What question did this study set out to answer?

This study investigates how maternal gestational weight gain and child BMI growth influence cardiometabolic risk in early childhood.

June 20, 2026Open Access

Late Preschool BMI Acceleration as the Strongest Predictor of Childhood Cardiometabolic Risk at School Entry: A Dual-Trajectory Cohort Study

Key Points

This study investigates how maternal gestational weight gain and child BMI growth influence cardiometabolic risk in early childhood.
Analyzed 39,169 mother-child pairs from Tianjin Women and Children Health Cohort.
Categorized maternal GWG into four patterns and child BMI into four trajectories.
Used multivariable linear regression and ANOVA to assess associations with metabolic outcomes at age 6.
Children with Late Rapid BMI growth were 99.7% overweight or obese at age 6.
Late Rapid group had higher triglycerides (β = 0.193 mmol/L) and glucose (β = 0.047 mmol/L) compared to Normal trajectory.
Excessive early-only maternal GWG had a weak association with higher cholesterol (β = 0.038).

Abstract

Objective: This study aimed to examine the independent and joint associations of maternal gestational weight gain (GWG) patterns and offspring BMI growth trajectories with lipid and glycemic profiles at age 6. Methods: This analysis included 39,169 mother–child pairs from the Tianjin Women and Children Health Cohort. Maternal GWG was categorized into four trajectories: Adequate throughout (reference), Excessive early-only, Excessive late-only, and Excessive throughout. Offspring body mass index (BMI) trajectories from birth to age 6 were identified using group-based trajectory modeling, yielding four groups: Persistent Low, Normal (reference), Early Rapid, and Late Rapid. Multivariable linear regression assessed associations with triglycerides (TG), total cholesterol (CHO), and fasting glucose (GLU) at age 6. Interaction was tested via two-way ANOVA. Results: Children with Late Rapid BMI growth (18.7%; accelerated gain after age 3) were almost universally overweight or obese by age 6 (99.7%). This trajectory was the strongest independent predictor of adverse metabolic outcomes. Compared to the Normal trajectory, the Late Rapid group had significantly higher TG (β = 0.193 mmol/L, 95% CI: 0.179– 0.206) and GLU (β = 0.047 mmol/L, 95% CI: 0.030– 0.064). The Persistent Low trajectory (12.3%) was associated with lower TG and GLU. Maternal GWG trajectories showed no independent association with offspring TG or GLU after adjustment for child’s current BMI; only Excessive early-only GWG retained a weak association with higher CHO (β = 0.038, 95% CI: 0.011– 0.064). A significant interaction was observed for TG ( P = 0.012). Conclusion: Late preschool BMI acceleration is the most influential factor for adverse cardiometabolic risk at school entry identified in this cohort, affecting one in five children with effect sizes five times larger than any maternal GWG pattern. Maternal GWG exerts minimal direct effects beyond shaping childhood growth. The preschool years represent a critical window for early BMI trajectory monitoring and targeted intervention. Keywords: preschool, BMI trajectory, gestational weight gain, cardiometabolic risk, triglycerides, childhood obesity

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