The association between maternal 25-hydroxyvitamin D concentration during gestation and early childhood cardio-metabolic outcomes: is there interaction with pre-pregnancy BMI?

Both maternal 25-hydroxyvitamin D (25OHD) status and pre-pregnancy BMI (pBMI) may influence offspring cardio-metabolic outcomes. Lower 25OHD concentrations have been observed in women with both low and high pBMIs, but the combined influence of pBMI and 25OHD on offspring cardio-metabolic outcomes is unknown. Therefore, this study investigated the role of pBMI in the association between maternal 25OHD concentration and cardio-metabolic outcomes in 5-6 year old children. Data were obtained from the ABCD cohort study and 1882 mother-child pairs were included. The offspring outcomes investigated were systolic and diastolic blood pressure, heart rate, BMI, body fat percentage (%BF), waist-to-height ratio, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, glucose, C-peptide, and insulin resistance (HOMA2-IR). 62% of the C-peptide samples were below the detection limit and were thus imputed using survival analysis. Models were corrected for maternal and offspring covariates and tested for interaction with pBMI. Interaction with pBMI was observed in the associations with insulin resistance markers: in offspring of overweight mothers (≥25.0 kg/m2), a 10 nmol/L increase in maternal 25OHD was associated with a 0.007(99%CI:-0.01,-0.001) nmol/L decrease in C-peptide and a 0.02(99%CI:-0.03,-0.004) decrease in HOMA2-IR. When only non-imputed data were analyzed, there was a trend for interaction in the relationship but the results lost significance. Interaction with pBMI was not observed for the other outcomes. A 10 nmol/L increase in maternal 25OHD was significantly associated with a 0.13%(99%CI:-0.3,-0.003) decrease in %BF after correction for maternal and child covariates. Thus, intrauterine exposure to both low 25OHD and maternal overweight may be associated with increased insulin resistance in offspring, while exposure to low 25OHD in utero may be associated with increased offspring %BF with no interactive effects from pBMI. Due to the limitations of this study, these results are not conclusive, however the observations of this study pose important research questions for future studies to investigate

Gestational weight gain charts for different body mass index groups for women in Europe, North America, and Oceania

BackgroundGestational weight gain differs according to pre-pregnancy body mass index and is related to the risks of adverse maternal and child health outcomes. Gestational weight gain charts for women in different pre-pregnancy body mass index groups enable identification of women and offspring at risk for adverse health outcomes. We aimed to construct gestational weight gain reference charts for underweight, normal weight, overweight, and grades 1, 2 and 3 obese women and to compare these charts with those obtained in women with uncomplicated term pregnancies.MethodsWe used individual participant data from 218,216 pregnant women participating in 33 cohorts from Europe, North America, and Oceania. Of these women, 9065 (4.2%), 148,697 (68.1%), 42,678 (19.6%), 13,084 (6.0%), 3597 (1.6%), and 1095 (0.5%) were underweight, normal weight, overweight, and grades 1, 2, and 3 obese women, respectively. A total of 138, 517 women from 26 cohorts had pregnancies with no hypertensive or diabetic disorders and with term deliveries of appropriate for gestational age at birth infants. Gestational weight gain charts for underweight, normal weight, overweight, and grade 1, 2, and 3 obese women were derived by the Box-Cox t method using the generalized additive model for location, scale, and shape.ResultsWe observed that gestational weight gain strongly differed per maternal pre-pregnancy body mass index group. The median (interquartile range) gestational weight gain at 40weeks was 14.2kg (11.4-17.4) for underweight women, 14.5kg (11.5-17.7) for normal weight women, 13.9kg (10.1-17.9) for overweight women, and 11.2kg (7.0-15.7), 8.7kg (4.3-13.4) and 6.3kg (1.9-11.1) for grades 1, 2, and 3 obese women, respectively. The rate of weight gain was lower in the first half than in the second half of pregnancy. No differences in the patterns of weight gain were observed between cohorts or countries. Similar weight gain patterns were observed in mothers without pregnancy complications.ConclusionsGestational weight gain patterns are strongly related to pre-pregnancy body mass index. The derived charts can be used to assess gestational weight gain in etiological research and as a monitoring tool for weight gain during pregnancy in clinical practice.Peer reviewe

Growth patterns from birth to overweight at age 5-6 years of children with various backgrounds in socioeconomic status and country of origin: the ABCD study

Introduction: Children from minority groups are at increased risk of overweight. This study compared BMI growth patterns from birth onwards of boys and girls with overweight at 5-6 years, according to socioeconomic status (SES) and country of origin, in order to gain more insight into the critical periods of growth to overweight. Methods: A total of 3714 singletons of the multi-ethnic ABCD study were included. Within children with overweight at age 5-6 years (N = 487, prevalence boys: 11.6%, girls: 14.6%), BMI growth patterns from birth onwards (12.8 serial measurements; SD = 3.1) were compared between children from European (69.4%) and non-European mothers (30.6%), and between children from low (20.8%), mid (37.0%) or high SES (42.2%), based on maternal educational level. Results: BMI growth to overweight did not differ between children of European or non-European mothers, but it did differ according to maternal SES. Children with overweight in the low and mid SES group had a lower BMI in the first 2 years of life, an earlier adiposity rebound and increased in BMI more rapidly after age 2, resulting in a higher BMI at age 7 years compared to children with overweight in the high SES group [∆BMI (kg/m2) between high and low SES: boys 1.43(95%CI:0.16;3.01) and girls 1.91(0.55;3.27)]. Conclusion: Children with overweight from low SES have an early adiposity rebound and accelerated growth to a higher BMI at age 5-6 years compared to children with overweight from the high SES group. These results imply that timing of critical periods for overweight development is earlier in children with a low socioeconomic background as compared to other children

Maternal early pregnancy lipid profile and offspring's lipids and glycaemic control at age 5-6 years: The ABCD study

Background & aims: Maternal early pregnancy lipid profile might influence offspring's lipids and glycaemic control, through an increased offspring's fat percentage. This explorative study investigates whether maternal early pregnancy lipid profile is associated with offspring's lipids and glycaemic control independently of offspring's fat percentage and if these associations are mediated by offspring's fat percentage. Possible sex differences in these associations are also examined. Methods: 1133 mother child pairs of the prospective ABCD-study were included. Maternal non-fasting lipids were collected in early pregnancy: triglycerides, total cholesterol (TC), Apolipoprotein Al (ApoA1), Apolipoprotein B (ApoB) and free fatty acids (FFA). Fasting triglycerides, TC, high density lipoprotein (HDL), low density lipoprotein (LDL), glucose and C-peptide were assessed in offspring aged 5-6 years and HOMA2-IR was calculated. Results: After adjustment for covariates, strongest associations were found between maternal TC and offspring's TC (boys beta(95%CI) = 0.141 (0.074-0.207); girls beta(95%Cl) = 0.268 (0.200; 0.336)) and LDL (boys beta(95%Cl) = 0.114 (0.052; 0.176); girls beta(95%CI) = 0.247 (0.181-0.312)), maternal ApoB and offspring's TC (boys beta(95%CI) = 0.638 (0.311-0.965); girls beta(95%CD = 1.121 (0.766-1.475)) and LDL (boys beta(95% CI) = 0.699 (0.393-1,005); girls beta(95%CI) = 1.198 (0.868-1.529)), and maternal ApoAl and offspring's HDL (only boys beta(95%CI) = 0.221 (0.101-0.341)). No significant association was found between maternal lipids and offspring's glycaemic control, and offspring's fat percentage played no mediating role. Conclusions: Maternal early pregnancy lipid profile is associated with offspring's lipid profile in childhood, with overall stronger associations in girls. This study provides further evidence that lowering lipid levels during pregnancy might be beneficial for the long term health of the offspring. (C) 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserve

Does maternal pre-pregnancy overweight or obesity influence offspring's growth patterns from birth up to 7 years? The ABCD-study

Background: Maternal pre-pregnancy overweight is known to program offspring for adverse health outcomes later in life. Aims: To investigate how growth patterns of weight, height and BMI from birth to 7 years differ according to maternal pre-pregnancy weight (normal weight, overweight and obesity), with specific attention for sex differences. Study design: Prospective multi-ethnic ABCD-study. Subjects: 3805 mother-child pairs were included. Self-reported maternal pre-pregnancy body mass index was categorized into: normal weight (18.5-25 kg/m(2); n = 3354), overweight (25-30 kg/m(2); n = 711) and obesity (>= 30 kg/m(2); n = 241). Outcome measures: Population-specific growth patterns were used to compute SD-scores for weight, height and BMI (on average 12.7 (SD = 2.6) measurements for each child) for term born boys and girls separately. Mixed effect models were fitted to these SD-scores to determine the effect of pre-pregnancy EMI category on postnatal growth, corrected for maternal characteristics. Results: Compared to children of mothers with normal weight before pregnancy, children of overweight mothers grew faster in weight and BMI (boys and girls) and children of obese mothers grew faster in height (only girls), weight and BMI (boys and girls) during the first years of life. The differences seemed to increase with age and were in general larger in girls. Conclusion: Maternal overweight and obesity impact on offspring's weight, height and BMI growth pattern with increasing differences when children age. Effects were in general stronger for girls. These results suggest that a healthy weight before pregnancy may be beneficial for optimal weight, height and BMI growth in the offsprin

Is first trimester vitamin D status in nulliparous women associated with pregnancy related hypertensive disorders?

this study aimed to explore if maternal vitamin D status in early pregnancy was associated with pre-eclampsia and pregnancy-induced hypertension. Relationships between vitamin D status and blood pressure at the start of pregnancy as well as the occurrence of a mid-pregnancy drop in blood pressure were also explored. This secondary analysis was completed to investigate a possible mechanism for the association between vitamin D status and pregnancy related hypertensive disorders. data were obtained from the Amsterdam Born Children and their Development study, a prospective community-based cohort study based in Amsterdam, The Netherlands. a total of 2074 nulliparous women without pre-existing hypertension and with a known vitamin D status before 17 weeks gestation were included in the study. Vitamin D status was categorized into four groups: "normal" (≥50nmol/L), "insufficient" (30-49.9nmol/L) "deficient" (20-29.9nmol/L) or "severely deficient" ( <20nmol/L). logistic regression analysis was used to investigate if vitamin D status was related to the odds of experiencing pre-eclampsia or pregnancy-induced hypertension. Models were corrected for maternal age, ethnicity, pre-pregnancy BMI, smoking and socioeconomic status. χ(2) and ANOVA tests were used to investigate relationships between vitamin D status and the blood pressure parameters. when compared to women with a normal vitamin D status, women who were severely deficient had an increased risk for pre-eclampsia (OR 2.08; 95% CI, 1.05-4.13), but the association was rendered non-significant after correction (OR 1.88; 95% CI 0.79-4.48). There were no associations between vitamin D status and pregnancy-induced hypertension, starting blood pressure or the occurrence of a mid-pregnancy drop in blood pressure. no strong evidence was found for an association between first trimester vitamin D status and pregnancy related hypertensive disorders in nulliparous women. at this time, vitamin D supplementation is not warranted for the specific purpose of preventing pregnancy related hypertensive disorder

Maternal prepregnancy BMI, offspring's early postnatal growth, and metabolic profile at age 5-6 years: the ABCD Study

Maternal prepregnancy body mass index (pBMI) and offspring's accelerated postnatal growth have adverse consequences for later cardiometabolic health, but it is unknown how these two factors interact. To assess the association between maternal pBMI and offspring's metabolic profile at age 5-6 years and determine the role (independent/mediating/moderating) of offspring's postnatal growth in this association. In total, 1459 mother-child pairs from the prospective ABCD study with known maternal pBMI, offspring postnatal growth (weight and weight-for-length gain) between age 1-3 months (Δ SD score). We analyzed metabolic components of offspring at age 5-6 years, including waist-to-height-ratio (WHtR), systolic/diastolic blood pressure (SBP/DBP), fasting glucose, triglycerides, and high-density lipoprotein-cholesterol values, both individually (Z-scores) and combined (sum Z-scores; metabolic score). Maternal pBMI was positively associated with offspring's WHtR (β = 0.025; 95% confidence interval [CI], 0.010-0.039), SBP (β = 0.020; 95% CI, 0.005-0.0035), DBP (β = 0.016; 95% CI, 0.000-0.031), and metabolic score (β = 0.078; 95% CI, 0.039-0.118) after adjusting. Adding postnatal growth had no relevant impact on these effect sizes. Postnatal weight gain was independently associated with WHtR (β = 0.199; 95% CI, 0.097-0.300), fasting glucose values (β = 0.117; 95% CI, 0.008-0.227), metabolic score (β = 0.405; 95% CI, 0.128-0.682). Postnatal weight-for-length gain was independently associated with WHtR (β = 0.145; 95% CI, 0.080-0.211), and metabolic score (β = 0.301; 95% CI, 0.125-0.477). An interaction between maternal pBMI and postnatal weight gain was present in the association with SBP (P = .021) and metabolic score (P = .047), and between maternal pBMI and postnatal weight-for-length gain in the association with triglycerides (P = .022) and metabolic score (P = .042). Both high maternal pBMI and postnatal accelerated growth are associated with adverse metabolic components in early childhood. No evidence was found for a mediating role of postnatal growth. The combination of high maternal pBMI and postnatal accelerated growth amplified individual effect

Linear regression models of the association between maternal 25-hydroxyvitamin D concentration in early pregnancy and cardio-metabolic outcomes in 5–6 year old children (per 10 nmol/L increase of 25-hydroxyvitamin D) with testing for interaction with pre-pregnancy BMI.

<p>99%CI = 99% confidence interval, bpm = beats per minute, DBP = diastolic blood pressure, HOMA2-IR = homeostatic model assessment of insulin resistance, HDL-C = high density lipoprotein cholesterol, HR = heart rate, LDL-C = low density lipoprotein cholesterol, SBP = systolic blood pressure, TC = total cholesterol, TG = triglyceride, WHtR = waist-to-height ratio</p><p>¹adjusted for child age and gender (and child height for cardiovascular function outcomes);</p><p>²additionally adjusted for maternal education, ethnicity, maternal age, parity, smoking during gestation, duration of breastfeeding, use of vitamin D or A/D drops in infancy and child’s sedentary time</p><p>*Significant non-linear relationship presented in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0133313#pone.0133313.g004" target="_blank">Fig 4</a></p><p>^† Significant interaction. Associations presented in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0133313#pone.0133313.g003" target="_blank">Fig 3</a></p><p>Linear regression models of the association between maternal 25-hydroxyvitamin D concentration in early pregnancy and cardio-metabolic outcomes in 5–6 year old children (per 10 nmol/L increase of 25-hydroxyvitamin D) with testing for interaction with pre-pregnancy BMI.</p

Study population characteristics as a function of maternal 25-hydroxyvitamin D status in early pregnancy.

<p>25OHD = 25-hydroxyvitamin D, pBMI = pre-pregnancy BMI</p><p>Mean values significantly different from reference:</p><p>*p<0.05,</p><p>**p<0.01,</p><p>***p<0.001</p><p>^†P-value for differences between vitamin D categories, as tested by X² for categorical variables, and ANOVA and independent sample t-tests for continuous variables</p><p>^‡Reference group</p><p>Study population characteristics as a function of maternal 25-hydroxyvitamin D status in early pregnancy.</p