Association of trimester-specific gestational weight gain with fetal growth, offspring obesity, and cardiometabolic traits in early childhood

Am J Obstet Gynecol. 2015 Apr;212(4):502.e1-14. doi: 10.1016/j.ajog.2014.12.038. Epub 2014 Dec 31.


Objective: The purpose of this study was to investigate the association of trimester-specific gestational weight gain with offspring fetal growth, obesity risk, and cardiometabolic health outcomes from birth to 4 years of age.

Study design: We conducted the present study with 977 mother-child pairs of the pregnancy cohort "Rhea" study in Crete, Greece. We measured birthweight, body mass index from 6 months to 4 years of age, waist circumference, skinfold thickness, blood pressure, and blood levels of lipids, C-reactive protein, and adipose tissue hormones at 4 years of age. We used multiple linear and log Poisson regression models to examine the association of exposure with continuous or binary outcomes, respectively.

Results: Greater rate of gestational weight gain in the first trimester of pregnancy (per 200 g/wk) was associated with increased risk of overweight/obesity from 2 years (relative risk [RR], 1.25; 95% confidence interval [CI], 1.09-1.42) to 4 years of age (RR, 1.15; 95% CI, 1.05-1.25), but not with birth size. Each 200 g/wk of weight gain in the first trimester of pregnancy was also associated with greater risk of high waist circumference (RR, 1.13; 95% CI, 1.04-1.23), high sum of skinfold thickness (RR, 1.15; 95% CI, 1.02-1.29), and higher diastolic blood pressure at 4 years of age (β, 0.43 mm Hg; 95% CI, 0.00-0.86). Greater rate of gestational weight gain during the second and third trimesters of pregnancy (per 200 g/wk) was associated with greater risk of large-for-gestational-age neonates (RR, 1.22; 95% CI, 1.02, 1.45) and higher levels of cord blood leptin (ratio of geometric means, 1.08; 95% CI, 1.00-1.17), but not with child anthropometry at later ages.

Conclusion: Timing of gestational weight gain may influence childhood cardiometabolic outcomes differentially.

Keywords: blood pressure; children; gestational weight gain; obesity; pregnancy cohort.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biomarkers / blood
  • Blood Pressure
  • Body Mass Index
  • Child, Preschool
  • Female
  • Fetal Development / physiology*
  • Follow-Up Studies
  • Humans
  • Infant, Newborn
  • Leptin / blood
  • Lipids / blood
  • Male
  • Models, Statistical
  • Pediatric Obesity / blood
  • Pediatric Obesity / etiology*
  • Pregnancy
  • Pregnancy Trimesters / physiology*
  • Prenatal Exposure Delayed Effects / blood
  • Prenatal Exposure Delayed Effects / etiology*
  • Prospective Studies
  • Risk Factors
  • Skinfold Thickness
  • Waist Circumference
  • Weight Gain / physiology*


  • Biomarkers
  • Leptin
  • Lipids