Objectives To investigate the association of trimester-specific gestational weight gain with offspring fetal growth, obesity risk, and cardio-metabolic health outcomes from birth up to 4 years of age. Study design We conducted the present study in 977 mother-child pairs of the pregnancy cohort “Rhea” study in Crete, Greece. We measured birth weight, body mass index from 6 months to 4 years of age, waist circumference, skinfold thickness, blood pressure, and blood levels of lipids, C-reactive protein, and adipose tissue hormones at 4 years of age. We used multiple linear and log Poisson regression models to examine the association of exposure with continuous or binary outcomes respectively. Results Greater rate of gestational weight gain in the first trimester of pregnancy (per 200 g/week) was associated with increased risk of overweight/obesity from 2 years [RR: 1.25, (95% CI: 1.09, 1.42)] to 4 years of age [RR: 1.15, (95% CI: 1.05, 1.25)], but not with birth size. Each 200 gr/week of weight gain in the first trimester of pregnancy was also associated with greater risk of high waist circumference [RR: 1.13, (95% CI: 1.04, 1.23)], high sum of skinfold thickness [RR: 1.15 (95% CI: 1.02, 1.29)] and higher diastolic blood pressure at 4 years of age [β: 0.43 mmHg (95% CI: 0.00, 0.86)]. Greater rate of gestational weight gain during the second and third trimesters of pregnancy (per 200 gr/week) was associated with greater risk of large for gestational age neonates [RR: 1.22, (95% CI: 1.02, 1.45)] and higher levels of cord blood leptin [ratio of geometric means: 1.08 (95% CI: 1.00, 1.17)], but not with child anthropometry at later ages. Conclusion Timing of gestational weight gain may differentially influence childhood cardio-metabolic outcomes.

Background In adults, adherence to the Mediterranean diet has been inversely associated with cardiovascular risk, but the extent to which diet in pregnancy is associated with offspring adiposity is unclear. We aimed to investigate the association between adherence to Mediterranean diet in pregnancy and offspring cardiometabolic traits in two pregnancy cohorts. Methods We studied 997 mother-child pairs from Project Viva in Massachusetts, USA, and 569 pairs from the Rhea study in Crete, Greece. We estimated adherence to the Mediterranean diet with an a priori defined score (MDS) of 9 foods and nutrients (0 to 9). We measured child weight, height, waist circumference, skin fold thicknesses, blood pressure (BP), and blood levels of lipids, c-reactive protein, and adipokines in mid-childhood (median 7.7 years) in Viva, and in early childhood (median 4.2 years) in Rhea. We calculated cohort-specific effects, and pooled effects estimates with random-effects models for cohort and child age. Results In Project Viva the mean (SD) MDS was 2.7 (1.6); in Rhea it was 3.8 (1.7). In the pooled analysis, for each 3-point increment in the MDS, offspring BMI z score was lower by 0.14 units (95% CI, −0.15 to −0.13), waist circumference by 0.39cm (95% CI, −0.64 to −0.14), and the sum of skin fold thicknesses by 0.63mm (95% CI, −0.98 to −0.28). We also observed lower offspring systolic (−1.03 mmHg; 95% CI, −1.65 to −0.42) and diastolic BP (−0.57mmHg; 95% CI, −0.98 to −0.16). Conclusion Greater adherence to Mediterranean diet during pregnancy may protect against excess offspring cardiometabolic risk.

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BackgroundPrenatal exposure to endocrine-disrupting chemicals such as persistent organic pollutants (POPs) may increase risk of obesity later in life.ObjectiveWe examined the relation of in utero POPs exposure to offspring obesity and cardiometabolic risk factors at 4 years of age in the Rhea mother–child cohort in Crete, Greece (n = 689).MethodsWe determined concentrations of polychlorinated biphenyls (PCBs), dichlorodiphenyldichloroethylene (DDE), and hexachlorobenzene (HCB) in first-trimester maternal serum. We measured child weight, height, waist circumference, skinfold thicknesses, blood pressure (BP), blood levels of lipids, C-reactive protein, and adipokines at 4 years of age. Childhood obesity was defined using age- and sex-specific cut points for body mass index (BMI) as recommended by the International Obesity Task Force.ResultsOn multivariable regression analyses, a 10-fold increase in HCB was associated with a higher BMI z-score (adjusted β = 0.49; 95% CI: 0.12, 0.86), obesity [relative risk (RR) = 8.14; 95% CI: 1.85, 35.81], abdominal obesity (RR = 3.49; 95% CI: 1.08, 11.28), greater sum of skinfold thickness (β = 7.71 mm; 95% CI: 2.04, 13.39), and higher systolic BP (β = 4.34 mmHg; 95% CI: 0.63, 8.05) at 4 years of age. Prenatal DDE exposure was associated with higher BMI z-score (β = 0.27; 95% CI: 0.04, 0.5), abdominal obesity (RR = 3.76; 95% CI: 1.70, 8.30), and higher diastolic BP (β = 1.79 mmHg; 95% CI: 0.13, 3.46). PCBs were not significantly associated with offspring obesity or cardiometabolic risk factors.ConclusionsPrenatal exposure to DDE and HCB was associated with excess adiposity and higher blood pressure levels in early childhood.CitationVafeiadi M, Georgiou V, Chalkiadaki G, Rantakokko P, Kiviranta H, Karachaliou M, Fthenou E, Venihaki M, Sarri K, Vassilaki M, Kyrtopoulos SA, Oken E, Kogevinas M, Chatzi L. 2015. Association of prenatal exposure to persistent organic pollutants with obesity and cardiometabolic traits in early childhood: the Rhea mother–child cohort (Crete, Greece). Environ Health Perspect 123:1015–1021; http://dx.doi.org/10.1289/ehp.1409062

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ContextMaternal pre-pregnancy obesity may increase the risk of childhood obesity but it is unknown whether other metabolic factors in early pregnancy such as lipid profile and hypertension are associated with offspring cardiometabolic traits.ObjectiveOur objective was to investigate whether fasting lipid, glucose, and insulin levels during early pregnancy and maternal pre-pregnancy weight status, are associated with offspring adiposity measures, lipid levels and blood pressure at preschool age.Design and MethodsThe study included 618 mother-child pairs of the pregnancy cohort “Rhea” study in Crete, Greece. Pregnant women were recruited at the first prenatal visit (mean: 12weeks, SD: 0.7). A subset of 348 women provided fasting serum samples for glucose and lipid measurements. Outcomes measures were body mass index, abdominal circumference, sum of skinfold thickness, and blood pressure measurements at 4 years of age. A subsample of 525 children provided non-fasting blood samples for lipid measurements.ResultsPre-pregnancy overweight/obesity was associated with greater risk of offspring overweight/obesity (RR: 1.83, 95%CI: 1.19, 2.81), central adiposity (RR: 1.97, 95%CI: 1.11, 3.49), and greater fat mass by 5.10mm (95%CI: 2.49, 7.71) at 4 years of age. These associations were more pronounced in girls. An increase of 40mg/dl in fasting serum cholesterol levels in early pregnancy was associated with greater skinfold thickness by 3.30mm (95%CI: 1.41, 5.20) at 4 years of age after adjusting for pre-pregnancy BMI and several other confounders. An increase of 10mmHg in diastolic blood pressure in early pregnancy was associated with increased risk of offspring overweight/obesity (RR: 1.22, 95%CI: 1.03, 1.45), and greater skinfold thickness by 1.71mm (95% CI: 0.57, 2.86) at 4 years of age.ConclusionsMetabolic dysregulation in early pregnancy may increase the risk of obesity at preschool age.

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