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Kacperska M, Mizera J, Pilecki M, Pomierny-Chamioło L. The impact of excessive maternal weight on the risk of neuropsychiatric disorders in offspring-a narrative review of clinical studies. Pharmacol Rep 2024; 76:452-462. [PMID: 38649593 PMCID: PMC11126479 DOI: 10.1007/s43440-024-00598-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
The global prevalence of overweight and obesity is a significant public health concern that also largely affects women of childbearing age. Human epidemiological studies indicate that prenatal exposure to excessive maternal weight or excessive gestational weight gain is linked to various neurodevelopmental disorders in children, including attention deficit hyperactivity disorder, autism spectrum disorder, internalizing and externalizing problems, schizophrenia, and cognitive/intellectual impairment. Considering that inadequate maternal body mass can induce serious disorders in offspring, it is important to increase efforts to prevent such outcomes. In this paper, we review human studies linking excessive maternal weight and the occurrence of mental disorders in children.
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Affiliation(s)
- Magdalena Kacperska
- Department of Toxicology, Jagiellonian University Medical College, Medyczna 9, 30-688, Kraków, Poland
| | - Józef Mizera
- Department of Toxicology, Jagiellonian University Medical College, Medyczna 9, 30-688, Kraków, Poland
| | - Maciej Pilecki
- Department of Psychiatry, Jagiellonian University Medical College, Kopernika 21a, 31-500, Kraków, Poland
| | - Lucyna Pomierny-Chamioło
- Department of Toxicology, Jagiellonian University Medical College, Medyczna 9, 30-688, Kraków, Poland.
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Terada S, Isumi A, Doi S, Fujiwara T. Association of maternal pre-pregnancy body mass index with resilience and prosociality of the offspring aged 6-7 years old: a population-based cohort study in Japan. Eur Child Adolesc Psychiatry 2024; 33:861-869. [PMID: 37087710 DOI: 10.1007/s00787-023-02209-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/04/2023] [Indexed: 04/24/2023]
Abstract
The association between maternal pre-pregnancy obesity and child behavior problems has been widely researched, leaving a gap in understanding the positive aspects of children's mental health. The present study aimed to investigate the association between maternal pre-pregnancy body mass index (BMI) and resilience and prosociality among 6-7 year-old children in Japan. A retrospective cohort study was conducted using data from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study, a population-based study in 2017 and 2019 including all first-grade students in public schools in Adachi, Tokyo, Japan (n = 7328, response rate = 84.7%). Resilience and prosociality were measured by the Children's Resilient Coping Scale and the Strength and Difficulties Questionnaire, respectively. Maternal pre-pregnancy weight and height were reported based on the Mother and Child Health Handbook, and BMI was categorized as underweight (BMI < 18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9), and obesity (BMI ≥ 30). Linear regression models were employed to control for covariates. Maternal pre-pregnancy obesity was found to be negatively associated with child resilience (coefficient: - 3.29; 95% CI - 6.42--0.15), while maternal underweight was negatively associated with child prosociality (coefficient: - 0.12; 95% CI - 0.24--0.005) compared to mothers of pre-pregnancy normal BMI. Perinatal factors, such as gestational weight gain, gestational age, and birth weight, did not mediate the association. Our findings suggest that maternal pre-pregnancy obesity is linked to decreased resilience and maternal underweight is linked to decreased prosociality in children aged 6-7 years. Maintaining an appropriate BMI range before pregnancy may be crucial for enhancing resilience and prosociality of offspring.
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Affiliation(s)
- Shuhei Terada
- Department of Global Health Promotion, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Aya Isumi
- Department of Health Policy, Tokyo Medical and Dental University, Tokyo, Japan
| | - Satomi Doi
- Department of Health Policy, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan.
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Zhang S, Lin T, Zhang Y, Liu X, Huang H. Effects of parental overweight and obesity on offspring's mental health: A meta-analysis of observational studies. PLoS One 2022; 17:e0276469. [PMID: 36548252 PMCID: PMC9778529 DOI: 10.1371/journal.pone.0276469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Children of parents who were overweight/obese prior to pregnancy face a variety of neurodevelopmental challenges. The goal of this meta-analysis is to compile evidence about the impact of parental overweight/obesity on their children's mental health. METHODS The databases Cochrane Library, EMBASE, Pubmed, PsycINFO, and Web of Science were searched until May 2022. The pooled effect size was calculated using the fixed and random effect models. We also performed I2 index, subgroup analyses, sensitivity analyses, quality assessment, and publication bias analysis. The protocol was registered on the PROSPERO database (CRD42022334408). RESULTS For maternal exposure (35 studies), both maternal overweight [OR 1.14 (95% CI 1.10,1.18)] and maternal obesity [OR 1.39 (95% CI (1.33, 1.45)] were significantly associated with offspring's mental disorders. Maternal pre-pregnancy overweight/obesity increased the risk of attention-deficit/hyperactivity disorder (ADHD) [OR 1.55 (95% CI 1.42,1.70)], autism spectrum disorder (ASD) [OR 1.37 (95% CI 1.22,1.55)], cognitive/intellectual delay [OR 1.40 (95% CI 1.21,1.63)], behavioral problems [OR 1.50 (95% CI 1.35,1.66)] and other mental diseases [OR 1.30 (95% CI 1.23,1.37)]. For paternal exposure (6 studies), paternal obesity [OR 1.17 (95% CI 1.06, 1.30)] but not overweight [OR 1.03 (95% CI 0.95,1.11)] was significantly associated with offspring's mental disorders. CONCLUSIONS Parental overweight/obesity might have negative consequences on offspring's mental health and pre-pregnancy weight control is advised.
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Affiliation(s)
- Shuyu Zhang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Tingting Lin
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Yu Zhang
- School of Nursing, Hangzhou Medical College, Hangzhou, China
| | - Xinmei Liu
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Hefeng Huang
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
- Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences (No. 2019RU056), Shanghai, China
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- * E-mail:
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Pulli EP, Silver E, Kumpulainen V, Copeland A, Merisaari H, Saunavaara J, Parkkola R, Lähdesmäki T, Saukko E, Nolvi S, Kataja EL, Korja R, Karlsson L, Karlsson H, Tuulari JJ. Feasibility of FreeSurfer Processing for T1-Weighted Brain Images of 5-Year-Olds: Semiautomated Protocol of FinnBrain Neuroimaging Lab. Front Neurosci 2022; 16:874062. [PMID: 35585923 PMCID: PMC9108497 DOI: 10.3389/fnins.2022.874062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/12/2022] [Indexed: 02/03/2023] Open
Abstract
Pediatric neuroimaging is a quickly developing field that still faces important methodological challenges. Pediatric images usually have more motion artifact than adult images. The artifact can cause visible errors in brain segmentation, and one way to address it is to manually edit the segmented images. Variability in editing and quality control protocols may complicate comparisons between studies. In this article, we describe in detail the semiautomated segmentation and quality control protocol of structural brain images that was used in FinnBrain Birth Cohort Study and relies on the well-established FreeSurfer v6.0 and ENIGMA (Enhancing Neuro Imaging Genetics through Meta Analysis) consortium tools. The participants were typically developing 5-year-olds [n = 134, 5.34 (SD 0.06) years, 62 girls]. Following a dichotomous quality rating scale for inclusion and exclusion of images, we explored the quality on a region of interest level to exclude all regions with major segmentation errors. The effects of manual edits on cortical thickness values were relatively minor: less than 2% in all regions. Supplementary Material cover registration and additional edit options in FreeSurfer and comparison to the computational anatomy toolbox (CAT12). Overall, we conclude that despite minor imperfections FreeSurfer can be reliably used to segment cortical metrics from T1-weighted images of 5-year-old children with appropriate quality assessment in place. However, custom templates may be needed to optimize the results for the subcortical areas. Through visual assessment on a level of individual regions of interest, our semiautomated segmentation protocol is hopefully helpful for investigators working with similar data sets, and for ensuring high quality pediatric neuroimaging data.
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Affiliation(s)
- Elmo P. Pulli
- Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
- *Correspondence: Elmo P. Pulli, ; orcid.org/0000-0003-3871-8563
| | - Eero Silver
- Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
| | - Venla Kumpulainen
- Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
| | - Anni Copeland
- Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Harri Merisaari
- Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Radiology, University of Turku, Turku, Finland
| | - Jani Saunavaara
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Riitta Parkkola
- Department of Radiology, University of Turku, Turku, Finland
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Tuire Lähdesmäki
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Ekaterina Saukko
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Saara Nolvi
- Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Turku Institute for Advanced Studies, University of Turku, Turku, Finland
- Department of Psychology, University of Turku, Turku, Finland
| | - Eeva-Leena Kataja
- Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Riikka Korja
- Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychology, University of Turku, Turku, Finland
| | - Linnea Karlsson
- Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
- Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland
| | - Hasse Karlsson
- Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
- Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland
| | - Jetro J. Tuulari
- Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
- Turku Collegium for Science, Medicine and Technology, University of Turku, Turku, Finland
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Wang G, Schwartz GL, Kim MH, White JS, Glymour MM, Reardon S, Kershaw KN, Gomez SL, Inamdar PP, Hamad R. School Racial Segregation and the Health of Black Children. Pediatrics 2022; 149:186781. [PMID: 35434734 PMCID: PMC9173588 DOI: 10.1542/peds.2021-055952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Few researchers have evaluated whether school racial segregation, a key manifestation of structural racism, affects child health, despite its potential impacts on school quality, social networks, and stress from discrimination. We investigated whether school racial segregation affects Black children's health and health behaviors. METHODS We estimated the association of school segregation with child health, leveraging a natural experiment in which school districts in recent years experienced increased school segregation. School segregation was operationalized as the Black-White dissimilarity index. We used ordinary least squares models as well as quasi-experimental instrumental variables analysis, which can reduce bias from unobserved confounders. Data from the Child Development Supplement of the Panel Study of Income Dynamics (1997-2014, n = 1248 Black children) were linked with district-level school segregation measures. Multivariable regressions were adjusted for individual-, neighborhood-, and district-level covariates. We also performed subgroup analyses by child sex and age. RESULTS In instrumental variables models, a one standard deviation increase in school segregation was associated with increased behavioral problems (2.53 points on a 27-point scale; 95% CI, 0.26 to 4.80), probability of having ever drunk alcohol (0.23; 95% CI, 0.049 to 0.42), and drinking at least monthly (0.20; 95% CI, 0.053 to 0.35). School segregation was more strongly associated with drinking behaviors among girls. CONCLUSIONS School segregation was associated with worse outcomes on several measures of well-being among Black children, which may contribute to health inequities across the life span. These results highlight the need to promote school racial integration and support Black youth attending segregated schools.
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Affiliation(s)
- Guangyi Wang
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
| | - Gabriel L Schwartz
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
| | - Min Hee Kim
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
| | - Justin S White
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Sean Reardon
- Graduate School of Education, Stanford University, Palo Alto, California
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Pushkar P Inamdar
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California,Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
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Mitchell AJ, Dunn GA, Sullivan EL. The Influence of Maternal Metabolic State and Nutrition on Offspring Neurobehavioral Development: A Focus on Preclinical Models. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:450-460. [PMID: 34915175 PMCID: PMC9086110 DOI: 10.1016/j.bpsc.2021.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/19/2021] [Accepted: 11/29/2021] [Indexed: 12/22/2022]
Abstract
The prevalence of both obesity and neurodevelopmental disorders has increased substantially over the last several decades. Early environmental factors, including maternal nutrition and metabolic state during gestation, influence offspring neurodevelopment. Both human and preclinical models demonstrate a link between poor maternal nutrition, altered metabolic state, and risk of behavioral abnormalities in offspring. This review aims to highlight evidence from the current literature connecting maternal nutrition and the associated metabolic changes with neural and behavioral outcomes in the offspring, as well as identify possible mechanisms underlying these neurodevelopmental outcomes. Owing to the highly correlated nature of poor nutrition and obesity in humans, preclinical animal models are important in distinguishing the unique effects of maternal nutrition and metabolic state on offspring brain development. We use a translational lens to highlight results from preclinical animal models of maternal obesogenic diet related to alterations in behavioral and neurodevelopmental outcomes in offspring. Specifically, we aim to highlight results that resemble behavioral phenotypes described in the diagnostic criteria of neurodevelopmental conditions in humans. Finally, we examine the proinflammatory nature of maternal obesity and consumption of a high-fat diet as a mechanism for neurodevelopmental alterations that may alter offspring behavior later in life. It is important that future studies examine potential therapeutic interventions and prevention strategies to interrupt the transgenerational transmission of the disease. Given the tremendous risk to the next generation, changes need to be made to ensure that all pregnant people have access to nutritious food and are informed about the optimal diet for their developing child.
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Affiliation(s)
- A J Mitchell
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon; Department of Neuroscience, Oregon National Primate Research Center, Beaverton, Oregon
| | - Geoffrey A Dunn
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Elinor L Sullivan
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon; Department of Psychiatry, Oregon Health & Science University, Portland, Oregon; Department of Neuroscience, Oregon National Primate Research Center, Beaverton, Oregon; Department of Human Physiology, University of Oregon, Eugene, Oregon.
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Abstract
Importance The pandemic of obesity during pregnancy now afflicts 1 out of every 2 pregnant women in the United States. Even though unintended pregnancy has decreased to 45% of all pregnancies, 50% of those unintended pregnancies occur in obese women. Objective This study aims to identify why current lifestyle interventions for obese pregnancy are not effective and what the newer complications are for obesity during pregnancy. Evidence Acquisition Available literatures on current treatments for maternal obesity were reviewed for effectiveness. Emerging maternal and infant complications from obesity during pregnancy were examined for significance. Results Limitations in successful interventions fell into 3 basic categories to include the following: (1) preconception weight loss; (2) bariatric surgery before pregnancy; and (3) prevention of excessive gestational weight gain during pregnancy. Emerging significant physiological changes from maternal obesity is composed of inflammation (placenta and human milk), metabolism (hormones, microbiome, fatty acids), and offspring outcomes (body composition, congenital malformations, chronic kidney disease, asthma, neurodevelopment, and behavior). Conclusions and Relevance Are current prepregnancy lifestyle and behavioral interventions feasible to prevent maternal obesity complications? Epigenetic and metabolomic research will be critical to determine what is needed to blunt the effects of maternal obesity and to discover successful treatment.
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Tien J, Lewis GD, Liu J. Prenatal risk factors for internalizing and externalizing problems in childhood. World J Pediatr 2020; 16:341-355. [PMID: 31617077 PMCID: PMC7923386 DOI: 10.1007/s12519-019-00319-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND A growing body of research has documented the effects of prenatal risk factors on a wide spectrum of adverse offspring health outcomes. Childhood behavior problems, such as externalizing and internalizing problems, are no exception. This comprehensive literature review aims to summarize and synthesize current research about commonly experienced prenatal risk factors associated with internalizing and externalizing problems, with a focus on their impact during childhood and adolescence. Potential mechanisms as well as implications are also outlined. DATA SOURCES The EBSCO, Web of Science, PubMed, Google Scholar, and Scopus databases were searched for studies examining the association between prenatal risk factors and offspring internalizing/externalizing problems, using keywords "prenatal" or "perinatal" or "birth complications" in combination with "internalizing" or "externalizing". Relevant articles, including experimental research, systematic reviews, meta-analyses, cross-sectional and longitudinal cohort studies, and theoretical literature, were reviewed and synthesized to form the basis of this integrative review. RESULTS Prenatal risk factors that have been widely investigated with regards to offspring internalizing and externalizing problems encompass health-related risk factors, including maternal overweight/obesity, substance use/abuse, environmental toxicant exposure, maternal infection/inflammation, as well as psychosocial risk factors, including intimate partner violence, and anxiety/depression. Collectively, both epidemiological and experimental studies support the adverse associations between these prenatal factors and increased risk of emotional/behavioral problem development during childhood and beyond. Potential mechanisms of action underlying these associations include hormonal and immune system alterations. Implications include prenatal education, screening, and intervention strategies. CONCLUSIONS Prenatal risk factors are associated with a constellation of offspring internalizing and externalizing problems. Identifying these risk factors and understanding potential mechanisms will help to develop effective, evidence-based prevention, and intervention strategies.
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Affiliation(s)
- Joyce Tien
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Gary D Lewis
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jianghong Liu
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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Shook LL, Kislal S, Edlow AG. Fetal brain and placental programming in maternal obesity: A review of human and animal model studies. Prenat Diagn 2020; 40:1126-1137. [PMID: 32362000 DOI: 10.1002/pd.5724] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 03/26/2020] [Accepted: 04/21/2020] [Indexed: 12/13/2022]
Abstract
Both human epidemiologic and animal model studies demonstrate that prenatal and lactational exposure to maternal obesity and high-fat diet are associated with adverse neurodevelopmental outcomes in offspring. Neurodevelopmental outcomes described in offspring of obese women include cognitive impairment, autism spectrum disorder (ASD), attention deficit hyperactivity disorder, anxiety and depression, disordered eating, and propensity for reward-driven behavior, among others. This review synthesizes human and animal data linking maternal obesity and high-fat diet consumption to abnormal fetal brain development, and neurodevelopmental and psychiatric morbidity in offspring. It highlights key mechanisms by which maternal obesity and maternal diet impact fetal and offspring development, and sex differences in offspring programming. In addition, we review placental effects of maternal obesity, and the role the placenta might play as an indicator vs mediator of fetal programming.
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Affiliation(s)
- Lydia L Shook
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sezen Kislal
- Massachusetts General Hospital Research Institute, Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrea G Edlow
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Massachusetts General Hospital Research Institute, Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
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10
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Robinson SL, Ghassabian A, Sundaram R, Trinh MH, Lin TC, Bell EM, Yeung E. Parental Weight Status and Offspring Behavioral Problems and Psychiatric Symptoms. J Pediatr 2020; 220:227-236.e1. [PMID: 32067780 PMCID: PMC7186145 DOI: 10.1016/j.jpeds.2020.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/10/2019] [Accepted: 01/09/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess relations of prepregnancy maternal and paternal obesity with offspring behavioral problems and psychiatric symptoms at 7-8 years in the Upstate KIDS study, a prospective cohort study. STUDY DESIGN Maternal body mass index (BMI) was calculated from prepregnancy height and weight provided in vital records or self-report at 4 months postpartum. Mothers reported paternal height and weight. At 7-8 years, mothers indicated if their children had been diagnosed with ADHD or anxiety (n = 1915). Additionally, children's behavior was measured with the Strengths and Difficulties Questionnaire at 7 years of age (n = 1386) and the Vanderbilt ADHD Diagnostic Parent Rating Scale at 8 years of age (n = 1484). Based on Strengths and Difficulties Questionnaire scores, we identified children with borderline behavioral problems. Adjusted risk ratios (aRR) and 95% CIs were estimated with robust multivariable Poisson regression. RESULTS Compared with children of mothers with a BMI of <25, children whose mothers had BMI 25-30, 30-35, and ≥35 kg/m2 had higher risks of reported ADHD (aRR, 1.14, 95% CI, 0.78-1.69; aRR, 1.96, 95% CI, 1.29-2.98; and aRR, 1.82, 95% CI,1.21-2.74, respectively). Risks of hyperactivity problems identified by the Strengths and Difficulties Questionnaire and a positive screen for inattentive or hyperactive/impulsive behavior with the Vanderbilt ADHD Diagnostic Parent Rating Scale were also higher with increasing maternal prepregnancy BMI. Paternal BMI was not associated with child outcomes. CONCLUSIONS Our findings suggest that maternal, rather than paternal, obesity is associated with maternal report of child ADHD diagnosis and inattentive or hyperactivity problems. Further research is needed to understand how maternal obesity might influence these behavioral changes during or after pregnancy.
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Affiliation(s)
- Sonia L Robinson
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Akhgar Ghassabian
- Departments of Pediatrics, Environmental Medicine, and Population Health, New York University School of Medicine, New York, NY
| | - Rajeshwari Sundaram
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Mai-Han Trinh
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | | | - Erin M Bell
- Departments of Environmental Health Sciences, and Epidemiology and Biostatistics, University at Albany School of Public Health, Albany, NY
| | - Edwina Yeung
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
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11
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Bellver J, Mariani G. Impact of parental over- and underweight on the health of offspring. Fertil Steril 2019; 111:1054-1064. [PMID: 31036339 DOI: 10.1016/j.fertnstert.2019.02.128] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 12/15/2022]
Abstract
Parental excess weight and especially pregestational maternal obesity and excessive weight gain during pregnancy have been related to an increased risk of metabolic (obesity, type 2 diabetes, cardiovascular disease, metabolic syndrome) and nonmetabolic (cancer, osteoporosis, asthma, neurologic alterations) diseases in the offspring, probably mediated by epigenetic mechanisms of fetal programming. Maternal underweight is less common in developed societies, but the discrepancy between a poor nutritional environment in utero and a normal or excessive postnatal food supply with rapid growth catch-up appears to be the main candidate mechanism of the development of chronic diseases during the offspring's adulthood. The role of the postnatal environment in both scenarios (parental overweight or underweight) also seems to influence the offspring's health. Lifestyle interventions before and during pregnancy in both parents, but especially in the mother, as well as in children after birth, are advisable to counteract the many undesirable chronic conditions described.
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Affiliation(s)
- José Bellver
- Instituto Valenciano de Infertilidad, School of Medicine, University of Valencia, Valencia, Spain; Department of Pediatrics, Obstetrics and Gynecology, School of Medicine, University of Valencia, Valencia, Spain.
| | - Giulia Mariani
- Instituto Valenciano de Infertilidad, School of Medicine, University of Valencia, Valencia, Spain
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The association between pre-pregnancy overweight/obesity and offspring's behavioral problems and executive functioning. Early Hum Dev 2018; 122:32-41. [PMID: 29864728 DOI: 10.1016/j.earlhumdev.2018.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/15/2018] [Accepted: 05/19/2018] [Indexed: 11/24/2022]
Abstract
The prevalence of obesity among women of childbearing age has been rising dramatically over the last decades. Pre-pregnancy obesity may have negative neurodevelopmental consequences for the offspring. The present study examined the association of maternal pre-pregnancy overweight and obesity with child behavior problems and executive functioning at age 5 years. Data of 4094 mother-child pairs of the Amsterdam Born Children and their Development birth cohort study was used. Child behavioral problems were assessed with the maternal and teacher version of the Strengths and Difficulties Questionnaire. Two executive functioning constructs, inhibitory control and cognitive flexibility, were measured with the Response Organization Objects task of the Amsterdam Neuropsychological Tasks test battery. Increased maternal pre-pregnancy BMI was associated with an increase in children's behavioral problems (OR total behavioral problems reported by mothers pre-pregnancy obesity versus normal weight: 1.78 [95% CI 1.17 to 2.69] and reported by teachers for pre-pregnancy overweight versus normal weight: 1.32 [1.00 to 1.74]). Maternal pre-pregnancy obesity was associated with an increase in peer relationship problems reported by teachers (OR: 1.77 [1.18 to 2.64]). It was also associated with a small decrease in cognitive flexibility (increased Reaction Time in ms: B = 67.59 [5.88 to 129.30] and Within Subject Standard Deviation in ms: B = 76.46 [32.00 to 120.92]), but not with inhibitory control. Cognitive flexibility did not mediate the association between maternal pre-pregnancy BMI and children's behavioral problems.
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Sanchez CE, Barry C, Sabhlok A, Russell K, Majors A, Kollins SH, Fuemmeler BF. Maternal pre-pregnancy obesity and child neurodevelopmental outcomes: a meta-analysis. Obes Rev 2018; 19:464-484. [PMID: 29164765 PMCID: PMC6059608 DOI: 10.1111/obr.12643] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/18/2017] [Accepted: 10/12/2017] [Indexed: 12/29/2022]
Abstract
This review examined evidence of the association between maternal pre-pregnancy overweight/obesity status and child neurodevelopmental outcomes. PubMed and PsycINFO databases were systematically searched for empirical studies published before April 2017 using keywords related to prenatal obesity and children's neurodevelopment. Of 1483 identified papers, 41 were included in the systematic review, and 32 articles representing 36 cohorts were included in the meta-analysis. Findings indicated that compared with children of normal weight mothers, children whose mothers were overweight or obese prior to pregnancy were at increased risk for compromised neurodevelopmental outcomes (overweight: OR = 1.17, 95% CI [1.11, 1.24], I2 = 65.51; obese: OR = 1.51; 95% CI [1.35, 1.69], I2 = 79.63). Pre-pregnancy obesity increased the risk of attention deficit-hyperactivity disorder (OR = 1.62; 95% CI [1.23, 2.14], I2 = 70.15), autism spectrum disorder (OR = 1.36; 95% CI [1.08, 1.70], I2 = 60.52), developmental delay (OR = 1.58; 95% CI [1.39, 1.79], I2 = 75.77) and emotional/behavioural problems (OR = 1.42; 95% CI [1.26, 1.59], I2 = 87.74). Given the current obesity prevalence among young adults and women of childbearing age, this association between maternal obesity during pregnancy and atypical child neurodevelopment represents a potentially high public health burden.
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Affiliation(s)
- C E Sanchez
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - C Barry
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - A Sabhlok
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - K Russell
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - A Majors
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - S H Kollins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - B F Fuemmeler
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
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Deardorff J, Smith LH, Petito L, Kim H, Abrams BF. Maternal Prepregnancy Weight and Children's Behavioral and Emotional Outcomes. Am J Prev Med 2017; 53:432-440. [PMID: 28712831 PMCID: PMC5610087 DOI: 10.1016/j.amepre.2017.05.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 04/13/2017] [Accepted: 05/11/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION This study investigated associations between maternal prepregnancy BMI and child behaviors at ages 9-11 years and examine interaction by race and gender. METHODS The National Longitudinal Survey of Youth and the Children and Young Adults surveys are U.S.-based, ongoing longitudinal studies, initiated in 1979 and 1986, respectively. Mothers (n=2,952) reported pregnancy and child (n=5,660) developmental information at multiple time points. Child total, internalizing, and externalizing problems at ages 9-11 years were assessed using the Behavior Problems Index (BPI), collected biennially until 2012. Associations between prepregnancy BMI and child BPI outcomes were examined, as well as two- and three-way interactions by race and gender. Analyses were conducted in 2017. RESULTS Boys whose mothers had higher prepregnancy weights exhibited higher total BPI and externalizing scores at ages 9-11 years versus those with normal-weight mothers. Boys with severely obese mothers had higher total BPI (mean difference=7.99, 95% CI=3.53, 12.46) and externalizing (mean difference=5.77, 95% CI=1.50, 10.04) scores. Prepregnancy underweight was associated with boys' higher total BPI (mean difference=2.34, 95% CI=0.02, 4.66) and externalizing (mean difference=3.30, 95% CI=0.69, 5.91); these associations were not significant in sensitivity analyses. No associations emerged for girls or internalizing problems. Two-way interactions by race and three-way interactions by race and gender were not significant. CONCLUSIONS Maternal prepregnancy weight was associated with BPI level among boys. Boys with severely obese mothers exhibited markedly higher behavioral problems at ages 9-11 years versus those with normal-weight mothers, regardless of race. Maintaining healthy prepregnancy weight may be important for preventing boys' deleterious behavior outcomes in middle childhood.
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Affiliation(s)
- Julianna Deardorff
- Community Health Sciences Division, School of Public Health, University of California, Berkeley, Berkeley, California.
| | - Louisa H Smith
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Lucia Petito
- Division of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Hyunju Kim
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Barbara F Abrams
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
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A Review of the Impact of Maternal Obesity on the Cognitive Function and Mental Health of the Offspring. Int J Mol Sci 2017; 18:ijms18051093. [PMID: 28534818 PMCID: PMC5455002 DOI: 10.3390/ijms18051093] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/03/2017] [Accepted: 05/16/2017] [Indexed: 12/15/2022] Open
Abstract
Globally, more than 20% of women of reproductive age are currently estimated to be obese. Children born to obese mothers are at higher risk of developing obesity, coronary heart disease, diabetes, stroke, and asthma in adulthood. Increasing clinical and experimental evidence suggests that maternal obesity also affects the health and function of the offspring brain across the lifespan. This review summarizes the current findings from human and animal studies that detail the impact of maternal obesity on aspects of learning, memory, motivation, affective disorders, attention-deficit hyperactivity disorder, autism spectrum disorders, and neurodegeneration in the offspring. Epigenetic mechanisms that may contribute to this mother–child interaction are also discussed.
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Edlow AG. Maternal obesity and neurodevelopmental and psychiatric disorders in offspring. Prenat Diagn 2016; 37:95-110. [PMID: 27684946 DOI: 10.1002/pd.4932] [Citation(s) in RCA: 186] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/21/2016] [Accepted: 09/22/2016] [Indexed: 12/19/2022]
Abstract
There is a growing body of evidence from both human epidemiologic and animal studies that prenatal and lactational exposure to maternal obesity and high-fat diet are associated with neurodevelopmental and psychiatric disorders in offspring. These disorders include cognitive impairment, autism spectrum disorders, attention deficit hyperactivity disorder, cerebral palsy, anxiety and depression, schizophrenia, and eating disorders. This review synthesizes human and animal data linking maternal obesity and high-fat diet consumption to abnormal fetal brain development and neurodevelopmental and psychiatric morbidity in offspring. In addition, it highlights key mechanisms by which maternal obesity and maternal diet might impact fetal and offspring neurodevelopment, including neuroinflammation; increased oxidative stress, dysregulated insulin, glucose, and leptin signaling; dysregulated serotonergic and dopaminergic signaling; and perturbations in synaptic plasticity. Finally, the review summarizes available evidence regarding investigational therapeutic approaches to mitigate the harmful effects of maternal obesity on fetal and offspring neurodevelopment. © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Andrea G Edlow
- Division of Maternal-Fetal Medicine, Department of Ob/Gyn, Tufts Medical Center, Boston, MA, USA.,Mother Infant Research Institute, Tufts Medical Center, Boston, MA, USA
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Gillespie SL, Christian LM. Body Mass Index as a Measure of Obesity: Racial Differences in Predictive Value for Health Parameters During Pregnancy. J Womens Health (Larchmt) 2016; 25:1210-1218. [PMID: 27487272 DOI: 10.1089/jwh.2016.5761] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND As a measure of obesity, body mass index (BMI; kg/m2) is an imperfect predictor of health outcomes, particularly among African Americans. However, BMI is used to guide prenatal care. We examined racial differences in the predictive value of maternal BMI for physiologic correlates of obesity, serum interleukin (IL)-6 and C-reactive protein (CRP), as well as cesarean section and infant birth weight. METHODS One hundred five pregnant women (40 European American, 65 African American) were assessed during the second trimester. BMI was defined as per prepregnancy weight. Electrochemiluminescence and enzyme-linked immunosorbent assays were used to quantify IL-6 and CRP, respectively. Birth outcomes were determined by medical record review. RESULTS Women of both races classified as obese had higher serum IL-6 and CRP than their normal-weight counterparts (ps ≤ 0.01). However, among women with overweight, elevations in IL-6 (p < 0.01) and CRP (p = 0.06) were observed among European Americans, but not African Americans (ps ≥ 0.61). Maternal obesity was a significantly better predictor of cesarean section among European Americans versus African Americans (p = 0.03) and BMI was associated with infant birth weight among European Americans (p < 0.01), but not African Americans (p = 0.94). Effects remained after controlling for gestational age at delivery, gestational diabetes, and gestational weight gain as appropriate. CONCLUSIONS BMI may be a less valid predictor of correlates of overweight/obesity among African Americans versus European Americans during pregnancy. This should be considered in epidemiological studies of maternal-child health. In addition, studies examining the comparative validity of alternative/complementary measures to define obesity in pregnancy are warranted to inform clinical care.
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Affiliation(s)
| | - Lisa M Christian
- 2 Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center , Columbus, Ohio.,3 Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center , Columbus, Ohio.,4 The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center , Columbus, Ohio.,5 Department of Psychology, The Ohio State University , Columbus, Ohio
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