES, curtailed infant sleep, inappropriate bottle use, introduction of solid food intake before age 4 months, and infant antibiotic exposure as risk factors for childhood obesity.
Modifiable risk factors in the first 1,000 days can inform future research and policy priorities and intervention efforts to prevent childhood obesity.
Using Estimated Fetal Weight From Ultrasonography at 18 to 22 Weeks to Predict Gestational Diabetes Mellitus and Newborn Macrosomia
2014, Journal of Obstetrics and Gynaecology Canada
Citation Excerpt :
For example, EFW at 28 to 32 weeks’ gestation has a strong negative predictive value for LGA status at birth.9 Conversely, EFW did predict both birth weight and LGA status among women without GDM, as noted by others.7,10 EFW at 18 to 22 weeks alone does not appear to be a reliable indicator of birth weight or LGA status among newborns of women with GDM.
To determine if fetal macrosomia in the second trimester predicts the onset of gestational diabetes mellitus (GDM) or large for gestational age (LGA) birth weight.
We performed a case–control study using data from the Diabetes in Pregnancy Clinic in our tertiary care hospital. Cases were women with GDM requiring insulin (n = 65) or controlled with diet (n = 65). Control subjects were women who screened negative for GDM at 24 to 28 weeks’ gestation (n = 131). Estimated fetal weight (EFW) was determined by ultrasound at 18 to 22 weeks.
Estimated fetal weight that was one standard deviation (70 g) higher at 18 to 22 weeks was not associated with subsequent GDM (adjusted OR [aOR] 1.00, 95% confidence intervals 0.61 to 1.66), but was associated with a 231 g (95% CI 128 g to 334 g) increase in birth weight and increased odds of LGA (aOR 4.02, 95% CI 1.76 to 9.19) after adjusting for gestational age at the time of estimating fetal weight, maternal age, parity, BMI and GDM treatment.
EFW at 18 to 22 weeks did not predict the onset of GDM, but did predict LGA.
Déterminer si la macrosomie fœtale constatée au deuxième trimestre permet de prédire l’apparition du diabète sucré gestationnel (DSG) ou la constatation d’une hypertrophie fœtale (HF).
Nous avons mené une étude cas-témoins au moyen de données issues de la Diabetes in Pregnancy Clinic de notre hôpital de soins tertiaires. Les cas étaient constitués de femmes présentant un DSG traité à l’insuline (n = 65) ou maîtrisé par le régime alimentaire (n = 65). Les témoins étaient constitués de femmes ayant obtenu des résultats négatifs au dépistage du DSG à 24-28 semaines de gestation (n = 131). Le poids fœtal estimé (PFE) a été déterminé par échographie à 18-22 semaines.
Le poids fœtal estimé qui était plus élevé d’un écart-type (70 g) à 18-22 semaines n’a pas été associé à un DSG subséquent (RC corrigé [RCc], 1,00; IC à 95 %, 0,61 - 1,66), mais a été associé à une hausse de 231 g (IC à 95 %, 128 g-334 g) du poids de naissance et à des risques accrus de constater une HF (RCc, 4,02; IC à 95 %, 1,76 - 9,19), à la suite de la neutralisation des effets de l’âge gestationnel au moment de l’estimation du poids fœtal, de l’âge maternel, de la parité, de l’IMC et du traitement contre le DSG.
Bien que le PFE à 18-22 semaines n’ait pas permis de prédire l’apparition du DSG, il a permis de prédire la constatation d’une HF.
Is the Biphasic Effect of Diabetes and Obesity on Fetal Growth a Risk Factor for Childhood Obesity?
2023, Diabetes Care
Relationships between intrauterine fetal growth trajectories and markers of adiposity and inflammation in young adults
2022, International Journal of Obesity
Fetal growth at different gestational periods and risk of impaired childhood growth, low childhood weight and obesity: a prospective birth cohort study
2021, BJOG: An International Journal of Obstetrics and Gynaecology

View all citing articles on Scopus

: Funded by National Institutes of Health (grants HL-64925, HD-034568, and HL-068041). The authors declare no conflicts of interest.

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Original ArticleSecond Trimester Estimated Fetal Weight and Fetal Weight Gain Predict Childhood Obesity

Objective

Study design

Results

Conclusion

Section snippets

Methods

Results

Discussion

J Pediatr

J Pediatr

Am J Obstet Gynecol

Am J Obstet Gynecol

Obesity and the developmental origins of health and disease

J Paediatr Child Health

The long-term effects of prenatal development on growth and metabolism

Semin Reprod Med

Rapid infancy weight gain and subsequent obesity: systematic reviews and hopeful suggestions

Acta Paediatr

Weight status in the first 6 months of life and obesity at 3 years of age

Pediatrics

Timing and tempo of first-year rapid growth in relation to cardiovascular and metabolic risk profile in early adulthood

JAMA

Growth in foetal life and infancy is associated with abdominal adiposity at the age of 2 years: the generation R study

Clin Endocrinol (Oxf)

Fetal and postnatal growth and blood pressure at the age of 2 years. The Generation R Study

J Hypertens

Is sonographic assessment of fetal weight influenced by formula selection?

J Ultrasound Med

Original Article
Second Trimester Estimated Fetal Weight and Fetal Weight Gain Predict Childhood Obesity