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Weight gain during pregnancy and development of specific childhood asthma phenotypes

Published online July 17, 2024

Although pre-pregnancy body mass index (BMI) and weight gain during pregnancy, also known as gestational weight gain (GWG), may be associated with childhood asthma development, the mechanism by which these two prenatal factors contribute to childhood asthma development was unclear. To address this issue, we evaluated the associations of pre-pregnancy BMI and GWG with allergic and nonallergic asthma phenotypes in childhood.

Shiroshita and colleagues conducted a prospective, population-based birth cohort study of 1,265 term and healthy infants (INSPIRE) to assess the impact of weight gain during pregnancy on childhood asthma risk which was published in The Journal of Allergy and Clinical Immunology: In Practice. Pre-pregnancy body mass index (BMI) was categorized according to World Health Organization (WHO) guidelines: underweight (<18.5 kg/m²), normal weight (18.5-24.9 kg/m²), overweight (25-29.9 kg/m²), and obese (≥30 kg/m²). Gestational weight gain (GWG) was classified based on the Institute of Medicine (IOM) recommendations, which consider pre-pregnancy BMI. The IOM guidelines define adequate GWG as 28-40 lbs (12.5-18 kg) for underweight, 25-35 lbs (11.5-16 kg) for normal weight, 15-25 lbs (7-11.5 kg) for overweight, and 11-20 lbs (5-9 kg) for pregnant women with obesity. Allergic asthma in the study was identified by a combination of clinical asthma diagnosis and a positive skin test to an aeroallergen or a blood specific IgE level to an aeroallergen of ≥0.35 kU/L.

Children born to mothers with inadequate gestational weight gain (GWG) (compared with adequate GWG) had a significant increased risk of developing allergic asthma (adjusted odds ratio: 3.49 [95% CI: 1.66-7.32], P = .001). Similarly, children born to mothers with excessive GWG (compared with adequate GWG) also had a greater risk of allergic asthma (adjusted odds ratio: 2.55 [95% CI: 1.34-4.85], P = .004). No significant association was found between pre-pregnancy BMI and asthma or between GWG and nonallergic asthma. These findings suggest that both inadequate and excessive GWG are linked to an increased risk of allergic asthma in children, underscoring the importance of maintaining optimal GWG during pregnancy for favorable child health outcomes.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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