LAUSR

Childhood obesity prevention efforts are increasingly focused on the prenatal period, but the effects of these interventions on birth weight have been mixed.1 In this issue of Pediatrics , Moore et al2 present evidence suggesting the importance of neonatal adiposity, as opposed to birth weight alone, as a predictor of overweight in early childhood. The effects were robust: at age 5 years, the difference in the prevalence of overweight among children born 1 SD above versus below the mean for neonatal adiposity was 23% vs 3%. Contributors to neonatal adiposity may include shared genetics as well as epigenetic changes or metabolic priming caused by intrauterine exposure to a myriad of known (eg, diet and smoking) and unknown factors in the maternal environment. For the pediatric provider, the results raise the possibility that our postnatal interventions in infancy and early childhood are too little, too late. Although neonatal adiposity is an end point for prenatal obstetrical interventions, it is a starting point for pediatric interventions. If neonatal adiposity is nearly entirely explained by shared genetics … Address correspondence to Megan H. Pesch, MD, MS, University of Michigan, 300 N Ingalls St, 1111 SE, Ann Arbor, MI 48109-5456. E-mail: pesch{at}umich.edu