Skip to main content

Influence of maternal adiposity, preterm birth and birth weight centiles on early childhood obesity in an Indigenous Australian pregnancy-through-to-early-childhood cohort study

  • K. G. Pringle (a1) (a2) (a3), Y. Q. Lee (a1) (a2) (a3), L. Weatherall (a3), L. Keogh (a3), C. Diehm (a3) (a4), C. T. Roberts (a5), S. Eades (a6), A. Brown (a7), R. Smith (a1) (a8), E. R. Lumbers (a1) (a2), L. J. Brown (a4) (a9), C. E. Collins (a9) (a10) and K. M. Rae (a1) (a3) (a4) (a8) (a11)...

Childhood obesity rates are higher among Indigenous compared with non-Indigenous Australian children. It has been hypothesized that early-life influences beginning with the intrauterine environment predict the development of obesity in the offspring. The aim of this paper was to assess, in 227 mother–child dyads from the Gomeroi gaaynggal cohort, associations between prematurity, Gestation Related-Optimal Weight (GROW) centiles, maternal adiposity (percentage body fat, visceral fat area), maternal non-fasting plasma glucose levels (measured at mean gestational age of 23.1 weeks) and offspring BMI and adiposity (abdominal circumference, subscapular skinfold thickness) in early childhood (mean age 23.4 months). Maternal non-fasting plasma glucose concentrations were positively associated with infant birth weight (P=0.005) and GROW customized birth weight centiles (P=0.008). There was a significant association between maternal percentage body fat (P=0.02) and visceral fat area (P=0.00) with infant body weight in early childhood. Body mass index (BMI) in early childhood was significantly higher in offspring born preterm compared with those born at term (P=0.03). GROW customized birth weight centiles was significantly associated with body weight (P=0.01), BMI (P=0.007) and abdominal circumference (P=0.039) at early childhood. Our findings suggest that being born preterm, large for gestational age or exposed to an obesogenic intrauterine environment and higher maternal non-fasting plasma glucose concentrations are associated with increased obesity risk in early childhood. Future strategies should aim to reduce the prevalence of overweight/obesity in women of child-bearing age and emphasize the importance of optimal glycemia during pregnancy, particularly in Indigenous women.

Corresponding author
Address for correspondence: Dr Kirsty Pringle, Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia. E-mail:
Hide All

Joint first authors.

Hide All
1. Centers for Disease Control and Prevention. Overweight and obesity. 2017. Retrieved 25 August 2017 from
2. United Nations International Children’s Fund WHO, The World Bank. Level and Trends in Malnutrition UNICEF-WHO-World Bank Joint Child Malnutrition Estimates. Key findings of the 2017 edition. UNICEF, New York; WHO, Geneva; The World Bank, Washington, DC: 2017. Retrieved 18 April 2018 from
3. WHO Multicentre Growth Reference Study Group. WHO child growth standards based on length/height, weight and age. Acta Paediatr. 2006; 450(Suppl.), 7685.
4. Australian Institute of Health and Welfare. Australia’s health 2016. 2016 Contract No.: Cat. no. AUS 199. Australian Institute of Health and Welfare: Canberra.
5. Australian Bureau of Statistics. Australian Aboriginal and Torres Strait Islander Health Survey: First Results, Australia, 2012-2013. 2013. Australian Bureau of Statistics: Canberra.
6. Ng, M, Fleming, T, Robinson, M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study. Lancet. 2014; 384, 766781.
7. Llewellyn, A, Simmonds, M, Owen, C, Woolacott, N. Childhood obesity as a predictor of morbidity in adulthood: a systematic review and meta-analysis. Obes Rev. 2016; 17, 5667.
8. Umer, A, Kelley, G, Cottrell, L, et al. Childhood obesity and adult cardiovascular disease risk factors: a systematic review with meta-analysis. BMC Public Health. 2017; 17, 683.
9. Barker, D. Developmental origins of adult health and diseases. J Epidemiol Community Health. 2004; 58, 114115.
10. Warner, M, Ozanne, S. Mechanisms involved in the developmental programming of adulthood diseases. Biochem J. 2010; 427, 333347.
11. Whincup, PH, Kaye, SJ, Owen, CG, et al. Birth weight and risk of type 2 diabetes: a systematic review. JAMA.. 2008; 300, 28862897.
12. Huxley, R, Owen, CG, Whincup, PH, et al. Is birth weight a risk factor for ischemic heart disease in later life? Am J Clin Nutr. 2007; 85, 12441250.
13. Huxley, RR, Shiell, AW, Law, CM. The role of size at birth and postnatal catch-up growth in determining systolic blood pressure: a systematic review of the literature. J Hypertens. 2000; 18, 815831.
14. Li, Y, Ley, SH, VanderWeele, TJ, et al. Joint association between birth weight at term and later life adherence to a healthy lifestyle with risk of hypertension: a prospective cohort study. BMC Med. 2015; 13, 175.
15. Kajantie, E, Osmond, C, Barker, DJ, Eriksson, JG. Preterm birth – a risk factor for type 2 diabetes? The Helsinki birth cohort study. Diabetes Care. 2010; 33, 26232625.
16. Thomas, EL, Parkinson, JR, Hyde, MJ, et al. Aberrant adiposity and ectopic lipid deposition characterize the adult phenotype of the preterm infant. Pediatr Res. 2011; 70, 507512.
17. Euser, AM, Finken, MJ, Keijzer-Veen, MG, et al. Associations between prenatal and infancy weight gain and BMI, fat mass, and fat distribution in young adulthood: a prospective cohort study in males and females born very preterm. Am J Clin Nutr. 2005; 81, 480487.
18. Mathai, S, Derraik, JG, Cutfield, WS, et al. Increased adiposity in adults born preterm and their children. PLoS One. 2013; 8, e81840.
19. Casey, P. Growth of low birth weight preterm children. Semin Perinatol. 2008; 32, 2027.
20. Gluckman, PD, Hanson, MA, Cooper, C, Thornburg, KL. Effect of in utero and early-life conditions on adult health and disease. N Engl J Med. 2008; 359, 6173.
21. Martin, A, Connelly, A, Bland, R, Reilly, J. Health impact of catch-up growth in low-birth weight infants: systematic review, evidence appraisal, and meta-analysis. Matern Child Nutr. 2017; 13.
22. Yu, Z, Han, S, Zhu, J, et al. Pre-pregnancy body mass index in relation to infant birth weight and offspring overweight/obesity: a systematic review and meta-analysis. PLoS One. 2013; 8, e61627.
23. Poston, L. Maternal obesity, gestational weight gain and diet as determinants of offspring long term health. Best Pract Res Clin Endocrinol Metab. 2012; 26, 627639.
24. Philipps, L, Santhakumaran, S, Gale, C, et al. The diabetic pregnancy and offspring BMI in childhood: a systematic review and meta-analysis. Diabetologia. 2011; 54, 19571966.
25. Dabelea, D, Hanson, R, Lindsay, R, et al. Intrauterine exposure to diabetes conveys risks for type 2 diabetes and obesity: a Study of Discordant Sibships. Diabetes. 2000; 49, 22082211.
26. Crume, TL, Ogden, L, West, NA, et al. Association of exposure to diabetes in utero with adiposity and fat distribution in a multiethnic population of youth: the Exploring Perinatal Outcomes among Children (EPOCH) Study. Diabetologia. 2011; 54, 8792.
27. Metzger, BE. Long-term outcomes in mothers diagnosed with gestational diabetes mellitus and their offspring. Clin Obstet Gynaecol. 2007; 50, 972979.
28. Eriksson, J, Sandboge, S, Salonen, M, Kajantie, E, Osmond, C. Maternal weight in pregnancy and offspring body composition in late adulthood: findings from the Helsinki Birth Cohort Study (HBCS). Ann Med. 2015; 47, 9499.
29. Boney, C, Verma, A, Tucker, R, Vohr, B. Metabolic syndrome in childhood: association with birth weight, maternal obesity and gestational diabetes mellitus. Pediatrics. 2005; 115, e290e296.
30. Eriksson, J, Sandboge, S, Salonen, M, Kajantie, E, Osmond, C. Longterm consequences of maternal overweight in pregnancy on offspring later health: findings from the Helsinki Birth Cohort Study. Ann Med. 2014; 46, 434438.
31. Australian Institute of Health and Welfare. The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples. 2015. AIHW: Canberra.
32. Australian Institute of Health and Welfare. Australia’s Mothers and Babies 2014—In Brief, Contract No.: Cat no. PER 87, 2016. Canberra: Australian Institute of Health and Welfare.
33. Dyer, SM, Gomersall, JS, Smithers, LG, et al. Prevalence and characteristics of overweight and obesity in Indigenous Australian children: a systematic review. Crit Rev Food Sci Nutr. 2017; 57, 13651376.
34. Vos, T, Barker, B, Begg, S, Stanley, L, Lopez, AD. Burden of disease and injury in Aboriginal and Torres Strait Islander Peoples: the Indigenous health gap. Int J Epidemiol. 2009; 38, 470477.
35. McNamara, BJ, Gubhaju, L, Chamberlain, C, Stanley, F, Eades, SJ. Early life influences on cardio-metabolic disease risk in aboriginal populations – what is the evidence? A systematic review of longitudinal and case-control studies. Int J Epidemiol. 2012; 41, 16611682.
36. Ashman, AM, Collins, CE, Weatherall, L, et al. A cohort of Indigenous Australian women and their children through pregnancy and beyond: the Gomeroi gaaynggal study. J Dev Origins Health Dis. 2016; 7, 357368.
37. World Health Organisation. Global Strategy on Diet, Physical Activity and Health. 2016. Retrieved 10 November 2017 from
38. Dehghan, M, Merchant, AT. Is bioelectrical impedance accurate for use in large epidemiological studies? Nutr J. 2008; 7, 26.
39. Ellis, KJ, Bell, SJ, Chertow, GM, et al. Bioelectrical impedance methods in clinical research: a follow-up to the NIH Technology Assessment Conference. Nutrition. 1999; 15, 874880.
40. Pietrobelli, A, Rubiano, F, St-Onge, MP, Heymsfield, SB. New bioimpedance analysis system: improved phenotyping with whole-body analysis. Eur J Clin Nutr. 2004; 58, 14791484.
41. Neovius, M, Hemmingsson, E, Freyschuss, B, Udden, J. Bioelectrical impedance underestimates total and truncal fatness in abdominally obese women. Obesity. 2006; 14, 17311738.
42. Gibson, AL, Holmes, JC, Desautels, RL, Edmonds, LB, Nuudi, L. Ability of new octapolar bioimpedance spectroscopy analyzers to predict 4-component-model percentage body fat in Hispanic, black, and white adults. Am J Clin Nutr. 2008; 87, 332338.
43. Volgyi, E, Tylavsky, FA, Lyytikainen, A, et al. Assessing body composition with DXA and bioimpedance: effects of obesity, physical activity, and age. Obesity. 2008; 16, 700705.
44. Bedogni, G, Malavolti, M, Severi, S, et al. Accuracy of an eight-point tactile-electrode impedance method in the assessment of total body water. Eur J Clin Nutr. 2002; 56, 11431148.
45. Gardosi, J, Francis, A. Customised Weight Centile Calculator. GROW version (AU). Gestation Network 2018. Retrieved 18 April 2018 from
46. Cole, TJ, et al. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000; 320, 12401243.
47. Cohen, J. Statistical Power Analysis for the Behavior Science. 1988. Lawrence Erlbaum Association: Hillsdale, NJ.
48. Reilly, JJ, Kelly, J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes. 2011; 35, 891898.
49. Pringle, KG, Weatherall, L, Roberts, TC, et al. The Gomeroi Gaaynggal cohort: a preliminary study of the maternal determinants of pregnancy outcomes in Indigenous Australian women. J Preg Child Health. 2015; 3, 211.
50. Pringle, KG, Rae, K, Weatherall, L, et al. Effects of maternal inflammation and exposure to cigarette smoke on birth weight and delivery of preterm babies in a cohort of Indigenous Australian women. Front Immunol. 2015; 6, 89.
51. Woo Baidal, JA, Locks, LM, Cheng, ER, et al. Risk factors for childhood obesity in the first 1,000 days: a systematic review. Am J Prev Med. 2016; 50, 761779.
52. Kapral, N, Miller, SE, Scharf, RJ, Gurka, MJ, DeBoer, MD. Associations between birthweight and overweight and obesity in school-age children. Pediatr Obes. 2017 [Epub ahead of print]. doi: 10.1111/ijpo.12227.
53. Hadfield, RM, Lain, SJ, Simpson, JM, et al. Are babies getting bigger? An analysis of birthweight trends in New South Wales, 1990-2005. Med J Aust. 2009; 190, 312315.
54. Castillo-Laura, H, Santos, IS, Quadros, LC, Matijasevich, A. Maternal obesity and offspring body composition by indirect methods: a systematic review and meta-analysis. Cad Saude Publica. 2015; 31, 20732092.
55. Long, N, George, L, Uthlaut, A, et al. Maternal obesity and increased nutrient intake before and during gestation in the ewe results in altered growth, adiposity, and glucose tolerance in adult offspring. J Anim Sci. 2010; 88, 35463553.
56. McCurdy, C, Bishop, J, Williams, S, et al. Maternal high-fat diet triggers lipotoxicity in the fetal livers of nonhuman primates. J Clin Invest. 2009; 119, 323335.
57. Samuelsson, A, Matthews, P, Argenton, M, et al. Diet-induced obesity in female mice leads to offspring hyperphagia, adiposity, hypertension, and insulin resistance: a novel murine model of developmental programming. Hypertension. 2008; 51, 383392.
58. Drake, A, Reynolds, R. Impact of maternal obesity on offspring obesity and cardiometabolic disease risk. Reproduction. 2010; 140, 387398.
59. Clausen, TD, Mathiesen, ER, Hansen, T, et al. High prevalence of type 2 diabetes and pre-diabetes in adult offspring of women with gestational diabetes mellitus or type 1 diabetes: the role of intrauterine hyperglycemia. Diabetes Care. 2008; 31, 340346.
60. Boerschmann, H, Pflüger, M, Henneberger, L, Ziegler, A, Hummel, S. Prevalence and predictors of overweight and insulin resistance in offspring of mothers with gestational diabetes mellitus. Diabetes Care. 2010; 33, 18451849.
61. Pettitt, DJ, McKenna, S, McLaughlin, C, et al. Maternal glucose at 28 weeks of gestation is not associated with obesity in 2-year-old offspring: the Belfast Hyperglycemia and Adverse Pregnancy Outcome (HAPO) family study. Diabetes Care. 2010; 33, 12191223.
62. Krishnaveni, GV, Hill, JC, Leary, SD, et al. Anthropometry, glucose tolerance, and insulin concentrations in Indian children: relationships to maternal glucose and insulin concentrations during pregnancy. Diabetes Care. 2005; 28, 29192925.
63. Wright, CS, Rifas-Shiman, SL, Rich-Edwards, JW, et al. Intrauterine exposure to gestational diabetes, child adiposity, and blood pressure. Am J Hypertens. 2009; 22, 215220.
64. Bergman, RN, Kim, SP, Catalano, KJ, et al. Why visceral fat is bad: mechanisms of the metabolic syndrome. Obesity. 2006; 14(Suppl. 1), 16S19S.
65. Dabelea, D, Pettitt, D. Intrauterine diabetic environment confers risks for type 2 diabetes mellitus and obesity in the offspring, in addition to genetic susceptability. J Pediatric Endocrinol Metab. 2001; 14, 10851091.
66. Hillier, T, Pedula, K, Schmidt, M, et al. Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia. Diabetes Care. 2007; 30, 22872292.
67. Wang, Z, Hoy, W, McDonald, S. Body mass index in aboriginal Australians in remote communities. Aust N Z J Public Health. 2000; 24, 570575.
68. Adegbija, O, Hoy, WE, Wang, Z. Waist circumference values equivalent to body mass index points for predicting absolute cardiovascular disease risks among adults in an Aboriginal community: a prospective cohort study. BMJ Open. 2015; 5, e009185.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Journal of Developmental Origins of Health and Disease
  • ISSN: 2040-1744
  • EISSN: 2040-1752
  • URL: /core/journals/journal-of-developmental-origins-of-health-and-disease
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Type Description Title
Supplementary materials

Pringle et al. supplementary material
Table S2

 Word (3.3 MB)
3.3 MB
Supplementary materials

Pringle et al. supplementary material
Table S1

 Word (18 KB)
18 KB
Supplementary materials

Pringle et al. supplementary material
Figures S1-S2

 Word (10.0 MB)
10.0 MB


Altmetric attention score

Full text views

Total number of HTML views: 2
Total number of PDF views: 45 *
Loading metrics...

Abstract views

Total abstract views: 530 *
Loading metrics...

* Views captured on Cambridge Core between 16th May 2018 - 19th July 2018. This data will be updated every 24 hours.