Maternal BMI, Gestational Weight Gain, and Offspring CVD

Higher maternal body mass index (BMI) in early pregnancy and greater gestational weight gain (GWG) were associated with increased risks of early-onset cardiovascular disease (CVD) in offspring in a nationwide Swedish cohort study published in JAMA Network Open.

The study used national registry data for births from 1982 through 2014, excluding 1990 and 1991, and followed participants until a first CVD diagnosis, death, emigration, or December 31, 2023. Maternal BMI data were available for 2,496,335 offspring. The primary outcome was a composite of vascular disease, heart failure, hypertensive disease, cardiomyopathy, and atrial fibrillation. Adjusted Cox models estimated associations, while sibling analyses examined shared familial factors.

At the end of follow-up, offspring had a mean age of 23.3 years; over a median 22.0 years, 22,510 (0.9%) received a CVD diagnosis. Compared with offspring of mothers with normal BMI, adjusted hazard ratios were 1.29 for maternal overweight, 1.66 for obesity class 1, 2.16 for obesity class 2, and 2.74 for obesity class 3.

GWG data were available for 1,261,967 offspring. Compared with a reference GWG z score greater than −1 to less than 1, a score of 1 or higher was associated with increased major CVD risk overall (adjusted hazard ratio, 1.13; 95% CI, 1.08-1.19), including among offspring of mothers with normal weight (1.16; 95% CI, 1.09-1.22) and overweight (1.17; 95% CI, 1.04-1.31). Sibling analyses produced attenuated estimates; the authors said the associations generally remained evident.

GWG was missing for 49.4% of deliveries, and investigators lacked data on maternal diet and physical activity, leaving possible residual confounding. They also lacked offspring BMI, and registry-based outcome capture may have missed hypertension and other milder CVD managed in primary care. The authors cautioned that the findings are not direct evidence that reducing GWG during pregnancy would lower offspring CVD risk.

Source: Wang H, Möller J, Liang Y, Janszky I, László KD. Maternal body mass index, gestational weight gain, and cardiovascular disease in offspring. JAMA Netw Open. 2026;9(9):e2631324. doi:10.1001/jamanetworkopen.2026.31324