High maternal BMI and greater gestational weight gain were associated with increased risks of early-onset offspring CVD, highlighting the importance of managing maternal weight during pregnancy.
Key Findings
Results
Maternal overweight was associated with a 29% increased risk of cardiovascular disease in offspring compared to offspring of mothers with normal BMI.
HR 1.29 (95% CI, 1.24-1.33) for maternal overweight (BMI 25.0-29.9) vs. normal weight (BMI 18.5-24.9)
Study included 2,496,335 offspring born in Sweden from 1982 to 2014
22,510 offspring (0.9%) were diagnosed with CVD during follow-up
Median follow-up was 22.0 (IQR 14.7-30.4) years
Cox proportional hazards regression models were used to estimate HRs
Results
Maternal obesity showed a dose-response relationship with offspring CVD risk, with class 3 obesity associated with a nearly 3-fold increased risk.
HR 1.66 (95% CI, 1.57-1.75) for maternal obesity class 1 (BMI 30.0-34.9)
HR 2.16 (95% CI, 1.96-2.39) for maternal obesity class 2 (BMI 35.0-39.9)
HR 2.74 (95% CI, 2.29-3.28) for maternal obesity class 3 (BMI ≥40.0)
All comparisons were made against offspring of mothers with normal BMI (18.5-24.9)
The progressive increase across obesity classes suggests a dose-response pattern
Results
Greater gestational weight gain (GWG) was associated with higher offspring CVD risk across all maternal BMI groups.
GWG was standardized for gestational age into z scores
Among offspring of mothers with normal BMI, HR for higher GWG (z score ≥1) was 1.16 (95% CI, 1.09-1.22)
The association was observed across all BMI categories, not limited to any single group
GWG data were obtained from the Swedish Medical Birth Register
Results
Sibling analyses showed attenuation of the associations between maternal BMI and GWG with offspring CVD risk, but the associations remained generally evident.
Sibling analyses were conducted to assess the potential confounding role of shared familial factors
Higher maternal BMI and GWG were associated with attenuated risk of offspring CVD in sibling analyses
Despite attenuation, associations 'remained generally evident,' suggesting an independent association beyond shared familial confounding
This design helps control for genetic and environmental factors shared within families
Methods
The study population had a mean offspring age of 23.3 years at end of follow-up, indicating these CVD diagnoses represent early-onset disease.
Mean (SD) age of offspring at end of follow-up was 23.3 (9.8) years
51.4% of the 2,496,335 offspring were male
Offspring were followed from birth until first CVD diagnosis, death, emigration, or December 31, 2023
CVD data were retrieved from both the Patient Register and the Cause of Death Register
Individuals were born between January 1, 1982, and December 31, 2014
Methods
Maternal underweight (BMI <18.5) was included as a separate category in the analysis, reflecting the full spectrum of maternal BMI exposures studied.
BMI was categorized into six groups: underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), and obesity classes 1, 2, and 3
Maternal BMI was measured in early pregnancy from the Swedish Medical Birth Register
Normal weight (18.5-24.9) served as the reference category for all comparisons
The abstract does not report a specific HR for maternal underweight offspring CVD risk
What This Means
This large Swedish study followed nearly 2.5 million people from birth to adulthood to examine whether a mother's weight during pregnancy affects her child's risk of developing heart or blood vessel disease (cardiovascular disease, or CVD) later in life. The researchers found a clear pattern: the higher the mother's BMI at the start of pregnancy, the greater the child's risk of CVD. Compared to children of mothers with a healthy weight, children of overweight mothers had a 29% higher CVD risk, while children of mothers with severe obesity (BMI ≥40) had nearly three times the risk. Additionally, gaining more weight than average during pregnancy was also linked to higher CVD risk in children, even among mothers who started at a healthy weight.
To check whether these findings simply reflected shared family traits — such as genetics or lifestyle habits — the researchers also compared siblings within the same family. The associations became somewhat weaker in these sibling comparisons, suggesting that some of the risk is explained by shared family factors. However, the associations did not disappear entirely, indicating that maternal weight during pregnancy may have an independent effect on a child's cardiovascular health beyond what is explained by genetics or shared environment.
This research suggests that a mother's weight and weight gain during pregnancy may have lasting consequences for her child's heart health, even into early adulthood. Because the average age of the offspring at the end of follow-up was only about 23 years, the CVD cases observed represent unusually early-onset disease. These findings point to the potential long-term importance of supporting healthy weight before and during pregnancy, not only for the mother's health but also for the long-term health of her children.
Wang H, Möller J, Liang Y, Janszky I, László K. (2026). Maternal Body Mass Index, Gestational Weight Gain, and Cardiovascular Disease in Offspring.. JAMA network open. https://doi.org/10.1001/jamanetworkopen.2026.31324