PEDIATRIC ORIGINAL ARTICLE Gestational weight gain and adiposity, fat distribution, metabolic profile, and blood pressure in offspring: the IDEFICS project M Dello Russo 1 , W Ahrens 2 , T De Vriendt 3 , S Marild 4 , D Molnar 5 , LA Moreno 6 , A Reeske 2 , T Veidebaum 7 , YA Kourides 8 , G Barba 1 and A Siani 1 on behalf of the IDEFICS Consortium OBJECTIVE: To investigate the association between gestational weight gain (GWG) and total adiposity, body fat distribution, blood pressure (BP), and metabolic profile in offspring. DESIGN: Cross-sectional study. METHODS: Body mass index (BMI), waist, subscapular and tricipital skinfolds, and BP were measured and blood samples drawn in 12 775 children (aged 2–9 years) from the IDEFICS cohort. Overweight/obesity was defined by IOTF criteria. Parents filled in a questionnaire investigating child and familiar medical history and lifestyle. A section was dedicated to pregnancy history (including GWG). RESULTS: Anthropometric indices linearly and significantly increased across GWG tertiles (BMI z-score: tertile I ¼ 0.08, 0.03–0.13; tertile II ¼ 0.16, 0.12–0.21; tertile III ¼ 0.34, 0.28–0.40, Po0.01, mean, 95% CI) by analysis of covariance (ANCOVA) adjusted by child sex, age and practice of sport, birth weight, current maternal BMI, parental education, gestational age, age at delivery, alcohol and smoking during pregnancy, maternal diabetes mellitus, gestational hypertension, and breastfeeding duration. After inclusion of BMI z-score among covariates, HbA1c significantly increased across tertiles (P ¼ 0.009) while no differences were observed for BP, serum insulin, HOMA index, blood glucose and lipids. The adjusted risk of overweight/obesity significantly increased by 14 and 22% in tertiles II and III respectively, in comparison with tertile I by logistic regression analysis controlling for covariates. CONCLUSION: Maternal GWG is an independent predictor of total adiposity and body fat distribution in offspring during infancy. Exposure to perinatal factors should be taken into account for early prevention of overweight and obesity. International Journal of Obesity (2013) 37, 914–919; doi:10.1038/ijo.2013.35; published online 9 April 2013 Keywords: gestational weight gain; perinatal factors; childhood obesity; offspring BMI; offspring metabolic profile; offspring blood pressure INTRODUCTION The role of intrauterine environment in the future development of disease in offspring is an issue of extreme interest. So far, gestational weight gain (GWG) has been considered as an easy-to- measure estimate of intrauterine environment status and indeed, it is considered as an important determinant of the outcomes of delivery; for this reason, the Institute of Medicine (IOM) provided recommendations and cut-off values for GWG that were specifically individualised to pre-pregnancy body mass index (BMI). 1 Recent studies suggested that GWG, and more in general pre-natal factors, might play a role in the development of obesity later in life. 2–12 In particular, previous studies suggested that the maternal weight gain during pregnancy is associated with BMI of offspring during adult life 8,9 or childhood/adolescence; 3–6,9,10 the observed association was independent of relevant risk factors for overweight such as birth weight, maternal BMI, age and education level. 13 Genetic factors are likely to mediate the association between maternal GWG and future development of overweight in offspring. 14 However, evidence arose also for non-genetic perinatal factors possibly acting on offspring BMI, either in the shared familiar environment 15 or changes in the intrauterine environment, 16–20 the latter possibly involved in the permanent modulation of appetite control, and in the neuroendocrine pathways influencing adipose tissue development/function or energy metabolism. 16,20 However, although GWG was the object of many studies, some aspects need to be further clarified. First, only a few studies investigated till now on the role of GWG in the early development of overweight and obesity; in addition, in the majority of available studies, the outcome index mostly used was BMI, while no or little information is available on the association between GWG and other anthropometric measures, with particular regard to body fat distribution. Furthermore, the association between GWG and adiposity has been seldom investigated in large paediatric populations taking also into account, at the same time, of other possible health outcomes such as alterations of metabolic profile and high blood pressure. The aim of this study was to evaluate the association between GWG, total adiposity, body fat distribution, blood pressure and metabolic profile in children participating in the IDEFICS project, a 1 Epidemiology & Population Genetics, Institute of Food Sciences, CNR, Avellino, Italy; 2 Department of Epidemiological Methods and Etiologic Research, Bremen Institute for Prevention Research and Social Medicine (BIPS), University of Bremen, Bremen, Germany; 3 Department of Public Health/Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium; 4 Department of Paediatrics, Queen Silvia Children Hospital, Go ¨ teborg University, Go ¨ teborg, Sweden; 5 Department of Paediatrics, University of Pe ´cs Medical School, Pe ´ cs, Hungary; 6 GENUD Research Group, EU Ciencas de la Salud, University of Zaragoza, Zaragoza, Spain; 7 National Institute for Health Development, Tallinn, Estonia and 8 Research & Education Foundation of Child Health, Strovolos, Cyprus. Correspondence: Dr G Barba, Epidemiology & Population Genetics, Institute of Food Sciences, CNR, Via Roma, 64, 83100 Avellino, Italy. Email: gbarba@isa.cnr.it Received 4 September 2012; revised 20 February 2013; accepted 24 February 2013; published online 9 April 2013 International Journal of Obesity (2013) 37, 914–919 & 2013 Macmillan Publishers Limited All rights reserved 0307-0565/13 www.nature.com/ijo