Published online December 1, 2006
PEDIATRICS Vol. 118 No. 6 December 2006, pp. e1644-e1649 (doi:10.1542/peds.2006-1379)

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ARTICLE

Large Maternal Weight Loss From Obesity Surgery Prevents Transmission of Obesity to Children Who Were Followed for 2 to 18 Years

John G. Kral, MD, PhD^a, Simon Biron, MD^b, Serge Simard, MSc^c, Frédéric-Simon Hould, MD^b, Stéfane Lebel, MD^b, Simon Marceau, MD^b and Picard Marceau, MD, PhD^b

^a Department of Surgery, State University of New York Downstate Medical Center, Brooklyn, New York
^b Department of Surgery, Laval University, Québec, Québec, Canada
^c Laval Hospital Research Center, Québec, Québec, Canada

OBJECTIVE. Our aim was to compare the prevalence of obesity in 172 children who were aged 2 to 18 years and born to 113 obese mothers (BMI: 31 ± 9 kg/m²) with substantial weight loss after biliopancreatic bypass surgery with 45 same-age siblings who were born before maternal surgery (mothers’ BMI: 48 ± 8 kg/m²) and with current population standards.

METHODS. In this case series, with >88% follow-up in a tertiary referral center, crosssectional office chart and telephone data on childhood and adolescent weights were transformed to z scores.

RESULTS. After maternal surgery, the prevalence of obesity in the offspring decreased by 52% and severe obesity by 45.1%, with no increase in the prevalence of underweight. The z score reduction in obesity was gender specific, with boys reducing from 1.4 ± 1.3 before to 0.57 ± 1.7 after maternal surgery, corrected for birth order. The difference was not significant in girls (0.8 ± 1.3 vs 0.8 ± 1.2). Among children of both genders who were aged 6 to 18 years of age and born after maternal surgery, the prevalence of overweight was reduced to population levels.

CONCLUSIONS. Contrary to outcomes after intrauterine under- and overnutrition, the prevalence of overweight and obesity in children of mothers with large voluntary postsurgical weight loss was similar to that in the general population, with no increase in underweight. The results demonstrate the importance of potentially modifiable epigenetic factors in the cause of obesity.

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Key Words: fetal origins • gestational weight gain • overnutrition • severe obesity • biliopancreatic diversion

Abbreviations: BPD—biliopancreatic diversion • BMS—before maternal surgery • AMS—after maternal surgery • SGA—small for gestational age

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Accepted Jun 15, 2006.

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