Rationale:

• High body weight affects fetal outcome, and intrauterine imprinting can affect long-term control of body weight.

Evidence:

• Strong evidence supports the association between gestational weight gains and pre-term birth, low birth weight, macrosomia (1), large-for-gestational age infants, small-for-gestational age infants, and neonatal mortality, particularly among blacks (2; 3; 4; 5; 6; 7).
• Weight gain in pregnancy predicts childhood weights. Odds of overweight at age 7 are increased by 3% for every 1 kg of gestational weight gain (8).
• A meta-analysis shows that maternal obesity is associated with an increased risk of neural tube and other (9) congenital defects during pregnancy (10).
• Smoking during pregnancy increases the risk of obesity in male and female offspring (11; 12; 13; 14; 15; 16; 17; 18; 19) by 50% (adjusted OR, 1.50 [CI, 1.36 to 1.65]) (20), particularly in white women. Only black women who smoked heavily had heavier children. Smoking among Asian and Native American women had much less effect (21).
• The risk of gestational diabetes increases with increasing BMI (22), and gestational diabetes increases birth weight and subsequent risk of obesity (23; 24). According to one report, the outcome for infants and mothers with type 1 diabetes also depends on duration of breast feeding and infant birth size (25).
• There is a positive trend for childhood overweight with maternal glucose screening values; treatment of gestational diabetes attenuates this relation (26).
• Prepregnancy weight, weight gain during pregnancy, chronic or gestational diabetes, and hypertension increase risk for cesarean delivery (27; 28; 29; 30; 31). Women with gestational diabetes who gain more than 10 lb before their next pregnancy also have an increased risk of having a cesarean section (32).
• Infants who are small for gestational age are at higher risk for diabetes, hypertension, and the metabolic syndrome (33).
• Higher maternal prepregnancy weight (34), higher gestational weight gain (29), and maternal age (29) increase the risk (odds ratio >2) for childhood weight above the 95^th percentile (18; 35; 36) and for the metabolic syndrome (37; 38).
• Obesity is associated with increased risk of hypertensive disorders (39), stillbirth (40), cesarean delivery, fetal distress, and early neonatal death, particularly in nulliparous women (41; 42; 43; 44), but BMI is a weak predictor of pre-eclampsia (45).
• Children of women who were both overweight and gained a large amount of weight during gestation had a two-fold risk of attention-deficit hyperactivity disorder symptoms (OR, 2.10 [CI, 1.19 to 3.72]) compared to those of normal-weight women (46).

Comments:

• None.