Childhood obesity has become a growing concern in recent years, with rates steadily increasing across the globe. While various factors can contribute to this trend, research has shown that the prenatal environment can play a significant role in a child’s subsequent risk of obesity. In particular, the metabolic status of pregnant women has been found to impact the metabolic health of their offspring. A recent study takes this one step further, examining how the metabolic subtypes of pregnant women may impact the obesity risk of their children. This article will explore the findings of this study and what they indicate about the importance of maternal health during pregnancy.
A new study published in JAMA Network Open suggests that varying metabolic subtypes in pregnant women lead to differences in offspring obesity risk. While maternal glucose and body mass index (BMI) have been associated with offspring adiposity and metabolic traits, other glycemic and non-glycemic factors may also impact fetal programming. The study aimed to examine associations between metabolic subgroup classifications and adiposity traits in offspring through a review of the Healthy Start Study, which was conducted from 2010 to 2014. The study included pregnant women aged 15 years and older with no history of stillbirth, under 24 weeks’ gestation, singleton birth, and no severe pre-existing chronic disease. Participants of the observational study completed in-person visits at mid-pregnancy, late pregnancy, delivery, and early childhood.
A total of 1325 women participated in the study, and biomarkers including glucose, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), triglycerides (TGs), free fatty acids (FFAs), insulin, tumor necrosis factor α (TNF-α), and TGs:HDL-C and the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) were measured. Metabolic subgroups of women were determined using unsupervised k-means clustering. Inputs comprised 7 biomarkers at about 17 weeks’ gestation measured from fasting blood samples and 2 biomarker indices implicated in in-utero metabolic programming.
PEA POD was used to measure neonatal fat mass (FM) and fat-free mass (FFM), with birthweight z score measured through weight at delivery and gestational age. Large-for-gestational age status was determined using national reference data. FM and FFM were calculated through whole body air displacement plethysmography in early childhood, with FM/FMM used to calculate fat mass percentage (FM%). Covariates included maternal race and ethnicity, parity, educational attainment, dietary intake, and prenatal smoking status.
The study divided the women into 5 metabolic subgroups, including a reference group, a high HDL-C subgroup, a dyslipidemic–high TG group, a dyslipidemic–high FFA group, and an insulin resistant (IR)–hyperglycemic group. Low GDM frequency and a balanced distribution of educational status were seen in the reference subgroup, and a higher quality diet and the lowest prevalence of prepregnancy obesity in the HDL-C subgroup. Women in the dyslipidemic–high TG subgroup had the highest rates of prenatal smoking, lower educational attainment, and older age. FFA levels were 79.2% higher than the reference subgroup in the dyslipidemic–high FFA subgroup, but other biomarker levels were lower than the clinical threshold for metabolic risk in this group. Atherogenic lipid levels were seen in over a third of women in the IR-hyperglycemic subgroup.
Higher neonatal and childhood BMI percentile was seen in children of the IR-hyperglycemic subgroup compared to the reference subgroup. Children born to women in the dyslipidemic–high FFA subgroup were 3 times more likely of developing FM% compared to the reference group. Higher FM% was also seen in children of women in the dyslipidemic–high TGs, along with higher BMI in childhood. Offspring outcomes did not differ between the high HDL-C and reference subgroups.
The risk of childhood obesity was almost 5 times higher in children born to women in the IR-hyperglycemic subgroup compared to the reference subgroup. This group also had a 9 times greater risk of high FM%. The findings highlight the importance of maternal metabolic health in pregnancy and its potential influence on offspring obesity risk. However, the study also notes that the findings need to be confirmed in other populations and through larger studies.
In conclusion, the risk of offspring obesity may be determined by the metabolic subtype of a pregnant woman. Understanding the importance of early intervention and making healthy lifestyle choices during pregnancy can ultimately reduce the risk of childhood obesity. Future research is needed to continue exploring the complex links between maternal health and child development, and to develop effective interventions that can positively impact families and communities. By working together, healthcare professionals, policymakers, and families can make a meaningful difference in the health outcomes of future generations.
