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Longer breastfeeding duration reduces the positive relationships among gestational weight gain, birth weight and childhood anthropometrics
  1. Yeyi Zhu1,
  2. Ladia M Hernandez1,
  3. Yongquan Dong1,
  4. John H Himes2,
  5. Steven Hirschfeld3,
  6. Michele R Forman1
  1. 1Department of Nutritional Sciences, University of Texas at Austin, Austin, Texas, USA
  2. 2Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
  3. 3Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
  1. Correspondence to Dr Yeyi Zhu, Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD 20852, USA; yeyi.zhu{at}


Background The relationship between gestational weight gain (GWG) and childhood growth remains controversial. An examination on whether infant feeding practices mediate this relationship may improve our understanding of it.

Methods We investigated whether the relationships among GWG, birth weight and childhood anthropometrics were mediated through infant feeding practices (breastfeeding duration and age at introduction of solid foods) in a cross-sectional multiethnic study of 1387 mothers and their children aged 0–5.9 years in the USA (2011–2012). Child anthropometrics included age-specific and sex-specific z-scores for weight-for-age (WAZ), height/length-for-age (HAZ), weight-for-height/length (WHZ) and body mass index-for-age (BMIZ); and ulnar length, a marker for limb growth. We used structural equation modelling to calculate standardised path coefficients and total, direct and indirect associations of GWG, birth weight and infant feeding practices with child anthropometrics.

Results Maternal GWG had a positive indirect association with all anthropometrics mediated via birth weight, whereas longer breastfeeding duration reduced the positive associations of GWG and birth weight with WAZ, WHZ and BMIZ in non-Hispanics (β=−0.077, −0.064 and −0.106, respectively). Longer breastfeeding duration and introducing solid foods at a later age were positively associated with ulnar length (β=0.023 and 0.030, respectively) but not HAZ, suggesting a distinct association, for the first time, with limb growth.

Conclusions Findings suggest that promoting longer breastfeeding duration among women with excessive GWG who had high birthweight newborns may mitigate the potential for their offspring to develop obesity. In addition, findings reinforce the importance of promoting appropriate GWG and preventing high birth weight, which are positively associated with childhood anthropometrics.


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