What question did this study set out to answer?

To investigate how maternal prepregnancy body mass index and gestational weight gain influence the risk of early childhood overweight and obesity.

April 16, 2026International Journal of Obesity1 citationsOpen Access

The association of prenatal adiposity characteristics with early childhood overweight and obesity: findings from a large and diverse mother–child cohort

HMHua MinGeorge Mason University MBMichael S. Bloom GLGrace N. LawrenceGeorge Mason University

Key Points

To investigate how maternal prepregnancy body mass index and gestational weight gain influence the risk of early childhood overweight and obesity.
Conducted a prospective cohort study of 2899 mother-child dyads in northern Virginia from 2012 to 2019.
Self-reported maternal prepregnancy BMI categorized as overweight or obesity, and gestational weight gain assessed.
Child weight tracked every six months until 24 months, then annually to assess overweight and obesity status.
Utilized generalized linear models to predict children’s body weight Z-scores, adjusting for various covariates.
Performed causal mediation analysis to explore the roles of birth weight and growth velocity.
Approximately 25.4% of children were classified as overweight and 10.5% as obese at 36 months.
Higher maternal prepregnancy BMI significantly correlated with childhood obesity risk, particularly in non-Hispanic mothers.
40.8% of mothers experienced excess gestational weight gain.
Causal mediation analysis indicated 26.8% of the association between maternal BMI and childhood obesity was mediated by birth weight.

Abstract

Abstract Background Maternal prepregnancy body mass index (ppBMI) and gestational weight gain (GWG) are risk factors for overweight and obesity (OWO) in childhood. However, a better understanding of the magnitude, timing, and mediating mechanisms of these associations can inform interventions to improve maternal and child health. Methods We conducted a prospective cohort study of 2899 mother–child dyads in northern Virginia (2012–2019). Maternal ppBMI was self-reported and GWG was calculated and categorized as excess (EGWG) using 2009 Institute of Medicine guidelines. Child weight was reported by parents every six months from birth to 24 months, and annually thereafter. Childhood OWO was defined as >85th percentile of WHO growth charts at 36 months. Generalized linear and mixed models estimated maternal OWO status and GWG as predictors of children’s body weight Z-score and growth velocity, adjusted for covariate. Causal mediation analysis was used to quantify birth weight and early growth velocity as intervening factors. Results: Mothers self-reported Hispanic (32.08%) and non-Hispanic (51.98%) ethnicity (15.94% missing). Mean ± SD ppBMI was 25.5 ± 5.4 kg/m² (35.46% with obesity) and GWG was 14.2 ± 6.8 kg (40.8% EGWG). At 36 months, 25.4% of children had overweight and 10.5% had obesity. Higher ppBMI (RR = 1.04 per 1.00 kg/m 2 ; 95% CI: 1.03–1.06) and GWG was associated with childhood risk of OWO among non-Hispanic but not Hispanic mothers (interaction P = 0.02). Similarly, maternal obesity status (RR = 1.64; 95% CI: 1.26–2.13) and EGWG (RR = 1.38; 95% CI: 1.09–1.74) were associated with childhood OWO risk. Approximately 26.8% (95% CI: 14.9%–55.9%) of the ppBMI–OWO association could be attributed to birth weight. Conclusions Maternal ppBMI and GWG were independently associated with risk of OWO in early childhood OWO, with variations by child age and ethnicity, highlighting the potential of pre- and perinatal interventions to reduce childhood obesity risk.

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