Maternal healthy lifestyle during pregnancy and offspring metabolic health phenotypes in childhood.

BACKGROUND AND AIM: Maternal lifestyle factors during pregnancy may influence offspring risk of childhood overweight-obesity (OW-OB). Obesity is a heterogenous condition with different metabolic phenotypes; limited research on their associations with early-life exposures exists. We investigated associations of a composite maternal healthy lifestyle score (HLS) and offspring metabolic phenotypes throughout childhood. METHODS AND RESULTS: Study-specific analyses were conducted on mother-child dyads (n = 6088) from four European studies: two RCTs (secondary analysis) and two mother-child cohorts. The HLS was calculated based on pre-pregnancy BMI, and diet quality, physical activity, smoking status, and alcohol consumption during pregnancy. Children were classified as metabolically healthy/unhealthy phenotypes with underweight-normal weight or OW-OB, according to their BMI category and the absence/presence of at least one metabolic risk factor (high systolic or diastolic blood pressure, low HDL cholesterol, high triglycerides or elevated glucose concentrations). Maternal HLS associations with offspring metabolic health phenotypes at early (5-5.5 years), mid- (8-9 years) and late (11 years) childhood were assessed using multinomial logistic regressions. The majority of children were classified as metabolically healthy with underweight-normal weight, whereas metabolically healthy and unhealthy OW-OB children represented 3.5-13.6% and 3.9-14.8%, respectively. Consistently across studies, a higher maternal HLS was associated with a lower risk of offspring being metabolically unhealthy OW-OB across early, mid- and late childhood (RRR [95% CI] ranged from 0.43 [0.29, 0.65] to 0.80 [0.71, 0.91]). Associations with other phenotypes were less consistent. CONCLUSIONS: Greater maternal adherence to healthy lifestyle behaviours during pregnancy was associated with a lower risk of metabolically unhealthy OW-OB among offspring. TRIAL REGISTRATION: CHOP: EU-Childhood Obesity Project. NCT00338689. https://clinicaltrials.gov/, ROLO: Current Controlled Trials. ISRCTN54392969. https://www.isrctn.com/.