Adriëtte Oostvogels

Chapter 9 discusses the interpretation of the main findings, methodological considerations and implications for future research and public health. The research presented in this thesis suggests that both maternal characteristics – in particular high maternal pBMI, an atherogenic early pregnancy lipid profile, both maternal and paternal family history of diabetes – and offspring’s postnatal growth were independently associated with cardiometabolic profile in early childhood. Maternal early pregnancy lipid profile or postnatal growth did not mediate the asociations between maternal pBMI and offspring’s cardiometabolic profile. However, accelerated postnatal growth modified the association between pBMI and cardiometabolic profile at age 5-6 years, with the most detrimental outcomes found in children of mothers with overweight and accelerated postnatal weight- or weight-for-length gain. Girls were more affected by maternal overweight than boys when it comes to faster postnatal growth and lipid profile in childhood. There were socioeconomic inequalities in growth to overweight. Future research should compare maternal and paternal influences and study maternal early pregnancy lipid profile throughout pregnancy and not only in early pregnancy. Moreover, also other maternal metabolic parameters and low-grade inflammation during pregnancy should be investigated to gain more insight in underlying mechanisms of the association between maternal pBMI and childhood cardiometabolic profile. When it comes to growth, also growth measures like BMI/adiposity peak and the adiposity rebound should be studied in more detail. Based on this thesis, prevention of childhood obesity can be started at any given moment, before pregnancy, during pregnancy, or in infancy. Preconception interventions, however, might change health-related behaviours on the long-term in both mother and father, creating not only a healthier prenatal, but also a healthier postnatal environment for the offspring. In Youth Health Care, special attention should be focussed on girls of mothers with obesity as these are more sensitive to maternal overweight than boys. Also special attention is needed for children of low socioeconomic background as they are not overweight in the first years, but increase rapidly in BMI resulting in the highest BMI among overweight children. Finally, an integral prevention program, like the ‘Amsterdamse Aanpak Gezond Gewicht’ which involves health care providers, schools and the municipality working together might help prevent childhood obesity. 249 Summary