Association of Prepregnancy BMI, Gestational Weight Gain, and Child Birth Weight With Metabolic Dysfunction in Children and Adolescents With Obesity

Kelsey Pearson, MS, RD; Kristine C. Jordan, PhD, MPH; Julie Metos, PhD, MPH; Richard Holubkov, PhD; M. Nazeem Nanjee, PhD; Nicole L. Mihalopoulos, MD, MPH


South Med J. 2020;113(10):482-487. 

In This Article

Abstract and Introduction


Objectives: Previous studies have reported that maternal prepregnancy body mass index (BMI), gestational weight gain (GWG), and child birth weight are positively associated with metabolic dysfunction (a broader term than metabolic syndrome) in children and adolescents. Physical activity habits may play a role in reducing these risk factors. The objectives of this study were to investigate the association of prepregnancy BMI, GWG, child birth weight, physical activity, and sedentary time with metabolic dysfunction in a cohort of children and adolescents with obesity.

Methods: Participants (N = 117; 53% Hispanic) were children and adolescents, aged 8 to 17 years, with obesity. Fasting serum glucose, insulin, and a complete lipid profile were obtained. Body weight, height, waist circumference, and blood pressure were measured. A self-reported survey assessed prepregnancy BMI, GWG, child birth weight, physical activity, and sedentary time. The χ 2 test and the Mantel-Haenzel test statistic were used to examine the differences in proportions for the outcome of metabolic dysfunction.

Results: In this sample, 76.9% of children and adolescents had metabolic dysfunction. Prepregnancy BMI and GWG were not associated with metabolic dysfunction. Child birth weight and sedentary behavior were positively correlated (P = 0.033 and P = 0.015, respectively) with a diagnosis of metabolic dysfunction. Physical activity levels were not associated with metabolic dysfunction. Hispanic and non-Hispanic youth were similar for all risk factors.

Conclusions: Contrary to previous studies, prepregnancy BMI and GWG were not correlated with metabolic dysfunction. These findings support the need for lifestyle interventions, particularly in reducing sedentary behaviors, in obese children and adolescents.


According to the Pregnancy Risk Assessment Monitoring System, 1 in 5 American women is obese at the time of conception.[1] During pregnancy, it has been estimated that 40% of women gain more weight than is recommended.[2] Excess gestational weight gain (GWG) and poor maternal nutritional status are associated with negative birth outcomes including large-for-gestational-age (LGA), excess adiposity, and adverse cardiometabolic outcomes.[2–7] Nehring and colleagues indicated that there was a 21% increased risk for being overweight in children born to mothers who experienced excess GWG.[8] In addition, the results of a meta-analysis by Gaillard et al[4] suggested a threefold higher risk of obesity in children born to obese mothers.

Child birth weight is associated with childhood obesity, diabetes mellitus, and cardiometabolic outcomes.[9,10] Classifications of child birth weight include small-for-gestational-age (SGA) (<5.5 lb), appropriate-for-gestational-age (AGA) (5.5–8.5 lb), and LGA (>8.5 lb).[11] SGA and LGA are strong predictors for developing metabolic dysfunction (eg, elevated blood pressure, insulin resistance, dyslipidemia) and obesity in adulthood.[12–16] Curhan and colleagues found a greater odds of developing hypertension in both men (odds ratio [OR] 1.26, 95% confidence interval [CI] 1.11–1.44) and women (OR 1.43, 95% CI 1.31–1.65) born SGA.[12,14] In addition, both men and women born LGA were approximately 1.5 times more likely to be in the highest body mass index (BMI) category compared with the lowest BMI category in adulthood.[12,14]

Children with excess abdominal adiposity are more likely to have markers of metabolic dysfunction than children with normal weight or overweight (BMI >5th percentile and <95th percentile for age and sex).[2] The term metabolic dysfunction is used to classify children and adolescents at overall increased risk for diabetes mellitus and cardiovascular disease.[17,18] The associations between various markers of metabolic dysfunction, such as increased waist-to-hip ratio (WHR), systolic blood pressure, and insulin resistance, have been linked to excessive GWG.[2–4,18,19]

The American Academy of Pediatrics guidelines recommend 60 minutes/day of physical activity every day and no more than 2 hours/day of screen time for children 5 years and older.[20–22] Children with decreased physical activity levels and increased sedentary time are more likely to have insulin resistance, as measured by the homeostatic model assessment of insulin resistance (HOMA-IR), a marker of metabolic dysfunction.[23] Increased screen time and sedentary behavior is associated with increased WHR, a known predictor of cardiovascular disease in children and adolescents.[18,24,25]

Childhood obesity, abdominal adiposity, and increased cardiometabolic risk have been correlated with excess GWG;[2–8] however, to our knowledge, the associations between excess GWG and the parameters of metabolic dysfunction have not been studied exclusively in a pediatric population with obesity. The purpose of the present study was to assess the associations among prepregnancy BMI, GWG, child birth weight, physical activity, and sedentary behavior with metabolic dysfunction in children and adolescents with obesity.