in mobilization of maternal adipose tissue and possibly lean body mass. Although the gestational metabolic milieu or offspring outcomes of pregnant women who experience weight loss have not yet been addressed in the scientific literature, there have been several studies on associations between ketonemia or ketonuria, which can occur among pregnant women subjected to short-term fasting (see Chapter 3), and cognition in offspring. Some, but not all, of these studies have found an association between biomarkers of maternal metabolic fuel alterations and child intellectual development (Stehbens et al., 1977; Rizzo et al., 1991; Silverman et al., 1991). In contrast, Persson and Gentz (1984) and Naeye and Chez (1981) did not find any association of maternal acetonuria, weight loss, or low GWG with either psychomotor development or IQ in children (see Chapter 3).

In summary, although no studies specifically address the impact of very low GWG or weight loss on child intellectual development, some evidence suggests that biomarkers of short-term negative energy balance during pregnancy may be related to the child’s intellectual development. These associations may be limited to women with diabetes during pregnancy.

Inasmuch as GWG has been associated with risk of preterm birth, it is plausible that GWG may also be a risk factor for childhood asthma since prematurity itself is a risk factor for childhood asthma—often as a result of suboptimal lung function and resulting neonatal respiratory morbidity (Dombkowski et al., 2008). For example, in a case-control study of 262 African American 4- to 9-year-old children receiving care at a hospital-based clinic, Oliveti et al. (1996) used maternal GWG (as determined from the mother’s self-report of prepregnancy weight and maternal weight measured at the time of delivery) and child medical records to examine pre- and perinatal risk factors for asthma (as defined either by physician diagnosis or wheezing or coughing that required asthma medication).

Multivariate logistic regression analyses showed that odds of prevalent asthma were 3.42 (95% CI: 1.72-6.79) times higher among women who gained less (versus more) than 20 total pounds during pregnancy. However, the authors neither adjusted for prepregnancy BMI nor examined the BMI-GWG interaction. Among children with asthma, 24.6 percent were born preterm compared to 13.7 percent of controls.

Another way that GWG could lead to the propensity for asthma in offspring is through alteration of the developing fetal immune system. For example, Willwerth et al. (2006) found that both inadequate and excessive GWG were associated with increased cord blood mononuclear cell proliferative responses to stimulation (OR = 2.3 and 2.6, respectively), compared