Maternal obesity, gestational diabetes, breastfeeding and childhood overweight at age 2 years Interview with:

Anny H. Xiang, PhD Kaiser Permanente Southern California Department of Research & Evaluation

Dr. Anny Xiang

Anny H. Xiang, PhD
Kaiser Permanente Southern California Department of Research & Evaluation What is the background for this study? What are the main findings?

Dr. Xiang: Previous studies have identified a link between maternal obesity, diabetes and/or excessive gestational weight gain and long-term obesity risk in children. Our study examined the interplay among all four factors associated with childhood obesity: pre-pregnancy obesity, gestational weight gain, gestational diabetes and breastfeeding. To our knowledge, the interplay among these factors and their independent contributions to childhood obesity with data from a large and multi-ethnic cohort under current standard clinical care had not been previously studied.

The study included 15,710 women who delivered babies at Kaiser Permanente medical facilities in Southern California in 2011. The key findings were:

  • A woman being obese (BMI of 30.0 or higher) prior to getting pregnant increased the odds of her child being overweight at age 2 by more than two-fold compared to women who had a normal pre-pregnancy weight (BMI between 18.5 and 25), after adjusting for weight gain during pregnancy, gestational diabetes and breastfeeding.
  • A woman being overweight (BMI between 25.0 and 29.9) prior to pregnancy was associated with 50 percent increased odds of her child being overweight at age 2.
  • Excessive weight gain during pregnancy was associated with 23 percent increased odds of a child being overweight at age 2 compared to women who had healthy weight gain during pregnancy after adjusting for pre-pregnancy weight, gestational diabetes and breastfeeding.
  • Breastfeeding for at least six months was associated with a 24 percent reduction for the odds of a child being overweight at age 2 regardless of a mother’s pre-pregnancy weight, gestational diabetes or excessive weight gain during pregnancy.
  • Gestational diabetes was not associated with the risk of a child being overweight at age 2. Women with gestational diabetes in this cohort were treated following standard clinical practice and had 40-49 percent lower rate of excessive weight gain during pregnancy and similar breastfeeding rates compared to women without gestational diabetes.

Excessive weight gain was defined according to Institute of Medicine guidelines, with normal-weight women gaining more than 35 pounds, overweight women gaining more than 25 pounds and obese women gaining more than 20 pounds during their pregnancy. Children were considered overweight at age 2 if their BMI was greater than the 85th percentile for their age and sex, based on growth charts from the Centers for Disease Control and Prevention. What should clinicians and patients take away from your report?

Dr. Xiang: Our study findings highlight the need for more public health efforts to reduce maternal obesity, assist with appropriate gestational weight gain and promote breastfeeding. What recommendations do you have for future research as a result of this study?

Dr. Xiang: This study only examined childhood BMI at age 2 years, when the long-term impact of exposures in utero may not yet become apparent. We would recommend tracking children for a longer period of time. Is there anything else you would like to add?

Dr. Xiang: Childhood obesity is linked with adult obesity and long-term negative health outcomes. There is an increasing effort to reduce prenatal and early life risk factors. It is important to assess which factors continue to contribute to childhood obesity given current efforts and standard care of pregnant women and children.


Bider-Canfield, Z., Martinez, M. P., Wang, X., Yu, W., Bautista, M. P., Brookey, J., Page, K. A.,Buchanan, T. A., and Xiang, A. H. (2016) Maternal obesity, gestational diabetes, breastfeeding and childhood overweight at age 2 years. Pediatric Obesity, doi: 10.1111/ijpo.12125. 

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on

 [wysija_form id=”5″]