Perinatal maternal and child growth mediate the association between maternal education and children’s overweight/obesity in Europe: The Feel4Diabetes-study

Background/Objectives: Early-life factors and maternal education interact with childhood overweight/obesity through pathways that remain unclear. Our aim was to investigate the predominant perinatal correlates of childhood overweight/obesity and their mediating effects on the association between maternal education and children's overweight/obesity. Subjects/Methods: In this cross-sectional study the total sample included 12211 children (4–12 years-old) from low socioeconomic status (SES) regions in six European countries, with 2663 having complete data for analysis. Interventions/methods: All measurements were carried out during August-September 2016. Children’s anthropometrics were measured and parents self-reported all other data (perinatal/ sociodemographic) via questionnaires. All variables were adjusted for maternal education, sex and age (p<0.05). Results: Maternal overweight (OR 1.54 (95% CI 1.19–1.99)), obesity (OR 2.51 (95% CI 1.57–4.00)), pre-pregnancy diabetes (OR 4.92 (95% CI 1.31–18.38)), smoking during pregnancy (OR 1.59 (95% CI 1.20–2.10)) and excessive gestational weight gain (OR 2.00 (95% CI 2.59–2.53)) were associated with childhood overweight/obesity. Children born small-for-gestational-age (OR 0.57 (95% CI 0.36–0.89)) had lower odds, whereas those born long-for-gestational-age (OR 1.49 (95% CI 1.15–1.92)) had higher odds of childhood overweight/obesity. Rapid weight gain during the first 6 months was positively associated (OR 1.30 (95% CI 1.04–1.63)) with overweight/obesity in children. Maternal pre-pregnancy weight status, rapid weight gain in the first 6 months and gestational weight gain mediated by 16.6%, 8.4%, and 7.8%, respectively, the maternal education-child obesity link. Conclusion: Perinatal factors play a crucial role in the onset of childhood obesity, and evidence suggests their association with maternal education. Families with lower education should be targeted, aiming to raise awareness of health issues related to maternal/children’s healthy lifestyle and improve nutrition knowledge, aiming to ensure healthy maternal weight prior to and during pregnancy and normal infant growth.