Maternal Obesity, Gestational Weight Gain, and Asthma in Offspring

Kristen J. Polinski, MSPH; Jihong Liu, ScD; Nansi S. Boghossian, PhD, MPH; Alexander C. McLain, PhD


Prev Chronic Dis. 2017;14(12):E109 

In This Article

Abstract and Introduction


Introduction Obesity is common among women of childbearing age; intrauterine exposure to maternal obesity or gestational weight gain may influence the development of asthma in early childhood. We examined the relationships of maternal obesity and gestational weight gain with asthma in offspring.

Methods We used data from the Early Childhood Longitudinal Study–Birth Cohort, which has a nationally representative sample of children followed from birth in 2001 through age 4 (n = 6,450). Asthma was based on parental report of a medical professional's diagnosis. We used generalized estimating equation binomial models to compute adjusted odds ratios (ORs) of childhood asthma with maternal obesity and 4 measures of gestational weight gain.

Results Compared with children of normal-weight mothers, children of obese mothers had increased risk of asthma (adjusted OR, 1.63; 95% confidence interval [CI], 1.26–2.12) by age 4, and children born to overweight mothers had similar risk (adjusted OR, 1.25; 95% CI, 0.99–1.59). Extreme-low weight gain (<5 kg) and extreme-high weight gain (≥25 kg) were associated with increased risk of asthma; however, the following measures were not significant predictors of asthma: meeting gestational weight gain recommendations of the Institute of Medicine, total gestational weight gain, and weekly rate of weight gain in the second and third trimesters.

Conclusion Extreme-low or extreme-high gestational weight gain and maternal obesity are risk factors for early childhood asthma, further evidence of the long-term impact of intrauterine exposure on children and the need to target preconception care to improve child health indicators.


Approximately 7% of children receive a diagnosis of asthma by age 4 years, making asthma one of the most common chronic conditions among children.[1] Childhood asthma is a leading cause of emergency department visits, hospitalizations, and missed school days.[2] Asthma-management practices target symptoms and contribute to huge health care expenditures. For example, a recent nationally representative study of school-aged children in the United States found that the total annual health care expenditures burden attributable to asthma was $5.92 billion.[3] Therefore, prevention and early diagnosis of asthma are particularly important in childhood.

Childhood asthma is believed to have in-utero origins;[4,5] for example, a cohort study found that 40% of children with a diagnosis of asthma by age 7 had reduced airflow and bronchial responsiveness as neonates.[4] Maternal weight and gestational weight gain may change the intrauterine environment and may affect the development of asthma.[6] A meta-analysis of possible links between maternal body mass index (BMI), gestational weight gain, and risk of asthma in offspring concluded that maternal obesity is significantly associated with asthma in offspring; however, limited evidence was given to support associations with gestational weight gain.[7]

To our knowledge, no studies have examined the association between gestational weight gain and asthma in offspring in a nationally representative sample of children in the United States. Previous studies used measures of gestational weight gain that did not account for gestational age, which can affect the amount of weight gained (ie, the shorter the pregnancy duration, the lower the weight gain). Furthermore, gestational weight gain was described inconsistently among studies (eg, as continuous data, as tertiles, as cutoffs), limiting comparability between studies.

The objective of this study was to describe the relationships of maternal obesity and gestational weight gain with risk of asthma in offspring in a multiethnic, nationally representative sample of young children in the United States.