BONN, Germany — Children are at a higher risk of becoming overweight if their mothers were obese at the start of their pregnancy. “Additional risk factors include the mother gaining a lot of weight during pregnancy, gestational diabetes, and a short breastfeeding period,” explained Regina Ensenauer, MD, head of the Department of Child Nutrition at the Max Rubner Institute in Karlsruhe, Germany, at this year’s congress of the German Nutrition Society (DGE), held recently in Bonn, Germany.
More than 1600 mother–child pairs have been observed since 2010 in the Programming of Enhanced Adiposity Risk in Childhood – Early Screening (PEACHES) cohort study, in which the scientists collated risk factors that affect children’s weight. Around 20% to 25% of children of obese mothers gain a significant amount of weight in their first few months of life, and this rapid weight increase often means that children struggle with obesity by preschool age.
“If I am already overweight at 4 or 5 years of age, then the risk of me staying overweight for the rest of my life, or becoming obese, is exorbitantly high,” added Ensenauer.
Scientists believe this may occur because of the fetal programming theory, according to which, obesity, and even gestational diabetes, can alter the environment in the womb. There are possible consequences. Children are sometimes already metabolically programmed for obesity and other unfavorable metabolic states when they are born. The child’s post-natal nutrition, for example, a short period of breastfeeding and poor diet in early childhood, could also increase these tendencies.
Early Identification of At-Risk Children
“If we were able to identify high-risk children early on, then pediatricians would, for example, have the chance to intervene at the third or fourth well-baby examination,” said the researcher. One risk score developed from the PEACHES study and validated in another cohort could potentially be used as a tool to identify at-risk children before they develop obesity.
The score uses the baby’s increase in weight, as well as other factors of which pediatricians are not necessarily aware, explained Ensenauer. “An extended history of pregnancy risk factors would be needed. Some of this history might be found in the maternity log. This would need to be fed into a prediction model that we have developed, and then the pediatrician would be able to calculate this child’s risk of becoming overweight.”
In addition, Ensenauer and colleagues are also studying the blood from the umbilical cords of children enrolled in PEACHES. “Umbilical cord blood contains certain metabolites, which have levels that are higher or lower in the children of mothers with a high body mass index (BMI). We are currently evaluating the best way to incorporate these findings into our research.”
The hope is that through early intervention it is possible to reverse the unfavorable effects to some extent. This is because the first 1000 days in a child’s life are particularly important and formative in this respect.
One possibility for early intervention would be to encourage the mother to continue breastfeeding the child until they are 6 months old, if possible. Another study, Breastfeeding Education For Risk Reduction (BEARR), is currently investigating whether additional targeted breastfeeding advice for mothers of at-risk children could make a difference, added Ensenauer.
“We are still evaluating the data on this. Not every pregnant woman needs it, but maybe those who have a lot of risk factors do.”
This article was translated from Medscape’s German edition.
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