---
title: "Maternal BMI in Early Pregnancy and Offspring Mortality up to Early Adulthood"
id: "plos-medicine-1-maternal-body-mass-index-in-early-pregnancy-and-offspring-mortality-up-to-early"
canonical_url: "https://medichelpline.com/clinical-feed/plos-medicine-1-maternal-body-mass-index-in-early-pregnancy-and-offspring-mortality-up-to-early"
content_type: "clinical_feed_article"
specialty: "Pediatrics"
source_name: "PLOS Medicine"
source_url: "https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217"
published_at: "2026-09-01T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Maternal BMI in Early Pregnancy and Offspring Mortality up to Early Adulthood
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-medicine-1-maternal-body-mass-index-in-early-pregnancy-and-offspring-mortality-up-to-early
- **Specialty:** [Pediatrics](https://medichelpline.com/clinical-feed/pediatrics.md)
- **Primary Source:** PLOS Medicine
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217)
- **Published At:** 2026-09-01T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This nationwide Swedish cohort study included 2,606,684 live births (1982–2014, excluding 1990–1991) with a median follow-up of 22.4 years to assess associations between **maternal BMI** in early pregnancy and offspring mortality up to early adulthood. - Maternal BMI was categorized as underweight (<18.5 kg/m2), normal (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), obesity grade I (30.0–34.9 kg/m2), grade II (35.0–39.9 kg/m2) and grade III (≥40.0 kg/m2); mortality data came from the national Cause of Death Register. - During follow-up 21,981 offspring (0.8%) died. Higher maternal BMI was associated with higher offspring all-cause mortality: HR 1.03 per 1 unit BMI increase (95% CI 1.02–1.03). - Compared with maternal normal BMI, offspring risks were increased for maternal overweight (HR 1.11, 95% CI 1.07–1.15) and for obesity grades I–III with progressively larger HRs: 1.27, 1.68, and 1.92, respectively; all p < 0.001. - Similar positive associations were observed for several common causes of death in the young, including **respiratory diseases**, **cardiovascular diseases**, and **congenital anomalies**. - Analyses adjusted for maternal age, education, income, marital status, country of birth, smoking in early pregnancy, psychiatric disorders and cardiovascular disease before childbirth; adverse pregnancy outcomes were also considered. - A cousin comparison analysis attenuated but did not eliminate the associations, suggesting partial influence of shared familial factors but not complete confounding. - The authors caution that residual confounding remains possible and the findings should not be taken as proof of causality; mechanisms remain to be elucidated. - The study underscores the potential public health importance of achieving a healthy maternal BMI prior to conception given the rising obesity prevalence among women of childbearing age.
## Clinical Analysis & Structured Key Points
[ Skip to main content ](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#main-content) Advertisement * [plos.org](https://plos.org/) * [Create account](https://community.plos.org/registration/new) * [Sign in](https://journals.plos.org/user/secure/login?page=%2Fplosmedicine%2Farticle%3Fid%3D10.1371%2Fjournal.pmed.1005217) * * About * Browse * Publish * [](https://journals.plos.org/plosmedicine/ "PLOS Medicine") * Search [advanced search](https://journals.plos.org/plosmedicine/search) * 0 [Save](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005217#savedHeader) [Total Mendeley and Citeulike bookmarks.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005217#savedHeader) * 0 [Citation](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005217#citedHeader) [Paper's citation count computed by Dimensions.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005217#citedHeader) * 27 [View](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005217#viewedHeader) [PLOS views and downloads.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005217#viewedHeader) * 0 [Share](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005217#discussedHeader) [Sum of Facebook, Twitter, Reddit and Wikipedia activity.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005217#discussedHeader) Open Access Peer-reviewed Research Article # Maternal body mass index in early pregnancy and offspring mortality up to early adulthood: A nationwide cohort study * Hui Wang , Roles Conceptualization, Data curation, Formal analysis, Software, Writing – original draft, Writing – review & editing * E-mail: hui.wang2@ki.se, wanghui2015@xinhuamed.com.cn Affiliations MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden, Department of Maternal and Child Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-3194-574X ](https://orcid.org/0000-0002-3194-574X "ORCID Registry") ⨯ * Hua Chen, Roles Data curation, Formal analysis, Writing – review & editing Affiliations Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden ⨯ * Jette Möller, Roles Writing – review & editing Affiliation Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0001-9513-5896 ](https://orcid.org/0000-0001-9513-5896 "ORCID Registry") ⨯ * Yajun Liang, Roles Writing – review & editing Affiliation Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0003-0870-4953 ](https://orcid.org/0000-0003-0870-4953 "ORCID Registry") ⨯ * Krisztina D. László Roles Conceptualization, Data curation, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – review & editing Affiliations Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-4695-477X ](https://orcid.org/0000-0002-4695-477X "ORCID Registry") ⨯ # Maternal body mass index in early pregnancy and offspring mortality up to early adulthood: A nationwide cohort study * Hui Wang, * Hua Chen, * Jette Möller, * Yajun Liang, * Krisztina D. László ![PLOS](https://journals.plos.org/resource/img/logo-plos-full-color.svg) x * Published: September 1, 2026 * * [Article](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217) * [Authors](https://journals.plos.org/plosmedicine/article/authors?id=10.1371/journal.pmed.1005217) * [Metrics](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005217) * [Comments](https://journals.plos.org/plosmedicine/article/comments?id=10.1371/journal.pmed.1005217) * [Media Coverage](http://plos.altmetric.com/details/doi/10.1371/journal.pmed.1005217) * [Abstract](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#abstract0) * [Author summary](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#abstract1) * [Introduction](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#sec004) * [Methods](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#sec005) * [Results](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#sec014) * [Discussion](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#sec015) * [Supporting information](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#sec016) * [References](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#references) * [Reader Comments](https://journals.plos.org/plosmedicine/article/comments?id=10.1371/journal.pmed.1005217) * [Figures](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217) ## Abstract ### Background Obesity is increasingly common among women of childbearing age worldwide. Maternal obesity during pregnancy may have long-term implications for offspring health, but its association with offspring mortality remains not well understood. In this nationwide cohort study, we examined the associations of maternal body mass index (BMI) in early pregnancy with all-cause and cause-specific mortality in offspring. ### Methods and findings We included 2,606,684 live births in Sweden during 1982–2014 (except for 1990 and 1991) and followed them from birth until death, emigration from Sweden, or December 31, 2023, whichever came first. Information on maternal BMI during early pregnancy was obtained from the Medical Birth Register and was categorized as: underweight (BMI ; email: socialstyrelsen@socialstyrelsen.se) and from Statistics Sweden ( ). The analytical code used in this study is publicly available on GitHub ( ) and has been archived in Zenodo ( ). **Funding:** This study was supported by the Swedish Research Council for Health, Working Life and Welfare ( ) (2015-00837 to KL) and the Heart and Lung Foundation ( ) (2023049324 to KL). This work was also supported by the Shanghai Jiao Tong University K.C.Wong Medical Fellowship Fund. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. **Competing interests:** The authors have declared that no competing interests exist. **Abbreviations:** BMI, body mass index; CI, confidence intervals; HRs, hazard ratios; ICD, International Classification of Diseases; MBR, Medical Birth Register; RECORD, Reporting of Studies Conducted using Observational Routinely-Collected Data ## Introduction Obesity has become increasingly prevalent among women of childbearing age worldwide [[1](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#pmed.1005217.ref001)]. A recent meta-analysis reported that the global prevalence of obesity in women of childbearing age has reached 16.3%, i.e., it affects approximately one in six pregnancies [[2](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#pmed.1005217.ref002)]. Compelling evidence suggests that maternal obesity during pregnancy is associated with several pregnancy complications, including miscarriage, hypertensive disorders of pregnancy, gestational diabetes mellitus, preterm birth, and delivery of a large for gestational age infant [[3](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#pmed.1005217.ref003),[4](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#pmed.1005217.ref004)]. Women with these pregnancy complications have increased risks of developing type 2 diabetes mellitus, cardiovascular diseases, and neurological disorders later in life [[5](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#pmed.1005217.ref005),[6](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#pmed.1005217.ref006)]. Maternal obesity during pregnancy may be an important determinant also for the long-term health of the offspring, both during childhood and in adulthood [[7](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#pmed.1005217.ref007)]. Maternal obesity has been found to be associated with increased risks of obesity [[8](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#pmed.1005217.ref008),[9](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#pmed.1005217.ref009)], metabolic disorders [[10](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#pmed.1005217.ref010)], cardiovascular diseases [[11](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#pmed.1005217.ref011)], and infectious diseases in offspring [[12](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#pmed.1005217.ref012)]. Two studies reported that maternal overweight and obesity are associated with an increased risk of infant mortality [[13](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#pmed.1005217.ref013),[14](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#pmed.1005217.ref014)]. Knowledge regarding the association between maternal overweight and obesity and the long-term risk of mortality in offspring is, however, limited. To our knowledge, only one study investigated this question and reported that maternal obesity was associated with a 30% increased risk of all-cause mortality in adult offspring [[15](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#pmed.1005217.ref015)]. However, due to its relatively small sample size (_n_ = 37,709), this study could not analyze dose–response relationships, nor the risk associated with the offspring’s cause-specific death. Further, the role of adverse pregnancy outcomes in this association has not been explored. Pregnancy complications, such as preterm birth and hypertensive disorders of pregnancy, are also associated with increased risks of premature mortality in offspring [[16](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#pmed.1005217.ref016),[17](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005217#pmed.1005217.ref017)]. Finally, it remains unclear whether the observed associations may be confounded by shared familial factors that influence both obesity and mortality. In this nationwide cohort study, we aimed to analyze the associations of maternal BMI with the risk of all-cause and cause-specific mortality in offspring during childhood, adolescence, and early adulthood, and when taking adverse pregnancy outcomes into consideration. We further assessed the role of confounding by shared familial (genetic or environmental) factors using cousin comparison analysis. We hypothesized that increased maternal BMI in early pregnancy is associated with a higher risk of offspring mortality. ## Methods ### Ethics statement The study was approved by the Research Ethics Committee at Karolinska Institute in
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