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Pregnancy weight gain: family studies on the effects on offspring’s body size and blood pressure
Karolinska Institutet.ORCID iD: 0000-0002-7295-7341
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Increasing maternal weight gain during pregnancy, gestational weight gain (GWG), is associated with several adverse outcomes in the child, e.g. high birth weight, childhood overweight and obesity, as well as adult blood pressure (BP). Studies have also shown that specific periods of pregnancy might be more sensitive in terms of influencing these outcomes. However, the aforementioned associations could be explained by genetic and/or environmental factors which are shared between the mother and child. As far as we know, no studies have examined to what extent these genetic and environmental factors explain the variation in GWG.

Aims: The overall aim of this PhD thesis was therefore to investigate the possible associations between GWG and the children’s birth weight and body mass index (BMI) during childhood (study 2), and BP during early adulthood (study 3), while taking environmental and genetic factors shared between the mother and child into account (within the twin/sibling pairs). The current thesis also aimed at exploring how much of the variation in GWG which is determined by genetic (the heritability) and both unique and common environmental factors (study 1).

Methods and Results: Study 1 was a register-based twin study with Swedish female monozygotic (MZ) and dizygotic (DZ) twin pairs with children born 1982-1989 and 1992- 2010. Genetic factors accounted for 43% of the variation in GWG in the first pregnancy (N = 694 twin mother-pairs) and 26% in the second pregnancy (N = 465 twin mother-pairs). Unique environmental factors explained the remaining variation in GWG. Studies 2 and 3 were both prospective cohort studies, where study 2 was based on a data-collection of Swedish MZ twin mothers born 1962 to 1975 and their children (N = 82 twin mother-pairs), and study 3 was register-based and included Swedish male sibling pairs born 1982-1989 (N = 4908 brother pairs). In study 2, the results indicated that total, and possibly also second and third trimester weight gain, were associated with birth weight in the offspring within the twin pairs in the fully adjusted model. In terms of GWG and offspring weight and BMI during infancy and childhood, no associations were found. In study 3, no significant associations were found between GWG and systolic BP, or diastolic BP, or the offspring’s risk of hypertension, neither within nor between the sibling pairs.

Conclusions: This thesis shows that the total GWG, and specifically weight gain during the second and third trimester, seem to be positively associated with offspring birth weight, but no effects were seen for BMI during infancy and childhood. However, due to the limited sample size, this requires further investigation. Moreover, no association was found between total GWG and the male sibling pairs’ BP at the age of 18 years. The variation in GWG seems to be largely explained by the mother’s unique environment during pregnancy and to a smaller degree by genetic factors.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet , 2016.
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:rkh:diva-2402ISBN: 978-91-7676-355-1 (print)OAI: oai:DiVA.org:rkh-2402DiVA: diva2:1096176
Available from: 2017-05-17 Created: 2017-05-17 Last updated: 2017-05-17Bibliographically approved
List of papers
1. Heritability of gestational weight gain--a Swedish register-based twin study
Open this publication in new window or tab >>Heritability of gestational weight gain--a Swedish register-based twin study
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2015 (English)In: Twin Research and Human Genetics, ISSN 1832-4274, E-ISSN 1839-2628, Vol. 18, no 4, 410-8 p.Article in journal (Refereed) Published
Abstract [en]

Gestational weight gain (GWG) is a complex trait involving intrauterine environmental, maternal environmental, and genetic factors. However, the extent to which these factors contribute to the total variation in GWG is unclear. We therefore examined the genetic and environmental influences on the variation in GWG in the first and second pregnancy in monozygotic (MZ) and dizygotic (DZ) twin mother-pairs. Further, we explored if any co-variance existed between factors influencing the variation in GWG of the mothers’ first and second pregnancies. By using Swedish nationwide record-linkage data, we identified 694 twin mother-pairs with complete data on their first pregnancy and 465 twin mother-pairs with complete data on their second pregnancy during 1982–2010. For a subanalysis, 143 twin mother-pairs had complete data on two consecutive pregnancies during the study period. We used structural equation modeling (SEM) to assess the contribution of genetic, shared, and unique environmental factors to the variation in GWG. A bivariate Cholesky decomposition model was used for the subanalysis. We found that genetic factors explained 43% (95% CI: 36–51%) of the variation in GWG in the first pregnancy and 26% (95% CI: 16–36%) in the second pregnancy. The remaining variance was explained by unique environmental factors. Both overlapping and distinct genetic and unique environmental factors influenced GWG in the first and the second pregnancy. This study showed that GWG has a moderate heritability, suggesting that a large part of the variation in the trait can be explained by unique environmental factors.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-2400 (URN)10.1017/thg.2015.38 (DOI)26111621 (PubMedID)
Available from: 2017-05-16 Created: 2017-05-16 Last updated: 2017-05-17Bibliographically approved
2. Total and Trimester-Specific Gestational Weight Gain and Offspring Birth and Early Childhood Weight: A Prospective Cohort Study on Monozygotic Twin Mothers and Their Offspring
Open this publication in new window or tab >>Total and Trimester-Specific Gestational Weight Gain and Offspring Birth and Early Childhood Weight: A Prospective Cohort Study on Monozygotic Twin Mothers and Their Offspring
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2016 (English)In: Twin Research and Human Genetics, ISSN 1832-4274, E-ISSN 1839-2628, Vol. 19, no 4, 367-76 p.Article in journal (Refereed) Published
Abstract [en]

Gestational weight gain (GWG) has in numerous studies been associated with offspring birth weight (BW) and childhood weight. However, these associations might be explained by genetic confounding as offspring inherit their mother's genetic potential to gain weight. Furthermore, little is known about whether particular periods of pregnancy could influence offspring body weight differently. We therefore aimed to explore total and trimester-specific effects of GWG in monozygotic (MZ) twin mother-pairs on their offspring's BW, weight at 1 year and body mass index (BMI) at 5 and 10 years. MZ twin mothers born 1962-1975 were identified in national Swedish registers, and data on exposure and outcome variables was collected from medical records. We analyzed associations within and between twin pairs. We had complete data on the mothers' GWG and offspring BW for 82 pairs. The results indicated that total, and possibly also second and third trimester GWG were associated with offspring BW within the twin pairs in the fully adjusted model (β = 0.08 z-score units, 95% CI: 0.001, 0.17; β = 1.32 z-score units, 95% CI: -0.29, 2.95; and β = 1.02 z-score units, 95% CI: -0.50, 2.54, respectively). Our findings, although statistically weak, suggested no associations between GWG and offspring weight or BMI during infancy or childhood. Our study suggests that total, and possibly also second and third trimester, GWG are associated with offspring BW when taking shared genetic and environmental factors within twin pairs into account. Larger family-based studies with long follow-up are needed to confirm our findings.

Keyword
birth weight, childhood body weight, genetics, gestational trimester, gestational weight gain, monozygotic twins
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-2399 (URN)10.1017/thg.2016.37 (DOI)27161254 (PubMedID)
Available from: 2017-05-16 Created: 2017-05-16 Last updated: 2017-05-17Bibliographically approved
3. No association of maternal gestational weight gain with offspring blood pressure and hypertension at age 18 years in male sibling-pairs: a prospective register-based cohort study
Open this publication in new window or tab >>No association of maternal gestational weight gain with offspring blood pressure and hypertension at age 18 years in male sibling-pairs: a prospective register-based cohort study
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2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 3, e0121202Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Maternal gestational weight gain (GWG) is associated with birth weight, obesity, and possibly blood pressure (BP) and hypertension in the offspring. These associations may however be confounded by genetic and/or shared environmental factors. In contrast to previous studies based on non-siblings and self-reported data, we investigated whether GWG is associated with offspring BP and hypertension, in a register-based cohort of full brothers while controlling for fixed shared effects.

METHODS: By using Swedish nation-wide record-linkage data, we identified women with at least two male children (full brothers) born 1982-1989. Their BP was obtained from the mandatory military conscription induction tests. We adopted linear and Poisson regression models with robust variance, using generalized estimating equations to analyze associations between GWG and BP, as well as with hypertension, within and between offspring sibling-pairs.

RESULTS: Complete data on the mothers' GWG and offspring BP was obtained for 9,816 brothers (4,908 brother-pairs). Adjusted regression models showed no significant associations between GWG and SBP (β = 0.03 mmHg per 1-kg GWG difference, [95% CI -0.08, 0.14], or DBP (β = -0.03 mmHg per 1-kg GWG difference [95% CI -0.11, 0.05]), or between GWG and offspring's risk of hypertension (relative risk = 1.0 [95% CI 0.99, 1.02], neither within nor between siblings.

CONCLUSIONS: In this large sibling-pair study, we did not find any significant association between GWG and offspring BP or the risk of hypertension at 18y, when taking genetic and environmental factors shared within sibling pairs into account. Further large sibling studies are required to confirm a null association between GWG and other cardiovascular risk factors.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-2401 (URN)10.1371/journal.pone.0121202 (DOI)25794174 (PubMedID)
Available from: 2017-05-16 Created: 2017-05-16 Last updated: 2017-07-14Bibliographically approved

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