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Gehring ND, Birken CS, Belanger S, Bridger T, Chanoine JP, Gibson WT, Hadjiyannakis S, Haines J, Hamilton J, Haqq AM, Henderson M, Ho J, Irvine B, Legault L, Luca P, Maguire J, McPherson AC, Morrison K, Wahi G, Weksberg R, Zwaigenbaum L, Ball GDC. Severe obesity and global developmental delay in preschool children: Findings from a Canadian Paediatric Surveillance Program study. Paediatr Child Health 2023; 28:107-112. [PMID: 37151929 PMCID: PMC10156927 DOI: 10.1093/pch/pxac109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/12/2022] [Indexed: 11/15/2022] Open
Abstract
Background The co-presentation of severe obesity (SO) and global developmental delay (GDD) in Canadian preschool children has not been examined. However, SO and GDD may require syndromic diagnoses and unique management considerations. Objectives To determine (1) minimum incidence; (2) age of onset and risk factors; and (3) health care utilization for co-presenting SO and GDD. Methods Through the Canadian Paediatric Surveillance Program (CPSP), a monthly form was distributed to participants from February 2018 to January 2020 asking for reports of new cases of SO and GDD among children ≤5 years of age. We performed descriptive statistics for quantitative questions and qualitative content analysis for open-ended questions. Results Forty-seven cases (64% male; 51% white; mean age: 3.5 ± 1.2 years) were included. Age of first weight concern was 2.5 ± 1.3 years and age of GDD diagnosis was 2.7 ± 1.4 years. Minimum incidence of SO and GDD was 3.3 cases per 100,000 for ≤5 years of age per year. Identified problems included school and/or behavioural problems (n = 17; 36%), snoring (n = 14; 30%), and asthma/recurrent wheeze (n = 10; 21%). Mothers of 32% of cases (n = 15) had obesity and 21% of cases (n = 10) received neonatal intensive care. Microarray was ordered for 57% (n = 27) of children. A variety of clinicians and services were accessed. As reported by CPSP participants, challenges faced by families and health service access were barriers to care. Conclusion Children with SO and GDD have multiple comorbidities, and require early identification and referral to appropriate services. These cases may also benefit from additional testing to rule out known genetic obesity syndromes.
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Affiliation(s)
- Nicole D Gehring
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine S Birken
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Stacey Belanger
- Department of Pediatrics, University of Montreal, Montreal, Québec, Canada
| | - Tracey Bridger
- Discipline of Pediatrics, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Jean-Pierre Chanoine
- Division of Endocrinology, University of British Columbia, Vancouver, British Columbia, Canada
| | - William T Gibson
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jess Haines
- Department of Family Relations & Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Jill Hamilton
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Andrea M Haqq
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Mélanie Henderson
- Department of Pediatrics, University of Montreal, Montreal, Québec, Canada
| | - Josephine Ho
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | | | - Laurent Legault
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
| | - Paola Luca
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Jonathon Maguire
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Amy C McPherson
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, Ontario, Canada
- Dalla Lana School of Public Health and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Katherine Morrison
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Gita Wahi
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Rosanna Weksberg
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, Ontario, Canada
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Geoff D C Ball
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Chen S, Fan M, Lee BK, Dalman C, Karlsson H, Gardner RM. Rates of maternal weight gain over the course of pregnancy and offspring risk of neurodevelopmental disorders. BMC Med 2023; 21:108. [PMID: 36959571 PMCID: PMC10035205 DOI: 10.1186/s12916-023-02799-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/20/2023] [Indexed: 03/25/2023] Open
Abstract
Background Previous studies have suggested that gestational weight gain (GWG) outside an optimal range increases the risks of neurodevelopmental disorders (NDDs) in offspring including autism spectrum disorder (ASD), intellectual disability (ID), and attention deficit/hyperactivity disorder (ADHD). The sequential development of the fetal brain suggests that its vulnerability may vary depending on the timing of exposure. Therefore, we aimed to investigate the associations of not only gestational age-standardized total GWG (GWG z-scores) but also the rate of GWG (RGWG) in the second and third trimesters with risks of NDDs in offspring. Methods In this population-based cohort study, we used maternal weight data from antenatal care records collected for 57,822 children born to 53,516 mothers between 2007 and 2010 in the Stockholm Youth Cohort. Children were followed from 2 years of age to December 31, 2016. GWG z-scores and RGWG (kg/week) in the second and third trimesters were considered as continuous variables in cox regression models, clustered on maternal identification numbers. Nonlinear relationships were accommodated using restricted cubic splines with 3 knots. RGWG were also categorized according to the 2009 US Institute of Medicine (IOM) guidelines for optimal GWG. According to the IOM guidelines, the optimal rate of GWG for the second and third trimesters for underweight, normal weight, overweight, and obese categories were 0.44–0.58, 0.35–0.50, 0.23–0.33, and 0.17–0.27 kg/week, respectively. Results During a mean follow-up of 5.4 years (until children were on average 7.4 years old), 2205 (3.8%) children were diagnosed with NDDs, of which 1119 (1.9%) received a diagnosis of ASD, 1353 (2.3%) ADHD, and 270 (0.5%) ID. We observed a J-shaped association between total GWG z-score and offspring risk of NDDs, with higher total GWG (GWG z-score = 2) associated with 19% increased risk of any NDD (95% CI = 3–37%) and lower total GWG (GWG z-score = − 2) associated with 12% increased risk of any NDDs (95% CI = 2–23%), compared to the reference (GWG z-score = 0). In the second trimester, lower RGWG (0.25 kg/week) was associated with a 9% increased risk of any NDD diagnosis (95% CI = 4–15%) compared to the median of 0.57 kg/week, with no apparent relationship between higher RGWG and risk of NDDs. In the third trimester, there was no apparent association between lower RGWG and risk of NDDs, though higher RGWG (1 kg/week) was associated with a 28% increased risk of NDD diagnosis (95% CI = 16–40%), compared to the median (0.51 kg/week). When considering categorized RGWG, we found that slow weight gain in the second trimester followed by rapid weight gain in the third trimester most significantly increased the risk of ADHD (HRadjusted = 1.55, 1.13–2.13) and ID (HRadjusted = 2.53, 1.15–5.55) in offspring. The main limitations of our study are the relatively few years for which detailed GWG data were available and the relatively short follow-up for the outcomes, limiting power to detect associations and misclassifying children who receive an NDD diagnosis later in childhood. Conclusions The relationship between maternal weight gain and children’s risk of NDDs varied according to timing in pregnancy, with the greatest risks associated with slow weight gain in the second trimester and rapid weight gain in the third trimester. Supplementary Information The online version contains supplementary material available at 10.1186/s12916-023-02799-6.
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Affiliation(s)
- Shuyun Chen
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Mengyu Fan
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Brian K. Lee
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- grid.166341.70000 0001 2181 3113Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA USA
- A.J. Drexel Autism Institute, Philadelphia, PA USA
| | - Christina Dalman
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- grid.425979.40000 0001 2326 2191Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Håkan Karlsson
- grid.4714.60000 0004 1937 0626Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Renee M. Gardner
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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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: 4] [Impact Index Per Article: 2.0] [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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Silva CCV, Santos S, Muetzel RL, Vernooij MW, van Rijn BB, Jaddoe VWV, El Marroun H. Maternal Cardiovascular Health in Early Pregnancy and Childhood Brain Structure. J Am Heart Assoc 2022; 11:e026133. [PMID: 36193935 DOI: 10.1161/jaha.122.026133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Poor cardiovascular health during pregnancy has been associated with adverse neurocognitive outcomes in the offspring. We examined the associations of maternal cardiovascular health factors with brain structure in 10-year-old children. Methods and Results We included 2797 mother-offspring pairs from the Generation R Study. Maternal body mass index, gestational weight gain, blood pressure, insulin, glucose, and lipid blood concentrations were obtained in early pregnancy. Childhood structural brain measures, including global metrics of brain tissue volumes and white matter microstructure, were quantified by magnetic resonance imaging at 10 years. As compared with offspring of mothers with normal weight, those of mothers with underweight had smaller total brain volume (difference, -28.99 [95% CI -56.55 to -1.45] cm3). Similarly, as compared with offspring of mothers with gestational weight gain between the 25th and 75th percentile, those of mothers with gestational weight loss or no gestational weight gain (<25th percentile), had smaller total brain volume (difference, -13.07 [95% CI, -23.82 to -2.32] cm3). Also, higher maternal diastolic blood pressure in early pregnancy was associated with lower offspring white matter mean diffusivity (difference, -0.07 [95% CI, -0.11 to -0.02] SD score). After multiple testing correction, only the association of maternal diastolic blood pressure with lower offspring white matter mean diffusivity remained statistically significant. No associations were observed of maternal insulin, glucose, and lipid concentrations with childhood brain outcomes. Conclusions Our findings suggest that maternal cardiovascular health during pregnancy might be related to offspring brain development in the long term. Future studies are needed to replicate our findings and to explore the causal nature of the associations.
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Affiliation(s)
- Carolina C V Silva
- The Generation R Study Group, Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands
- Department of Pediatrics Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam Rotterdam The Netherlands
| | - Susana Santos
- The Generation R Study Group, Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands
- Department of Pediatrics Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam Rotterdam The Netherlands
| | - Ryan L Muetzel
- Department of Child and Adolescent Psychiatry/Psychology Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands
| | - Meike W Vernooij
- Department of Radiology and Nuclear Medicine Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands
| | - Bas B van Rijn
- Departments of Obstetrics and Gynecology Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands
- Department of Pediatrics Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam Rotterdam The Netherlands
| | - Hanan El Marroun
- Department of Pediatrics Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam Rotterdam The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands
- Department of Psychology, Education and Child Studies Erasmus University Rotterdam, Erasmus School of Social and Behavioural Science Rotterdam The Netherlands
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5
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Quinte GC, Munhoz TN, Matijasevich A, Santos IS. Maternal pre-pregnancy body mass index and mental health problems in early adolescents from the 2004 Pelotas birth cohort. Sci Rep 2022; 12:14437. [PMID: 36002596 PMCID: PMC9402554 DOI: 10.1038/s41598-022-18032-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/03/2022] [Indexed: 11/10/2022] Open
Abstract
Possible mechanisms by which maternal pre-pregnancy body mass index (BMI) programs offspring mental disorders in late childhood are not fully clarified. To assess the association between maternal BMI and mental health problems at 11 years old, we used data from the 2004 Pelotas birth cohort which comprised 4231 newborns. Maternal pre-pregnancy BMI was analyzed as underweight (< 18.5), normal (18.5-24.9), overweight (25.0-29.9), and obesity (≥ 30.0). Mental health problems were assessed at the child's age of 11 years by the Strengths and Difficulties Questionnaire, total difficulties score and subscale scores (emotional symptoms, conduct problems, hyperactivity/inattention, and peer relationship problems), dichotomized into normal/borderline and abnormal category. The associations between maternal pre-pregnancy BMI and mental health problems in the whole sample and stratified by sex were estimated using crude and adjusted linear and logistic regression. Both linear and logistic regression showed that pre-pregnancy weight was associated with mental problems in early adolescents. Maternal pre-pregnancy obesity was associated with increased odds of total difficulty score among the whole sample. Boys whose mothers were pre-pregnancy overweight had higher odds of conduct problems (OR = 1.56; 95% CI: 1.13, 1.95), when compared to children of normal pre-pregnancy weight mothers, even after adjustments. Maternal pre-pregnancy obesity was associated with mental health problems in early adolescents; specifically, pre-pregnancy overweight increased the risk for conduct problems in 11 years old boys.
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Affiliation(s)
- Gabriela Callo Quinte
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - 3° Piso, Bairro Centro, Caixa Postal 464, Pelotas, RS, Cep: 96020-220, Brazil.
| | - Tiago N Munhoz
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - 3° Piso, Bairro Centro, Caixa Postal 464, Pelotas, RS, Cep: 96020-220, Brazil.,School of Psychology, Federal University of Pelotas, Pelotas, Brazil
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Ina S Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160 - 3° Piso, Bairro Centro, Caixa Postal 464, Pelotas, RS, Cep: 96020-220, Brazil
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Leonard H, Montgomery A, Wolff B, Strumpher E, Masi A, Woolfenden S, Williams K, Eapen V, Finlay-Jones A, Whitehouse A, Symons M, Licari M, Varcin K, Alvares G, Evans K, Downs J, Glasson E. A systematic review of the biological, social, and environmental determinants of intellectual disability in children and adolescents. Front Psychiatry 2022; 13:926681. [PMID: 36090348 PMCID: PMC9453821 DOI: 10.3389/fpsyt.2022.926681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/27/2022] [Indexed: 11/24/2022] Open
Abstract
AIM This systematic review aimed to identify the most important social, environmental, biological, and/or genetic risk factors for intellectual disability (ID). METHODS Eligible were published prospective or retrospective comparative studies investigating risk factors for ID in children 4-18 years. Exclusions were single group studies with no comparator without ID and a sample size <100. Electronic databases (Medline, Cochrane Library, EMBASE, PsycInfo, Campbell Collaboration, and CINAHL) were searched for eligible publications from 1980 to 2020. Joanna Briggs Institute critical appraisal instruments, appropriate for study type, were used to assess study quality and risk of bias. Descriptive characteristics and individual study results were presented followed by the synthesis for individual risk factors, also assessed using GRADE. RESULTS Fifty-eight individual eligible studies were grouped into six exposure topics: sociodemographic; antenatal and perinatal; maternal physical health; maternal mental health; environmental; genetic or biological studies. There were few eligible genetic studies. For half the topics, the certainty of evidence (GRADE) was moderate or high. CONCLUSION Multiple studies have examined individual potential determinants of ID, but few have investigated holistically to identify those populations most at risk. Our review would indicate that there are vulnerable groups where risk factors we identified, such as low socioeconomic status, minority ethnicity, teenage motherhood, maternal mental illness, and alcohol abuse, may cluster, highlighting a target for preventive strategies. At-risk populations need to be identified and monitored so that interventions can be implemented when appropriate, at preconception, during pregnancy, or after birth. This could reduce the likelihood of ID and provide optimal opportunities for vulnerable infants. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=120032], identifier [CRD42019120032].
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Affiliation(s)
- Helen Leonard
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Alicia Montgomery
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Brittany Wolff
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Elissa Strumpher
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Anne Masi
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Susan Woolfenden
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Katrina Williams
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | - Valsamma Eapen
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Amy Finlay-Jones
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Andrew Whitehouse
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Martyn Symons
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Melissa Licari
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Kandice Varcin
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Gail Alvares
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Kiah Evans
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Jenny Downs
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Emma Glasson
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
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Lee PMY, Tse LA, László KD, Wei D, Yu Y, Li J. Association of maternal body mass index with intellectual disability risk. Arch Dis Child Fetal Neonatal Ed 2021; 106:584-590. [PMID: 33849956 DOI: 10.1136/archdischild-2020-320793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/25/2021] [Accepted: 03/13/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The study aimed to investigate the association between maternal body mass index (BMI) in early pregnancy and children's intellectual disability (ID) risk in the absence of chromosomal disorders, neurofibromatosis and tuberous sclerosis, taking adverse birth outcomes, maternal hypertension/diabetes and maternal socioeconomic status into consideration. METHODS We conducted a cohort study of singletons without common genetic defects born in Sweden during 1992-2006, and followed them from birth until 31 December 2014 (n=1 186 836). Cox proportional hazards models were used to analyse the association between maternal BMI in early pregnancy and the risk of offspring's ID. RESULTS The risk of ID was higher in children born to mothers who were underweight (HR=1.21, 95% CI=1.07 to 1.36), overweight (HR=1.28, 95% CI=1.21 to 1.34) or had obesity class I (HR=1.63, 95% CI=1.53 to 1.74), obesity class II (HR=2.08, 95% CI=1.88 to 2.30) and obesity class III (HR=2.31, 95% CI=1.46 to 3.65) than in children born to normal weight mothers. Results remained consistent after excluding children with adverse birth outcome or born to mothers with gestational hypertension/diabetes. Analysis stratified by maternal education and annual household income showed that the association between maternal underweight and children's ID risk was attenuated among children of mothers with tertiary education or with high income. CONCLUSIONS Our findings suggest that maternal underweight or overweight/obesity in early pregnancy was associated with the development of ID in their offspring. This association was independent of the effect of adverse birth outcomes and maternal hypertension/diabetes. High socioeconomic status may attenuate the risk of ID among children of underweight mothers. This study highlights the importance of improving health education before conception to reduce children's ID risk.
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Affiliation(s)
- Priscilla Ming Yi Lee
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong
| | - Lap Ah Tse
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong
| | - Krisztina D László
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Dang Wei
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - YongFu Yu
- Department of Clinical Medicine-Department of Clinical Epidemiology, Aarhus Universitet, Aarhus, Midtjylland, Denmark
| | - Jiong Li
- Department of Clinical Medicine-Department of Clinical Epidemiology, Aarhus Universitet, Aarhus, Midtjylland, Denmark
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8
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Lee P, Tse LA, László KD, Wei D, Yu Y, Li J. Association of maternal gestational weight gain with intellectual developmental disorder in the offspring: a nationwide follow-up study in Sweden. BJOG 2021; 129:540-549. [PMID: 34455681 DOI: 10.1111/1471-0528.16887] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate the association between maternal gestational weight gain (GWG) and offspring's intellectual developmental disorders (IDD); how this association is modified by maternal early-pregnancy BMI. DESIGN Population-based cohort study. SETTING AND POPULATION All liveborn singletons with information on maternal GWG in the Swedish Medical Register during 1992-2006 (n = 467 485). METHODS We used three GWG classifications, (1) Institute of Medicine (IOM) guidelines ('ideal' GWG: maternal underweight = 12.7-18.1 kg; normal = 11.3-15.9 kg; overweight = 6.8-11.3 kg; obesity = 5.0-9.1 kg), (2) LifeCycle project recommendation ('ideal' GWG: maternal underweight = 14.0-16.0 kg; normal = 10.0-18.0 kg; overweight = 2.0-16.0 kg; obesity class I = 2.0-6.0 kg; obesity class II ≤0.0-4.0 kg; obesity class III ≤0.0-6.0 kg) and (3) GWG centiles. Hazard ratio (HR) and 95% CI for offspring's IDD risk using Cox regression. MAIN OUTCOME MEASURES IDD was extracted from Swedish National Patient Register (code ICD-9:317-319/ICD-10:F70-F79). RESULTS Forty-one per cent of children were born to mothers with excessive GWG, 32.8% with ideal GWG and 26.2% with inadequate GWG according to IOM guidelines. Inadequate GWG was associated with 21% higher risk of offspring's IDD (95% CI 1.11-1.31) relative to ideal GWG. In contrast, when using the LifeCycle classification, children of mothers with inadequate GWG (HR 1.14, 95% CI 1.05-1.24) or excessive GWG (HR 1.09, 95% CI 1.01-1.17) had higher risks of IDD than those of mothers with ideal GWG. When using GWG centiles, extremely low GWG (<20th centile) and low GWG (20th-40th centile) were associated with elevated offspring's IDD risk. Further stratified analysis by maternal early-pregnancy body mass index (BMI) showed that overweight/obese mothers (BMI ≥25 kg/m2 ) with extremely excessive GWG (>25 kg) was associated with an increased offspring's IDD. CONCLUSION Our findings suggest that inadequate maternal GWG may increase offspring's IDD risk, irrespective of maternal early-pregnancy BMI. Extremely excessive GWG (>25 kg) may increase offspring's IDD risk, but only among mothers with an early-pregnancy BMI ≥25 kg/m2 . TWEETABLE ABSTRACT Inadequate maternal weight gain during pregnancy may increase the risk of offspring's intellectual disability, regardless of maternal BMI.
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Affiliation(s)
- Pmy Lee
- JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - L A Tse
- JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - K D László
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - D Wei
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Y Yu
- Department of Clinical Medicine-Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - J Li
- Department of Clinical Medicine-Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
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9
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The impact of maternal obesity on childhood neurodevelopment. J Perinatol 2021; 41:928-939. [PMID: 33249428 DOI: 10.1038/s41372-020-00871-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 10/10/2020] [Accepted: 11/04/2020] [Indexed: 02/08/2023]
Abstract
There is growing clinical and experimental evidence to suggest that maternal obesity increases children's susceptibility to neurodevelopmental and neuropsychiatric disorders. Given the worldwide obesity epidemic, it is crucial that we acquire a thorough understanding of the available evidence, identify gaps in knowledge, and develop an agenda for intervention. This review synthesizes human and animal studies investigating the association between maternal obesity and offspring brain health. It also highlights key mechanisms underlying these effects, including maternal and fetal inflammation, alterations to the microbiome, epigenetic modifications of neurotrophic genes, and impaired dopaminergic and serotonergic signaling. Lastly, this review highlights several proposed interventions and priorities for future investigation.
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10
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Shrestha N, Ezechukwu HC, Holland OJ, Hryciw DH. Developmental programming of peripheral diseases in offspring exposed to maternal obesity during pregnancy. Am J Physiol Regul Integr Comp Physiol 2020; 319:R507-R516. [PMID: 32877239 DOI: 10.1152/ajpregu.00214.2020] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Obesity is an increasing global health epidemic that affects all ages, including women of reproductive age. During pregnancy, maternal obesity is associated with adverse pregnancy outcomes that lead to complications for the mother. In addition, maternal obesity can increase the risk of poor perinatal outcomes for the infant due to altered development. Recent research has investigated the effects of maternal obesity on peripheral organ development and health in later life in offspring. In this review, we have summarized studies that investigated the programming effects of maternal obesity before and during pregnancy on metabolic, cardiovascular, immune, and microbiome perturbations in offspring. Epidemiological studies investigating the effects of maternal obesity on offspring development can be complex due to other copathologies and genetic diversity. Animal studies have provided some insights into the specific mechanisms and pathways involved in programming peripheral disease risk. The effects of maternal obesity during pregnancy on offspring development are often sex specific, with sex-specific changes in placental transport and function suggestive that this organ is likely to play a central role. We believe that this review will assist in facilitating future investigations regarding the underlying mechanisms that link maternal obesity and offspring disease risk in peripheral organs.
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Affiliation(s)
- Nirajan Shrestha
- School of Medical Science, Griffith University, Southport, Queensland, Australia
| | - Henry C Ezechukwu
- Department of Medical Biochemistry, EKO University of Medicine and Health Science, Ijanikin, Nigeria
| | - Olivia J Holland
- School of Medical Science, Griffith University, Southport, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Deanne H Hryciw
- Environmental Futures Research Institute, Griffith University, Nathan, Queensland, Australia.,School of Environment and Science, Griffith University, Nathan, Queensland, Australia.,Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
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11
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Bick D, Taylor C, Bhavnani V, Healey A, Seed P, Roberts S, Zasada M, Avery A, Craig V, Khazaezadah N, McMullen S, O’Connor S, Oki B, Oteng-Ntim E, Poston L, Ussher M. Lifestyle information and access to a commercial weight management group to promote maternal postnatal weight management and positive lifestyle behaviour: the SWAN feasibility RCT. PUBLIC HEALTH RESEARCH 2020. [DOI: 10.3310/phr08090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Increasing numbers of UK women have overweight or obese body mass index scores when they become pregnant, or gain excessive weight in pregnancy, increasing their risk of adverse outcomes. Failure to manage postnatal weight is linked to smoking, non-healthy dietary choices, lack of regular exercise and poorer longer-term health. Women living in areas of higher social deprivation are more likely to experience weight management problems postnatally.
Objectives
The objectives were to assess the feasibility of conducting a definitive randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of lifestyle information and access to a commercial weight management group focusing on self-monitoring, goal-setting and motivation to achieve dietary change commencing 8–16 weeks postnatally to achieve and maintain weight management and positive lifestyle behaviour.
Design
The design was a randomised two-arm feasibility trial with a nested mixed-methods process evaluation.
Setting
The setting was a single centre in an inner city setting in the south of England.
Participants
Participants were women with body mass index scores of > 25 kg/m2 at antenatal ‘booking’ and women with normal body mass index scores (18.0–24.9 kg/m2) at antenatal booking who developed excessive gestational weight gain as assessed at 36 weeks’ gestation.
Main outcome measures
Recruitment, retention, acceptability of trial processes and identification of relevant economic data were the feasibility objectives. The proposed primary outcome was difference between groups in weight at 12 months postnatally, expressed as percentage weight change and weight loss from antenatal booking. Other proposed outcomes included assessment of diet, physical activity, smoking, alcohol consumption, body image, maternal esteem, mental health, infant feeding and NHS costs.
Results
Most objectives were achieved. A total of 193 women were recruited, 98 allocated to the intervention arm and 95 to the control arm. High follow-up rates (> 80%) were achieved to 12 months. There was an 8.8% difference in weight loss at 12 months between women allocated to the intervention arm and women allocated to the control arm (13.0% vs. 4.2%, respectively; p = 0.062); 47% of women in the intervention arm attended at least one weight management session, with low risk of contamination between arms. The greatest benefit was among women who attended ≥ 10 sessions. Barriers to attending sessions included capability, opportunity and motivation issues. Data collection tools were appropriate to support economic evaluation in a definitive trial, and economic modelling is feasible to quantify resource impacts and outcomes not directly measurable within a trial.
Limitations
The trial recruited from only one site. It was not possible to recruit women with normal body mass index scores who developed excessive pregnancy weight gain.
Conclusions
It was feasible to recruit and retain women with overweight or obese body mass index scores at antenatal booking to a trial comparing postnatal weight management plus standard care with standard care only and collect relevant data to assess outcomes. Approaches to recruit women with normal body mass index scores who gain excessive gestational weight need to be considered. Commercial weight management groups could support women’s weight management as assessed at 12 months postnatally, with probable greater benefit from attending ≥ 10 sessions. Process evaluation findings highlighted the importance of providing more information about the intervention on trial allocation, extended duration of time to commence sessions following birth and extended number of sessions offered to enhance uptake and retention. Results support the conduct of a future randomised controlled trial.
Trial registration
Current Controlled Trials ISRCTN39186148.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, UK
| | - Cath Taylor
- School of Health Sciences, University of Surrey, Guildford, UK
| | | | - Andy Healey
- King’s Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Paul Seed
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, UK
| | - Sarah Roberts
- King’s Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Amanda Avery
- Faculty of Science, University of Nottingham, Nottingham, UK
| | | | | | | | | | - Bimpe Oki
- Public Health, London Borough of Lambeth, London, UK
| | | | - Lucilla Poston
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, UK
| | - Michael Ussher
- Population Health Research Institute, St George’s, University of London, London, UK
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
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12
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Bastain TM, Chavez T, Habre R, Girguis MS, Grubbs B, Toledo-Corral C, Amadeus M, Farzan SF, Al-Marayati L, Lerner D, Noya D, Quimby A, Twogood S, Wilson M, Chatzi L, Cousineau M, Berhane K, Eckel SP, Lurmann F, Johnston J, Dunton GF, Gilliland F, Breton C. Study Design, Protocol and Profile of the Maternal And Developmental Risks from Environmental and Social Stressors (MADRES) Pregnancy Cohort: a Prospective Cohort Study in Predominantly Low-Income Hispanic Women in Urban Los Angeles. BMC Pregnancy Childbirth 2019; 19:189. [PMID: 31146718 PMCID: PMC6543670 DOI: 10.1186/s12884-019-2330-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/03/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The burden of childhood and adult obesity disproportionally affects Hispanic and African-American populations in the US, and these groups as well as populations with lower income and education levels are disproportionately affected by environmental pollution. Pregnancy is a critical developmental period where maternal exposures may have significant impacts on infant and childhood growth as well as the future health of the mother. We initiated the "Maternal And Developmental Risks from Environmental and Social Stressors (MADRES)" cohort study to address critical gaps in understanding the increased risk for childhood obesity and maternal obesity outcomes among minority and low-income women in urban Los Angeles. METHODS The MADRES cohort is specifically examining whether pre- and postpartum environmental exposures, in addition to exposures to psychosocial and built environment stressors, lead to excessive gestational weight gain and postpartum weight retention in women and to perturbed infant growth trajectories and increased childhood obesity risk through altered psychological, behavioral and/or metabolic responses. The ongoing MADRES study is a prospective pregnancy cohort of 1000 predominantly lower-income, Hispanic women in Los Angeles, CA. Enrollment in the MADRES cohort is initiated prior to 30 weeks gestation from partner community health clinics in Los Angeles. Cohort participants are followed through their pregnancies, at birth, and during the infant's first year of life through a series of in-person visits with interviewer-administered questionnaires, anthropometric measurements and biospecimen collection as well as telephone interviews conducted with the mother. DISCUSSION In this paper, we outline the study rationale and data collection protocol for the MADRES cohort, and we present a profile of demographic, health and exposure characteristics for 291 participants who have delivered their infants, out of 523 participants enrolled in the study from November 2015 to October 2018 from four community health clinics in Los Angeles. Results from the MADRES cohort could provide a powerful rationale for regulation of targeted chemical environmental components, better transportation and urban design policies, and clinical recommendations for stress-coping strategies and behavior to reduce lifelong obesity risk.
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Affiliation(s)
- Theresa M. Bastain
- Department of Preventive Medicine, USC Keck School of Medicine, University of Southern California, 2001 N. Soto Street, M/C 9237, Los Angeles, CA 90032 USA
| | - Thomas Chavez
- Department of Preventive Medicine, USC Keck School of Medicine, University of Southern California, 2001 N. Soto Street, M/C 9237, Los Angeles, CA 90032 USA
| | - Rima Habre
- Department of Preventive Medicine, USC Keck School of Medicine, University of Southern California, 2001 N. Soto Street, M/C 9237, Los Angeles, CA 90032 USA
| | - Mariam S. Girguis
- Department of Preventive Medicine, USC Keck School of Medicine, University of Southern California, 2001 N. Soto Street, M/C 9237, Los Angeles, CA 90032 USA
| | - Brendan Grubbs
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA USA
| | - Claudia Toledo-Corral
- Department of Preventive Medicine, USC Keck School of Medicine, University of Southern California, 2001 N. Soto Street, M/C 9237, Los Angeles, CA 90032 USA
- Department of Public Health, California State University Northridge, Los Angeles, CA USA
| | - Milena Amadeus
- Department of Preventive Medicine, USC Keck School of Medicine, University of Southern California, 2001 N. Soto Street, M/C 9237, Los Angeles, CA 90032 USA
| | - Shohreh F. Farzan
- Department of Preventive Medicine, USC Keck School of Medicine, University of Southern California, 2001 N. Soto Street, M/C 9237, Los Angeles, CA 90032 USA
| | - Laila Al-Marayati
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA USA
- Eisner Health, Los Angeles, CA USA
| | | | - David Noya
- South Central Family Health Center, Los Angeles, CA USA
| | - Alyssa Quimby
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA USA
| | - Sara Twogood
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA USA
| | - Melissa Wilson
- Department of Preventive Medicine, USC Keck School of Medicine, University of Southern California, 2001 N. Soto Street, M/C 9237, Los Angeles, CA 90032 USA
| | - Leda Chatzi
- Department of Preventive Medicine, USC Keck School of Medicine, University of Southern California, 2001 N. Soto Street, M/C 9237, Los Angeles, CA 90032 USA
| | - Michael Cousineau
- Department of Preventive Medicine, USC Keck School of Medicine, University of Southern California, 2001 N. Soto Street, M/C 9237, Los Angeles, CA 90032 USA
| | - Kiros Berhane
- Department of Preventive Medicine, USC Keck School of Medicine, University of Southern California, 2001 N. Soto Street, M/C 9237, Los Angeles, CA 90032 USA
| | - Sandrah P. Eckel
- Department of Preventive Medicine, USC Keck School of Medicine, University of Southern California, 2001 N. Soto Street, M/C 9237, Los Angeles, CA 90032 USA
| | | | - Jill Johnston
- Department of Preventive Medicine, USC Keck School of Medicine, University of Southern California, 2001 N. Soto Street, M/C 9237, Los Angeles, CA 90032 USA
| | - Genevieve F. Dunton
- Department of Preventive Medicine, USC Keck School of Medicine, University of Southern California, 2001 N. Soto Street, M/C 9237, Los Angeles, CA 90032 USA
- Department of Psychology, University of Southern California, Los Angeles, CA USA
| | - Frank Gilliland
- Department of Preventive Medicine, USC Keck School of Medicine, University of Southern California, 2001 N. Soto Street, M/C 9237, Los Angeles, CA 90032 USA
| | - Carrie Breton
- Department of Preventive Medicine, USC Keck School of Medicine, University of Southern California, 2001 N. Soto Street, M/C 9237, Los Angeles, CA 90032 USA
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13
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Hansen M, Greenop KR, Bourke J, Baynam G, Hart RJ, Leonard H. Intellectual Disability in Children Conceived Using Assisted Reproductive Technology. Pediatrics 2018; 142:peds.2018-1269. [PMID: 30442875 DOI: 10.1542/peds.2018-1269] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine whether children conceived using assisted reproductive technology (ART) have a higher risk of intellectual disability (ID) compared with non-ART-conceived children and describe known causes of ID in these groups. METHODS We linked ID and ART data from population-based registers in Western Australia. Our cohort included live births from 1994 to 2002 (n = 210 627) with at least 8 years of follow-up. The prevalence of ID was compared between ART- and non-ART-conceived children, and risk of ID was estimated using Poisson regression with robust SEs. We also stratified by plurality and gestation at delivery. RESULTS Children conceived using ART had a small increased risk of ID (risk ratio 1.58; 95% confidence interval 1.19-2.11) even when analyses were restricted to singleton births (risk ratio 1.56; 95% confidence interval 1.10-2.21). The risk of ID was more than doubled for those born very preterm, for severe ID, and after intracytoplasmic sperm injection (ICSI) treatments. Children conceived using ICSI had a greater risk of ID than those conceived using in vitro fertilization and were more likely to have a known genetic cause for ID (27.6% vs 12.9% in vitro fertilization and 11.9% non-ART). CONCLUSIONS The risk of ID was increased in children born after ART in Western Australia from 1994 to 2002. More recent cohorts should be examined to assess the impact of important changes in ART clinical practice. Our results are particularly pertinent because multiple embryo transfers are routinely performed in many countries, increasing the risk of preterm birth, and ICSI use rates are high.
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Affiliation(s)
| | | | | | - Gareth Baynam
- Telethon Kids Institute and.,Divisions of Paediatrics and.,Genetic Services of Western Australia and.,Western Australia Register of Developmental Anomalies.,King Edward Memorial Hospital, Perth, Australia; and
| | - Roger J Hart
- King Edward Memorial Hospital, Perth, Australia; and.,Obstetrics and Gynaecology, University of Western Australia, Perth, Australia.,Fertility Specialists of Western Australia, Perth, Australia
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14
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Wanyama R, Obai G, Odongo P, Kagawa MN, Baingana RK. Are women in Uganda gaining adequate gestational weight? A prospective study in low income urban Kampala. Reprod Health 2018; 15:160. [PMID: 30249266 PMCID: PMC6154409 DOI: 10.1186/s12978-018-0608-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/19/2018] [Indexed: 12/21/2022] Open
Abstract
Background Pre-pregnancy weight and weight gained during pregnancy significantly influence maternal and infant health. Little information is available regarding optimal gestational weight gain (GWG) in relation to pre-pregnancy body mass index (BMI) in Uganda. The study aimed at determining gestational weight gain (GWG) in women pregnant for the first and second time. Methods The study was prospective cohort study which included 221 HIV negative women pregnant for the first or second time. It was conducted in the antenatal clinic of the directorate of gynecology and obstetrics, Mulago hospital and women were recruited at ≤18 weeks of gestation by dates. Follow up measurements were done at 26 and 36 weeks gestation. Measured maternal height and reported pre-pregnancy weight were used to calculate BMI. Depending on BMI category, GWG was categorized as inadequate, adequate and excessive based on the Uganda Ministry of Health guidelines. Results The participants’ mean ± standard deviation (Sd) age was 20.9 ± 2.7 years and mean ± Sd BMI was 21.40 ± 2.73 kg/m2. None of the participants was obese and 68.8% (n = 132) were pregnant for the first time. The mean ± Sd GWG at time of delivery was 10.58 ± 2.44 kg. Inadequate GWG was recorded in 62.5% (n = 120/192) while only 3.1% (n = 6/192) of the participants gained excessive weight during pregnancy. Conclusion About 62% of pregnant women in Kampala did not gain adequate weight during their first/second pregnancy. We recommend that studies be carried out to assess whether the Uganda Ministry of Health recommendations for weight gain during are appropriate for preventing adverse pregnancy outcomes across populations in Uganda.
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Affiliation(s)
- Ronald Wanyama
- Lecturer, Biochemistry Department, Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda.
| | - Gerald Obai
- Lecturer, Physiology Department, Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda
| | - Pancras Odongo
- Lecturer, Internal Medicine Department, Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda
| | - Mike N Kagawa
- Lecturer, Obstetrics & Gynecology Department, College of Health Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Rhona K Baingana
- Lecturer, Biochemistry and Sports Science Department, School of Biological Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda
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15
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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: 160] [Impact Index Per Article: 26.7] [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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16
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Mikkelsen SH, Hohwü L, Olsen J, Bech BH, Liew Z, Obel C. Parental Body Mass Index and Behavioral Problems in Their Offspring: A Danish National Birth Cohort Study. Am J Epidemiol 2017; 186:593-602. [PMID: 28535165 DOI: 10.1093/aje/kwx063] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 10/25/2016] [Indexed: 11/12/2022] Open
Abstract
Maternal obesity has been associated with increased risk of offspring behavioral problems. We examined whether this association could be explained by familial factors by comparing associations for maternal body mass index (BMI) with associations for paternal BMI. We studied 38,314 children born to mothers enrolled in the Danish National Birth Cohort during 1996-2002. Data on maternal BMI was collected at 15 weeks of gestation, and paternal BMI was assessed when the child was 18 months old. When the child was 7 years old, the Strengths and Difficulties Questionnaire was completed by the parents. We estimated odds ratios for behavioral problems in offspring born to overweight/obese parents, and we found that maternal BMI was associated with offspring behavioral problems. Maternal BMI of 25.0-29.9 was associated with a 33% (odds ratio = 1.33, 95% confidence interval: 1.13, 1.57) higher risk of total difficulties in offspring, and maternal BMI of ≥30.0 was associated with an 83% (odds ratio = 1.83, 95% confidence interval: 1.49, 2.25) higher risk. Paternal obesity was also associated with higher risk of offspring behavioral problems, but stronger associations were observed with maternal prepregnancy obesity. Our results suggest that part of the association between maternal BMI and behavioral problems can be accounted for by genetic and social factors, but environmental risk factors may also contribute to the etiology of behavioral problems.
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17
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Mina TH, Lahti M, Drake AJ, Denison FC, Räikkönen K, Norman JE, Reynolds RM. Prenatal exposure to maternal very severe obesity is associated with impaired neurodevelopment and executive functioning in children. Pediatr Res 2017; 82:47-54. [PMID: 28288149 DOI: 10.1038/pr.2017.43] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 02/06/2017] [Indexed: 01/09/2023]
Abstract
BackgroundPrenatal maternal obesity has been associated with an increased risk of neurocognitive problems in childhood, but there are fewer studies on executive functioning.MethodsTests and questionnaires to assess neurodevelopment, executive functioning, and the ability to delay gratification were conducted in 113 children (mean (SD)=4.24 (0.63) years of age) born to mothers with very severe obesity (SO, body mass index (BMI)⩾40 kg/m2, n=51) or to lean mothers (BMI⩽25 kg/m2, n=62).ResultsPrenatal maternal SO predicted poorer neurodevelopment (unstandardized regression coefficient (B)=-0.42, 95% confidence interval (CI) (-0.82; -0.02)), worse problem-solving (odd ratio (OR)=0.60, 95% CI (1.13; 0.07)), and fine motor skills (OR=4.91, 95% CI (1.27; 19.04)), poorer executive functioning in areas of attention, inhibitory control, and working memory (standardized B=3.75, 95% CI (1.01; 13.93)) but not in self-gratification delay. The effects were independent of maternal concurrent psychological well-being and child's BMI, but not independent of maternal education.ConclusionFuture studies should investigate whether perinatal management of maternal obesity could prevent adverse outcomes in child neurodevelopment.
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Affiliation(s)
- Theresia H Mina
- University/BHF Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK.,Tommy's Centre for Maternal and Fetal Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Marius Lahti
- University/BHF Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK.,Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland
| | - Amanda J Drake
- University/BHF Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Fiona C Denison
- Tommy's Centre for Maternal and Fetal Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK.,MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Katri Räikkönen
- Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland
| | - Jane E Norman
- Tommy's Centre for Maternal and Fetal Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK.,MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Rebecca M Reynolds
- University/BHF Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK.,Tommy's Centre for Maternal and Fetal Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK
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18
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Widen EM, Kahn LG, Cirillo P, Cohn B, Kezios KL, Factor-Litvak P. Prepregnancy overweight and obesity are associated with impaired child neurodevelopment. MATERNAL AND CHILD NUTRITION 2017. [PMID: 28635158 DOI: 10.1111/mcn.12481] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The authors examined the relationship of prepregnancy body mass index (BMI) and gestational weight gain (GWG) with child neurodevelopment. Mother-child dyads were a subgroup (n = 2,084) of the Child Health and Development Studies from the Oakland, California, area enrolled during pregnancy from 1959 to 1966 and followed at child age 9 years. Linear regression was used to examine associations between prepregnancy BMI, GWG, and standardized Peabody Picture Vocabulary Test and Raven Progressive Matrices scores and to evaluate effect modification of GWG by prepregnancy BMI. Before pregnancy, 77% of women were normal weight, 8% were underweight, 11% were overweight, and 3% were obese. Associations between GWG and child outcomes did not vary by prepregnancy BMI, suggesting no evidence for interaction. In multivariable models, compared to normal prepregnancy BMI, prepregnancy overweight and obesity were associated with lower Peabody scores (b: -1.29; 95% CI [-2.6, -0.04] and b: -2.7; 95% CI [-5.0, -0.32], respectively). GWG was not associated with child Peabody score [b: -0.03 (95% CI: -0.13, 0.07)]. Maternal BMI and GWG were not associated with child Raven score (all P >0.05). Maternal prepregnancy overweight and obesity were associated with lower scores for verbal recognition in mid-childhood. These results contribute to evidence linking maternal BMI with child neurodevelopment. Future research should examine the role of higher prepregnancy BMI values and the pattern of pregnancy weight gain in child cognitive outcomes.
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Affiliation(s)
- Elizabeth Marie Widen
- Department of Nutritional Sciences, University of Texas at Austin, Austin, Texas, USA.,Department of Medicine, Columbia University Medical Center, New York, New York, USA.,Department of Epidemiology, Columbia University Medical Center, New York, New York, USA
| | - Linda Gross Kahn
- Department of Pediatrics, New York University School of Medicine, New York, New York, USA
| | - Piera Cirillo
- Child Health and Development Studies, Berkeley, California, USA
| | - Barbara Cohn
- Child Health and Development Studies, Berkeley, California, USA
| | - Katrina Lynn Kezios
- Department of Epidemiology, Columbia University Medical Center, New York, New York, USA
| | - Pam Factor-Litvak
- Department of Epidemiology, Columbia University Medical Center, New York, New York, USA
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19
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Minatoya M, Itoh S, Araki A, Tamura N, Yamazaki K, Nishihara S, Miyashita C, Kishi R. Associated factors of behavioural problems in children at preschool age: the Hokkaido study on environment and children's health. Child Care Health Dev 2017; 43:385-392. [PMID: 27868227 DOI: 10.1111/cch.12424] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/27/2016] [Accepted: 10/09/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Finding associated factors with childhood behavioural problems as early as preschool age is important. Studies have revealed several factors including socioeconomic factors, which may vary among different cultural background and population. However, investigation in general Japanese population of preschool age has not been well demonstrated. Thus, the objective of this study was to examine associated factors of childhood behavioural problems using Strengths and Difficulties Questionnaire (SDQ) in a prospective birth cohort study. METHODS Total 3813 SDQ were distributed between October 2014 and December 2015 to the subpopulation of prospective birth cohort study, the Hokkaido Study on Environment and Children's Health. The subpopulation consisted of participants who had reached age 5 and were born between April 2008 and December 2010. Baseline questionnaire filled at recruitment and birth record were used to obtain participant information. Children with total difficulties score ≧ 13 were defined as likelihood of behavioural problems. A total of 2553 children with valid answers were included into the analysis. The response rate was 67.1%. RESULTS Number of children with likelihood of behavioural problems was 521 (20.4%). Boys showed more problematic scores than girls. Multivariate analysis found that maternal pre-pregnancy BMI ≧ 30 kg/m2 , primipara, maternal education lower than high school, family income during pregnancy < 3 million yen/year and boy gender were the factors associated with increased odds ratio of likelihood of child behavioural problems. CONCLUSIONS This study found that prenatal socioeconomic factors were associated with likelihood of child behavioural problems at preschool age in Japan.
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Affiliation(s)
- M Minatoya
- Center for Environmental and Health Sciences, Sapporo, Japan
| | - S Itoh
- Center for Environmental and Health Sciences, Sapporo, Japan
| | - A Araki
- Center for Environmental and Health Sciences, Sapporo, Japan
| | - N Tamura
- Center for Environmental and Health Sciences, Sapporo, Japan
| | - K Yamazaki
- Center for Environmental and Health Sciences, Sapporo, Japan
| | - S Nishihara
- Center for Environmental and Health Sciences, Sapporo, Japan
| | - C Miyashita
- Center for Environmental and Health Sciences, Sapporo, Japan
| | - R Kishi
- Center for Environmental and Health Sciences, Sapporo, Japan
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20
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Lei Q, Niu J, Lv L, Duan D, Wen J, Lin X, Mai C, Zhou Y. Clustering of metabolic risk factors and adverse pregnancy outcomes: a prospective cohort study. Diabetes Metab Res Rev 2016; 32:835-842. [PMID: 27037671 DOI: 10.1002/dmrr.2803] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/18/2016] [Accepted: 03/23/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND The relative contributions of a cluster of metabolic risk factors to pregnancy complications are not fully understood. We investigated the correlation between clustering of metabolic risk factors and adverse pregnancy outcomes. METHODS This prospective cohort study was performed on pregnant women who sought health care during their whole gestation in a women's and children's hospital. The pregnancy outcomes were also followed. Pre-pregnancy overweight/obesity, as well as pregnancy high triglycerides, low high-density lipoprotein-cholesterol, hyperglycemia and raised blood pressure were defined as metabolic risk factors. Adverse pregnancy outcomes included preterm delivery, small/large for gestational age, preeclampsia, gestational diabetes mellitus, neonatal asphyxia and foetal demise. Stratified analyses were conducted on a total of 5535 women according to classification in each metabolic risk factor. The adjusted odds ratio (OR) for adverse pregnancy outcomes according to the number of clustering metabolic factors was calculated using the logistic regression analysis. RESULTS The number of metabolic risk factors and adverse pregnancy outcomes were positively correlated (Ptrend < 0.001). Compared with women without a metabolic risk factor, women with one metabolic risk factor had a risk (OR = 1.67 95%CI 1.42-1.96) of adverse pregnancy outcomes. Women with a cluster of two metabolic risk factors tended to develop more adverse pregnancy outcomes (OR = 3.32 95% CI 2.69-4.10), and the risk was much higher in women with a cluster of three or more metabolic risk factors (OR = 10.40 95%CI 7.37-14.69). CONCLUSIONS Pregnant women with a cluster of metabolic risk factors are more likely to have adverse pregnancy outcomes. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Qiong Lei
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China
| | - Jianmin Niu
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China.
| | - Lijuan Lv
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China
| | - Dongmei Duan
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China
| | - Jiying Wen
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China
| | - Xiaohong Lin
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China
| | - Caiyuan Mai
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China
| | - Yuheng Zhou
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong Province, China
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21
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Aubuchon-Endsley N, Morales M, Giudice C, Bublitz MH, Lester BM, Salisbury AL, Stroud LR. Maternal pre-pregnancy obesity and gestational weight gain influence neonatal neurobehaviour. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 27161802 DOI: 10.1111/mcn.12317] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 02/16/2016] [Accepted: 02/18/2016] [Indexed: 11/30/2022]
Abstract
Maternal weight before and during pregnancy is associated with offspring neurobehaviour in childhood. We investigated maternal weight prior to and during pregnancy in relation to neonatal neurobehaviour. We hypothesized that maternal obesity and excessive gestational weight gain would be associated with poor neonatal attention and affective functioning. Participants (n = 261) were recruited, weighed and interviewed during their third trimester of pregnancy. Pre-pregnancy weight was self-reported and validated for 210 participants, with robust agreement with medical chart review (r = 0.99). Neurobehaviour was measured with the NICU Network Neurobehavioural Scale (NNNS) administered on Days 2 and 32 postpartum. Maternal exclusion criteria included severe or persistent physical or mental health conditions (e.g. chronic disease or diagnoses of Bipolar Disorder or Psychotic Spectrum Disorders), excessive substance use, and social service/foster care involvement or difficulty understanding English. Infants were from singleton, full-term (37-42 weeks gestation) births with no major medical concerns. Outcome variables were summary scores on the NNNS (n = 75-86). For women obese prior to pregnancy, those gaining in excess of Institute of Medicine guidelines had infants with poorer regulation, lower arousal and higher lethargy. There were no main effects of maternal pre-pregnancy body mass index on neurobehaviour. Women gaining above Institute of Medicine recommendations had neonates with better quality of movement. Additional studies to replicate and extend results past the neonatal period are needed. Results could support underlying mechanisms explaining associations between maternal perinatal weight and offspring outcomes. These mechanisms may inform future prevention/intervention strategies. © 2016 Blackwell Publishing Ltd.
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Affiliation(s)
| | - Monique Morales
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, Rhode Island, USA
| | - Christina Giudice
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, Rhode Island, USA
| | - Margaret H Bublitz
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, Rhode Island, USA.,The Miriam Hospital, Centers for Behavioral and Preventive Medicine, Providence, Rhode Island, USA
| | - Barry M Lester
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, Rhode Island, USA.,Alpert Medical School of Brown University, Department of Pediatrics, Providence, Rhode Island, USA.,Brown Center for the Study of Children at Risk, Providence, Rhode Island, USA
| | - Amy L Salisbury
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, Rhode Island, USA.,Alpert Medical School of Brown University, Department of Pediatrics, Providence, Rhode Island, USA.,Brown Center for the Study of Children at Risk, Providence, Rhode Island, USA
| | - Laura R Stroud
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, Rhode Island, USA.,The Miriam Hospital, Centers for Behavioral and Preventive Medicine, Providence, Rhode Island, USA
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22
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Wang Y, McDermott S, Mann JR, Hardin JW. Preventing intellectual disability during pregnancy: what are the potentially high yield targets? J Perinat Med 2016; 44:421-32. [PMID: 26352060 DOI: 10.1515/jpm-2015-0059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 06/17/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To identify risk factors among children with unknown cause intellectual disability (ID) and to estimate the population-attributable risk (PAR) associated with these factors. METHODS This was a retrospective cohort study of maternal and child pairs born between 2004 and 2010 in South Carolina, and information was obtained from Medicaid billing records, birth certificates, and other administrative data. The data included 123,922 children and logistic generalized estimating equations (GEE) regression models were used to estimate the association of maternal risk factors and ID. We estimated models with and without birth weight as a covariate, since low birth weight is known to be a mediator of the association between some risk factors and ID in children. RESULTS The prevalence of ID in the children was 3.85% and the associations between risk factors and ID were similar for female and male children. We found that the odds of having ID were increased if a child's mother had a diagnosis of major depression; for male children, the odds ratio (OR) was 1.34 (95% confidence interval [CI] 1.14-1.59, PAR 2.17%); and for females, the OR was 1.59 (95% CI 1.30-1.95, PAR 4.70%). The odds of having ID were also increased for children of women with bipolar disorder (males - OR 1.95, 95% CI 1.53-2.48, PAR 2.85%; females - OR 1.63, 95% CI 1.20-2.22, PAR 2.05%). CONCLUSIONS Major maternal depression and bipolar disorder were each significantly associated with the odds of ID in children, each accounting for approximately 2-5% of the PAR, when controlling for covariates.
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Huang J, Zhu T, Qu Y, Mu D. Prenatal, Perinatal and Neonatal Risk Factors for Intellectual Disability: A Systemic Review and Meta-Analysis. PLoS One 2016; 11:e0153655. [PMID: 27110944 PMCID: PMC4844149 DOI: 10.1371/journal.pone.0153655] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 04/02/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The etiology of non-genetic intellectual disability (ID) is not fully known, and we aimed to identify the prenatal, perinatal and neonatal risk factors for ID. METHOD PubMed and Embase databases were searched for studies that examined the association between pre-, peri- and neonatal factors and ID risk (keywords "intellectual disability" or "mental retardation" or "ID" or "MR" in combination with "prenatal" or "pregnancy" or "obstetric" or "perinatal" or "neonatal". The last search was updated on September 15, 2015. Summary effect estimates (pooled odds ratios) were calculated for each risk factor using random effects models, with tests for heterogeneity and publication bias. RESULTS Seventeen studies with 55,344 patients and 5,723,749 control individuals were eligible for inclusion in our analysis, and 16 potential risk factors were analyzed. Ten prenatal factors (advanced maternal age, maternal black race, low maternal education, third or more parity, maternal alcohol use, maternal tobacco use, maternal diabetes, maternal hypertension, maternal epilepsy and maternal asthma), one perinatal factor (preterm birth) and two neonatal factors (male sex and low birth weight) were significantly associated with increased risk of ID. CONCLUSION This systemic review and meta-analysis provides a comprehensive evidence-based assessment of the risk factors for ID. Future studies are encouraged to focus on perinatal and neonatal risk factors and the combined effects of multiple factors.
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Affiliation(s)
- Jichong Huang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, China
| | - Tingting Zhu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, China
| | - Yi Qu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, China
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, China
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, 94143, United States of America
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24
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Jo H, Schieve LA, Sharma AJ, Hinkle SN, Li R, Lind JN. Maternal prepregnancy body mass index and child psychosocial development at 6 years of age. Pediatrics 2015; 135:e1198-209. [PMID: 25917989 PMCID: PMC4411780 DOI: 10.1542/peds.2014-3058] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Both obesity and developmental disabilities have increased in recent decades. Limited studies suggest associations between maternal prepregnancy obesity and child neurodevelopment. METHODS The Infant Feeding Practices Study II, a US nationally distributed longitudinal study of maternal health and infant health and feeding practices, was conducted from 2005 to 2007. In 2012, mothers were recontacted for information on their children's health and development. We examined associations between maternal prepregnancy BMI and child psychosocial development in 1311 mother-child pairs included in this follow-up study. Children's development was assessed by maternal report of child psychosocial difficulties from the Strengths and Difficulties Questionnaire, past developmental diagnoses, and receipt of special needs services. RESULTS Adjusting for sociodemographic factors, children of obese class II/III mothers (BMI >35.0) had increased odds of emotional symptoms (adjusted odds ratio [aOR] 2.24; 95% confidence interval [CI], 1.27-3.98), peer problems (aOR 2.07; 95% CI, 1.26-3.40), total psychosocial difficulties (aOR 2.17; 95% CI, 1.24-3.77), attention-deficit/hyperactivity disorder diagnosis (aOR 4.55; 95% CI, 1.80-11.46), autism or developmental delay diagnosis (aOR 3.13; 95% CI, 1.10-8.94), receipt of speech language therapy (aOR 1.93; 95% CI, 1.18-3.15), receipt of psychological services (aOR 2.27; 95% CI, 1.09-4.73), and receipt of any special needs service (aOR 1.99; 95% CI, 1.33-2.97) compared with children of normal weight mothers (BMI 18.5-24.9). Adjustment for potential causal pathway factors including pregnancy weight gain, gestational diabetes, breastfeeding duration, postpartum depression, and child's birth weight did not substantially affect most estimates. CONCLUSIONS Children whose mothers were severely obese before pregnancy had increased risk for adverse developmental outcomes.
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Affiliation(s)
- Heejoo Jo
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee;
| | - Laura A Schieve
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities
| | - Andrea J Sharma
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia; United States Public Health Service Commissioned Corps, Atlanta, Georgia; and
| | - Stefanie N Hinkle
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Ruowei Li
- Division of Nutrition, Physical Activity, and Obesity, and
| | - Jennifer N Lind
- United States Public Health Service Commissioned Corps, Atlanta, Georgia; and Division of Nutrition, Physical Activity, and Obesity, and Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia
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25
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Olagbuji BN, Olofinbiyi BA, Akintayo AA, Aduloju OP, Ade-Ojo PI. Maternal perspectives on gestational weight gain: Critical information on developing weight control interventions. Niger Med J 2015; 56:96-102. [PMID: 25838623 PMCID: PMC4382612 DOI: 10.4103/0300-1652.150689] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Our aim was to demonstrate what women reported being counselled about weight gain in pregnancy, their perceptions of inappropriate gestational weight gain (GWG), and plans for weight gain in pregnancy. MATERIALS AND METHODS A cross-sectional survey of perceptions of prenatal attendees about inappropriate GWG was conducted at the prenatal clinic of a referral tertiary health facility in south western, Nigeria, between January 1, 2013 and June 30, 2013. Primary outcomes were the perceptions of women about risks involved with inappropriate weight gain and the proportion of women who self-reported being counselled at all on GWG, and had the right knowledge of risk(s) involved with inappropriate weight gain during pregnancy. RESULTS Of the 348 women who completed the survey, approximately four-fifths (82.8%) reported GWG being discussed at all by health care provider. Fewer women (29.3%) believed there were maternal risks with excess weight gain compared to inadequate weight gain (34.8%). With respect to perception of risks of inappropriate weight gain to infants, 23.65 and 18.4%, respectively, believed there were infant risks with excess and inadequate GWG. Overweight women [OR 0.39 (95% CI 0.16-0.98)] and those who received GWG information from more than one type of health care provider [OR 4.71 (95% CI 1.64-13.78)] had significant increased rate of correct knowledge of risks involved with inappropriate GWG. CONCLUSION The lack of awareness of risks involved with inappropriate GWG by over half of respondents underscores the need for improvement in educational intervention on GWG in our environment.
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Affiliation(s)
- Biodun N. Olagbuji
- Women's and Adolescent Health Research Initiative, Ado Ekiti, Nigeria
- Department of Obstetrics and Gynaecology, Ekiti State University, Ado Ekiti, Nigeria
| | | | - Akinyemi A. Akintayo
- Department of Obstetrics and Gynaecology, Ekiti State University, Ado Ekiti, Nigeria
| | - Olusola P. Aduloju
- Department of Obstetrics and Gynaecology, Ekiti State University, Ado Ekiti, Nigeria
| | - Pius I. Ade-Ojo
- Department of Obstetrics and Gynaecology, Ekiti State University, Ado Ekiti, Nigeria
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Pan C, Deroche CB, Mann JR, McDermott S, Hardin JW. Is prepregnancy obesity associated with risk of cerebral palsy and epilepsy in children? J Child Neurol 2014; 29:NP196-201. [PMID: 24334343 DOI: 10.1177/0883073813510971] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We conducted a retrospective cohort study to investigate the association between prepregnancy obesity in women and risk of cerebral palsy and epilepsy in their children using data from the South Carolina Medicaid program. The cohort included 83,901 maternal-child pairs; 100 cases of cerebral palsy were initially identified, followed by 53 cases that had at least 2 cerebral palsy diagnoses. For confirmed epilepsy, diagnosed on at least 5 occasions or by more than 1 provider, 83,472 observations were included with 338 cases. There was no association between maternal body mass index and risk of childhood epilepsy. A significant association between increasing maternal body mass index and any diagnosis of cerebral palsy was found, and morbid obesity was associated with increased risk of any and confirmed cerebral palsy. In conclusion, there appears to be an association of maternal body mass index with cerebral palsy, but there is no evidence to support an association with epilepsy.
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Affiliation(s)
- Chun Pan
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Chelsea B Deroche
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Joshua R Mann
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Suzanne McDermott
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
| | - James W Hardin
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Berenson AB, Pohlmeier AM, Laz TH, Rahman M, McGrath CJ. Nutritional and weight management behaviors in low-income women trying to conceive. Obstet Gynecol 2014; 124:579-584. [PMID: 25162259 PMCID: PMC4147676 DOI: 10.1097/aog.0000000000000416] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the nutritional habits and weight management strategies of women trying to conceive as compared with women not trying to conceive. METHODS This was a cross-sectional survey of health behaviors including nutritional habits and weight management strategies of women aged 16-40 years who were low income, racially diverse, (n=1,711), and attending reproductive health clinics. Multivariable logistic regression analyses were performed to examine the association between pregnancy intention and various health behaviors after adjusting for demographic variables, gravidity, and obesity status. RESULTS A total of 8.9% (n=153) of the participants stated they were trying to get pregnant. Women trying to conceive were more likely than those not trying to have participated in a number of unhealthy weight loss practices in the past year. These included taking diet pills, supplements, or herbs (13.5% compared with 8.8%; adjusted odds ratio [OR] 1.97, 95% confidence interval [CI] 1.11-3.49), using laxatives or diuretics or inducing vomiting (7.7% compared with 3.0%; adjusted OR 2.70, CI 1.23-5.91), and fasting for 24 hours (10.7% compared with 5.5%; adjusted OR 2.15, CI 1.03-4.51). There were no significant differences between the two groups in amount of exercise, current smoking status, or current alcohol consumption Furthermore, fruit, green salad and other vegetables, and intake of soda and fast food were unrelated to pregnancy intention. CONCLUSION This study highlights that women trying to conceive are more likely to participate in unhealthy and potentially dangerous weight loss practices than women not trying to conceive. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Abbey B Berenson
- Department of Obstetrics & Gynecology, Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, Texas
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28
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Aubuchon-Endsley NL, Bublitz MH, Stroud LR. Pre-pregnancy obesity and maternal circadian cortisol regulation: Moderation by gestational weight gain. Biol Psychol 2014; 102:38-43. [PMID: 25038305 DOI: 10.1016/j.biopsycho.2014.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 05/23/2014] [Accepted: 07/03/2014] [Indexed: 01/20/2023]
Abstract
We investigated main and interactive effects of maternal pre-pregnancy obesity and gestational weight gain on circadian cortisol from the second to third trimester. A diverse sample of 215 pregnant women was enrolled. Maternal height and most recent pre-pregnancy weight were collected at study initiation (22% obese). Weight and circadian salivary cortisol samples were measured during second (24±4) and third (35±1 weeks) trimesters. During the third trimester, women who were obese prior to conception showed elevated evening cortisol versus normal weight women. This pattern was moderated by weight gain in excess of Institute of Medicine guidelines, such that women who were obese prior to conception and gained greater than 7.94kg by the 35±1 week visit displayed greatest elevations in evening cortisol. Given links between excessive prenatal glucocorticoid exposure and both poor maternal and offspring health outcomes, elevated maternal cortisol may be one mechanism underlying links between maternal obesity and adverse perinatal outcomes.
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Affiliation(s)
- Nicki L Aubuchon-Endsley
- Department of Psychology, Idaho State University, 921 S 8th Avenue, Stop 8112, Pocatello, ID 83209, USA.
| | - Margaret H Bublitz
- Centers for Behavioral and Preventive Medicine, 164 Summit Avenue, Providence, RI 02906, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA.
| | - Laura R Stroud
- Centers for Behavioral and Preventive Medicine, 164 Summit Avenue, Providence, RI 02906, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA.
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Bodnar LM, Abrams B, Bertolet M, Gernand AD, Parisi SM, Himes KP, Lash TL. Validity of birth certificate-derived maternal weight data. Paediatr Perinat Epidemiol 2014; 28:203-12. [PMID: 24673550 PMCID: PMC4036639 DOI: 10.1111/ppe.12120] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Studies using vital records-based maternal weight data have become more common, but the validity of these data is uncertain. METHODS We evaluated the accuracy of prepregnancy body mass index (BMI) and gestational weight gain (GWG) reported on birth certificates using medical record data in 1204 births at a teaching hospital in Pennsylvania from 2003 to 2010. Deliveries at this hospital were representative of births statewide with respect to BMI, GWG, race/ethnicity, and preterm birth. Forty-eight strata were created by simultaneous stratification on prepregnancy BMI (underweight, normal weight/overweight, obese class 1, obese classes 2 and 3), GWG (<20th, 20-80th, >80th percentile), race/ethnicity (non-Hispanic white, non-Hispanic black), and gestational age (term, preterm). RESULTS The agreement of birth certificate-derived prepregnancy BMI category with medical record BMI category was highest in the normal weight/overweight and obese class 2 and 3 groups. Agreement varied from 52% to 100% across racial/ethnic and gestational age strata. GWG category from the birth registry agreed with medical records for 41-83% of deliveries, and agreement tended to be the poorest for very low and very high GWG. The misclassification of GWG was driven by errors in reported prepregnancy weight rather than maternal weight at delivery, and its magnitude depended on prepregnancy BMI category and gestational age at delivery. CONCLUSIONS Maternal weight data, particularly at the extremes, are poorly reported on birth certificates. Investigators should devote resources to well-designed validation studies, the results of which can be used to adjust for measurement errors by bias analysis.
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Affiliation(s)
- Lisa M. Bodnar
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA,Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA,Magee-Womens Research Institute, Pittsburgh, PA
| | - Barbara Abrams
- Division of Epidemiology, School of Public Health, University of California at Berkeley, Berkeley, CA
| | - Marnie Bertolet
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Alison D. Gernand
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Sara M. Parisi
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Katherine P. Himes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA,Magee-Womens Research Institute, Pittsburgh, PA
| | - Timothy L. Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Bliddal M, Olsen J, Støvring H, Eriksen HLF, Kesmodel US, Sørensen TIA, Nøhr EA. Maternal pre-pregnancy BMI and intelligence quotient (IQ) in 5-year-old children: a cohort based study. PLoS One 2014; 9:e94498. [PMID: 24727836 PMCID: PMC3984139 DOI: 10.1371/journal.pone.0094498] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/16/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND An association between maternal pre-pregnancy BMI and childhood intelligence quotient (IQ) has repeatedly been found but it is unknown if this association is causal or due to confounding caused by genetic or social factors. METHODS We used a cohort of 1,783 mothers and their 5-year-old children sampled from the Danish National Birth Cohort. The children participated between 2003 and 2008 in a neuropsychological assessment of cognitive ability including IQ tests taken by both the mother and the child. Linear regression analyses were used to estimate the associations between parental BMI and child IQ adjusted for a comprehensive set of potential confounders. Child IQ was assessed with the Wechsler Primary and Preschool Scales of Intelligence--Revised (WPPSI-R). RESULTS The crude association between maternal BMI and child IQ showed that BMI was adversely associated with child IQ with a reduction in IQ of -0.40 point for each one unit increase in BMI. This association was attenuated after adjustment for social factors and maternal IQ to a value of -0.27 (-0.50 to -0.03). After mutual adjustment for the father's BMI and all other factors except maternal IQ, the association between paternal BMI and child IQ yielded a regression coefficient of -0.26 (-0.59 to 0.07), which was comparable to that seen for maternal BMI (-0.20 (-0.44 to 0.04)). CONCLUSION Although maternal pre-pregnancy BMI was inversely associated with the IQ of her child, the similar association with paternal BMI suggests that it is not a specific pregnancy related adiposity effect.
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Affiliation(s)
- Mette Bliddal
- Department of Gynaecology and Obstetrics, Odense University Hospital, and Institute of Clinical Research, Research Unit of Gynaecology and Obstetrics, University of Southern Denmark, Odense, Denmark
- * E-mail:
| | - Jørn Olsen
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Henrik Støvring
- Department of Public Health, Section for Biostatistics, Aarhus University, Aarhus, Denmark
| | - Hanne-Lise F. Eriksen
- Center of Functionally Integrative Neuroscience, Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ulrik S. Kesmodel
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Thorkild I. A. Sørensen
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Denmark
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospitals – Part of Copenhagen University Hospital, Copenhagen, Denmark
| | - Ellen A. Nøhr
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
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Mann JR, Deroche CB, Spiryda LB, McDermott S. Is pre-pregnancy weight a risk factor for intellectual disability? ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.13.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Crisham Janik MD, Newman TB, Cheng YW, Xing G, Gilbert WM, Wu YW. Maternal diagnosis of obesity and risk of cerebral palsy in the child. J Pediatr 2013; 163:1307-12. [PMID: 23932316 PMCID: PMC3812421 DOI: 10.1016/j.jpeds.2013.06.062] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 04/17/2013] [Accepted: 06/25/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine the association between maternal hospital diagnoses of obesity and risk of cerebral palsy (CP) in the child. STUDY DESIGN For all California hospital births from 1991-2001, we linked infant and maternal hospitalization discharge abstracts to California Department of Developmental Services records of children receiving services for CP. We identified maternal hospital discharge diagnoses of obesity (International Classification of Diseases, 9th edition 646.1, 278.00, or 278.01) and morbid obesity (International Classification of Diseases, 9th edition 278.01), and performed logistic regression to explore the relationship between maternal obesity diagnoses and CP. RESULTS Among 6.2 million births, 67 200 (1.1%) mothers were diagnosed with obesity, and 7878 (0.1%) with morbid obesity; 8798 (0.14%) children had CP. A maternal diagnosis of obesity (relative risk [RR] 1.30, 95% CI 1.09-1.55) or morbid obesity (RR 2.70, 95% CI 1.89-3.86) was associated with increased risk of CP. In multivariable analysis adjusting for maternal race, age, education, prenatal care, insurance status, and infant sex, both obesity (OR 1.27, 95% CI 1.06-1.52) and morbid obesity (OR 2.56, 95% CI 1.79-3.66) remained independently associated with CP. On stratified analyses, the association of obesity (RR 1.72, 95% CI 1.25-2.35) or morbid obesity (RR 3.79, 95% CI 2.35-6.10) with CP was only significant among women who were hospitalized prior to the birth admission. Adjusting for potential comorbidities and complications of obesity did not eliminate this association. CONCLUSIONS Maternal obesity may confer an increased risk of CP in some cases. Further studies are needed to confirm this finding.
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Affiliation(s)
| | - Thomas B. Newman
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA,Department of Pediatrics, UCSF, San Francisco, CA
| | - Yvonne W. Cheng
- Department of Obstetrics and Gynecology, UCSF, San Francisco, CA
| | - Guibo Xing
- Department of Obstetrics and Gynecology, UC Davis, Sacramento, CA
| | - William M. Gilbert
- Department of Obstetrics and Gynecology, Sutter Medical Center, Sacramento, CA
| | - Yvonne W. Wu
- Department of Neurology, UCSF, San Francisco, CA,Department of Pediatrics, UCSF, San Francisco, CA
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Maternal prepregnancy weight status and associations with children's development and disabilities at kindergarten. Int J Obes (Lond) 2013; 37:1344-51. [PMID: 23860335 DOI: 10.1038/ijo.2013.128] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 07/02/2013] [Accepted: 07/04/2013] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Obesity is prevalent among women of reproductive age, and developmental disabilities in children continue to increase. We examined associations between mother's prepregnancy body mass index (BMI) and physical and developmental disabilities, and objective measures of reading and math skills and fine and gross motor function in children. METHODS We used the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B; n=5200), a cohort of children born in 2001 and followed until kindergarten. Children were classified according to maternal prepregnancy BMI (in kg per m(2)): underweight (BMI <18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9), obese class I (BMI 30.0-34.9) and obese class II/III (BMI ≥ 35.0). Parent reports of doctor-diagnosed disabilities were collected up to kindergarten and classified as learning and behavioral or physical. Children's reading and math and fine and gross motor function were assessed at kindergarten according to standardized tests. Linear and modified logistic regression models were adjusted for maternal sociodemographic variables, family enrichment variables, and children's sex, age and year of kindergarten entry. Additional adjustment for current child BMI was performed in separate models. All data are weighted to be nationally representative of the children born in 2001. RESULTS Compared with children of normal-weight mothers, children born to obese class II/III mothers had an increased risk of learning or behavioral (risk ratio 1.67; 95% confidence interval 1.27, 2.21)), but not physical disabilities (risk ratio 0.57; 95% confidence interval 0.27, 1.22). Gross (P<0.001), but not fine (P=0.06) motor function was significantly associated with maternal BMI, but gross motor function was attenuated after adjustment for current child BMI (P=0.05). Children's reading scores (P=0.01) but not math scores (P=0.11) were significantly associated with maternal BMI. CONCLUSIONS In this nationally representative US cohort, children born to severely obese mothers had an increased risk for diagnosed learning and behavioral but not physical disabilities by kindergarten.
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