The association between maternal body mass index and child obesity: a systematic review and meta-analysis

Nicola Heslehurst (Corresponding Author), Rute Vieira, Zainab Akhter, Hayley Bailey, Emma Slack, Lem Ngongalah, Augustina Pemu, Judith Rankin

Research output: Contribution to journalArticlepeer-review

191 Citations (Scopus)
12 Downloads (Pure)



There is a global obesity crisis, particularly among women and disadvantaged populations. Early-life intervention to prevent childhood obesity is a priority for public health, global health, and clinical practice. Understanding the association between childhood obesity and maternal pre-pregnancy weight status would inform policy and practice by allowing one to estimate the potential for offspring health gain through channelling resources into intervention. This systematic review and meta-analysis aimed to examine the dose–response association between maternal body mass index (BMI) and childhood obesity in the offspring.

Methods and findings

Searches in MEDLINE, Child Development & Adolescent Studies, CINAHL, Embase, and PsycInfo were carried out in August 2017 and updated in March 2019. Supplementary searches included hand-searching reference lists, performing citation searching, and contacting authors. Two researchers carried out independent screening, data extraction, and quality assessment. Observational studies published in English and reporting associations between continuous and/or categorical maternal and child BMI or z-score were included. Categorical outcomes were child obesity (≥95th percentile, primary outcome), overweight/obesity (≥85th percentile), and overweight (85th to 95th percentile). Linear and nonlinear dose–response meta-analyses were conducted using random effects models. Studies that could not be included in meta-analyses were summarised narratively. Seventy-nine of 41,301 studies identified met the inclusion criteria (n = 59 cohorts). Meta-analyses of child obesity included 20 studies (n = 88,872); child overweight/obesity, 22 studies (n = 181,800); and overweight, 10 studies (n = 53,238). Associations were nonlinear and there were significantly increased odds of child obesity with maternal obesity (odds ratio [OR] 3.64, 95% CI 2.68–4.95) and maternal overweight (OR 1.89, 95% CI 1.62–2.19). Significantly increased odds were observed for child overweight/obesity (OR 2.69, 95% CI 2.10–3.46) and for child overweight (OR 1.80, 95% CI 1.25, 2.59) with maternal obesity. A limitation of this research is that the included studies did not always report the data in a format that enabled inclusion in this complex meta-analysis.


This research has identified a 264% increase in the odds of child obesity when mothers have obesity before conception. This study provides substantial evidence for the need to develop interventions that commence prior to conception, to support women of childbearing age with weight management in order to halt intergenerational obesity.

Original languageEnglish
Article numbere1002817
Number of pages20
JournalPLoS Medicine
Issue number6
Publication statusPublished - 11 Jun 2019

Bibliographical note

Funding: ES is a PhD student funded by the Medical Research Council (reference MR/K501396/1, AP is a PhD student funded by the Economic and Social Research Council (reference 160149300, ZA is a PhD student funded by Newcastle University Research Excellence Academy ( NH is funded by a National Institute of Health Research Career Development Fellowship (reference CDF-2018-11-ST2-011, The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

The authors would like to acknowledge Shannon Robalino (information scientist) for support in developing search strategies for database searches, and the authors who responded to our correspondence about additional data required for the meta-analysis. Authors who responded to our correspondence and provided the data requested were Dr Aline Andres, Professor Patrick Catalano, Dr Romy Gaillard, Professor Dana Dabelea, Dr Ai Kubo, Professor David Taylor-Robinson, Dr Sophie Wickham, Professor Christine Olson, and Dr Stephen Weng. Authors who responded to our correspondence but were unable to provide data were Zoe Bider-Canfield, Dr Claire Margerison-Zilko, Professor Juliana Kain, Dr Marieke de Hoog, and Professor Aaron Caughey.


  • AGE 7 Y


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