Maternal Overnutrition in Pregnancy Predicts Greater Body Mass Index Gains in Offspring by Early Midlife: A Systematic Review and Meta-Analysis.

Abstract

Maternal overnutrition during pregnancy predisposes children to increased adiposity later in life. This systematic review and meta-analysis examined how this association persists into adulthood and whether it differs by sex. MEDLINE, EMBASE, Scopus, and CENTRAL were searched for human studies published in English before May 2025. From 9191 screened records, 29 studies (430,764 mother-offspring pairs) provided quantitative data on the link between maternal pre-pregnancy body mass index (ppBMI) or gestational weight gain (GWG) and adiposity in adult offspring. The meta-analysis found significant positive associations between maternal ppBMI and offspring BMI, body fat percentage, or waist circumference. Each 1 kg/m² increase in maternal ppBMI was linked to a 0.4 kg/m² higher BMI and 0.35% more body fat in offspring. Maternal overweight/obesity predicted significantly higher offspring BMI or waist circumference, especially in females. Excessive GWG increased the odds of overweight/obesity in the offspring by 35% compared with adequate GWG. This correlation was stronger in early midlife (mean age 30-45) than in young adults. In early midlife offspring, each additional kilogram of GWG was linked to a 0.14 kg/m² higher BMI, independent of ppBMI. These findings underscore the importance of nutritional interventions before and during pregnancy to reduce obesity risk in adulthood.