Maternal obesity during pregnancy and premature mortality from cardiovascular event in adult offspring: follow-up of 1 323 275 person years

Rebecca M Reynolds, Keith M Allan, Edwin A Raja, Sohinee Bhattacharya, Geraldine McNeill, Philip C Hannaford, Nadeem Sarwar, Amanda J Lee, Siladitya Bhattacharya, Jane E Norman, Rebecca M Reynolds, Keith M Allan, Edwin A Raja, Sohinee Bhattacharya, Geraldine McNeill, Philip C Hannaford, Nadeem Sarwar, Amanda J Lee, Siladitya Bhattacharya, Jane E Norman

Abstract

Objectives: To determine whether maternal obesity during pregnancy is associated with increased mortality from cardiovascular events in adult offspring.

Design: Record linkage cohort analysis.

Setting: Birth records from the Aberdeen Maternity and Neonatal databank linked to the General Register of Deaths, Scotland, and the Scottish Morbidity Record systems.

Population: 37 709 people with birth records from 1950 to present day.

Main outcome measures: Death and hospital admissions for cardiovascular events up to 1 January 2012 in offspring aged 34-61. Maternal body mass index (BMI) was calculated from height and weight measured at the first antenatal visit. The effect of maternal obesity on outcomes in offspring was tested with time to event analysis with Cox proportional hazard regression to compare outcomes in offspring of mothers in underweight, overweight, or obese categories of BMI compared with offspring of women with normal BMI.

Results: All cause mortality was increased in offspring of obese mothers (BMI >30) compared with mothers with normal BMI after adjustment for maternal age at delivery, socioeconomic status, sex of offspring, current age, birth weight, gestation at delivery, and gestation at measurement of BMI (hazard ratio 1.35, 95% confidence interval 1.17 to 1.55). In adjusted models, offspring of obese mothers also had an increased risk of hospital admission for a cardiovascular event (1.29, 1.06 to 1.57) compared with offspring of mothers with normal BMI. The offspring of overweight mothers also had a higher risk of adverse outcomes.

Conclusions: Maternal obesity is associated with an increased risk of premature death in adult offspring. As one in five women in the United Kingdom is obese at antenatal booking, strategies to optimise weight before pregnancy are urgently required.

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: NS has worked for Pfizer since 2011, JEN has received research grants from (non-commercial) funding agencies for pregnancy related conditions (full list available on request); funding from UK government agencies for providing reports on maternal deaths; honorariums for book chapters and books in obstetrics and gynaecology; and fees for consultancy to a small drug company (Preglem) with an interest in obstetric/gynaecological drugs. JEN is an unpaid consultant to Hologic (who manufacture fibronectin among others).

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4793430/bin/reyr012069.f1_default.jpg
Fig 1 Identification of samples for analysis
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4793430/bin/reyr012069.f2_default.jpg
Fig 2 Kaplan-Meier curves for death rates in offspring according to maternal BMI category showing increased adjusted all cause premature mortality in offspring of obese mothers (BMI >30)
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4793430/bin/reyr012069.f3_default.jpg
Fig 3 Non-linear relation of maternal BMI with mortality in offspring, showing that odds of offspring death was more among mothers with low or high BMI before pregnancy compared with mothers with BMI of 23

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