Rates of maternal weight gain over the course of pregnancy and offspring risk of neurodevelopmental disorders

Higher prenatal dietary glycemic index in the third trimester of pregnancy is associated with infant negative affect at 6 months

The dietary glycemic index (GI) reflects post-prandial plasma glucose generation rate, with higher-GI foods rapidly increasing blood sugar. Prenatal consumption of high-GI foods is associated with offspring risk for obesity and metabolic disorders. The impact of prenatal dietary GI exposure on infant neurodevelopment remains unclear. Maternal dietary intake, percent adiposity, and insulin resistance were prospectively assessed during the second and third trimesters in a sample of women with healthy, singleton pregnancies (N = 302). Infant negative affect was prospectively assessed at six months using observer ratings (Still Face Paradigm) and caregiver-reports (Infant-Behavior Questionnaire-Revised). Structural equation models assessed the independent effects of second and third trimester maternal dietary GI, adiposity, insulin resistance on infant negative affect, adjusted for relevant covariates. Higher third, but not second, trimester dietary GI was associated with increased observer-rated infant negative affect (β = 0.14, p = .04) and with higher caregiver-reported infant sadness (β = 0.17, p = .01), suggesting a programming effect of prenatal dietary GI on infant neurodevelopment. Targeted interventions that decrease dietary GI in later pregnancy may prove more effective for optimizing infant behavioral health compared to longer-term changes needed to alter metabolic state. Identifying modifiable early contributors to infant negative affect supports proactive strategies for mitigating future psychopathology risk.

Maternal gestational weight gain and the long-term physical and neurological outcome of small for gestational age children: A 4-year real-world study based on a longitudinal cohort

BACKGROUND

Globally, small for gestational age (SGA) is increasingly prevalent, paralleling the common high-risk pregnancies with inappropriate gestational weight gain (GWG). However, whether maternal GWG was associated with their SGA offspring's long-term development remained unresolved.

OBJECTIVE

To examine the associations of maternal GWG with the long-term physical and neurological development of SGA children based on a real-world cohort in our hospital.

STUDY DESIGN

This retrospective cohort was conducted at our hospital between July 1, 2020, and December 2022. At baseline, we included 319 children diagnosed as SGA and followed up with these children for 12 to 48 months (median: 29 months). The primary outcomes were children's physical and neurological development at follow-ups which were grouped into those with inadequate, adequate, or excessive maternal GWG. We standardized the weight, height (length), body mass index, and ASQ-3 / ASQ:SE domain scores of children with different ages and genders into Z-scores to increase comparability. The adjusted odds ratio (OR) and its 95 % confidence interval (CI) controlling for covariates were calculated using the Hosmer-Lemeshow test model to assess the risk of impaired neurodevelopment.

RESULTS

Firstly, the birth weight and birth length of newborns in the inadequate GWG group were both smaller than those in the adequate GWG group and excessive GWG group. The proportions of severe SGA, neonatal respiratory distress syndrome, and bronchopulmonary dysplasia were higher in the inadequate GWG group compared to the adequate GWG group. Secondly, follow-up observations found that inadequate GWG group had significantly lower weight Z scores(0.12 vs 0.34), height Z scores(-0.11 vs 0.32)and high emaciation incidence (14.3 % vs. 5.0 %) compared to the adequate GWG group. Thirdly, in the follow-up of the neurodevelopment, children in the adequate GWG group had statistically higher Z scores in the gross motor, fine motor, problem-solving and personal-social domains compared to those in the inadequate GWG group and had statistically higher Z scores in the gross motor domain compared to those in the excessive GWG group; children in the excessive GWG group had statistically higher Z scores in the fine motor and personal-social domains compared to those in the inadequate GWG group. Inadequate GWG group was significantly correlated with a higher risk of delayed development in gross motor (OR 1.79, 95 % CI 1.15-2.77), fine motor (OR 1.6, 95 % CI 1.06-2.78), problem-solving (OR 2.08, 95 % CI 1.16-3.56), personal-social (OR 1.51, 95 % CI 1.05-2.18), and social-emotional (ASQ:SE) (OR 1.84, 95 % CI 1.05-3.22) domains than adequate GWG group. Meanwhile, excessive GWG group was significantly correlated with a higher risk of delayed development in gross motor (OR 1.6, 95 % CI 1.02-2.48) domain than adequate GWG group.

CONCLUSION

Inappropriate maternal GWG (inadequate or excessive) may affect the long-term physical and neurological development of SGA infants. Pregnant women, especially those with intrauterine growth restriction, need to maintain reasonable GWG and receive close monitoring and timely interventions to improve SGA children' long-term outcomes.

Proposed Physiological Mechanisms Underlying the Association between Adverse Childhood Experiences and Mental Health Conditions: A Narrative Review

Adverse childhood experiences (ACEs; e.g., physical abuse) can impact lifelong mental health both directly and intergenerationally, with effects transmitted from the parent to the child. Several physiological mechanisms have been proposed to explain the impacts of ACEs on mental health. The purpose of this narrative review was to synthesize and critique the peer-reviewed literature on physiological mechanisms proposed to underlie the impacts of ACEs on mental health, specifically: (1) hypothalamic-pituitary-adrenal axis functioning, (2) inflammation, (3) genetic inheritance and differential susceptibility, (4) epigenetics, (5) brain structure and function, (6) oxidative stress, and (7) metabolic profiles. We searched Google Scholar using variations of the terms "adverse childhood experiences", "mechanisms", and "mental health" to locate relevant peer-reviewed literature. We also mined citations of the identified literature to find additional important sources. The role of inflammation in the etiology of mental health conditions among those exposed to ACEs appeared promising, followed by hypothalamic-pituitary-adrenal axis functioning, brain structure and function, genetics, epigenetics, metabolism, and lastly, oxidative stress. Replication studies that examine the associations among ACEs, genetic inheritance and differential susceptibility, epigenetics, oxidative stress, and metabolism are required to better define links with mental health.

Prenatal Programming of Monocyte Chemotactic Protein-1 Signaling in Autism Susceptibility

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder that involves functional and structural defects in selective central nervous system (CNS) regions, harming the individual capability to process and respond to external stimuli, including impaired verbal and non-verbal communications. Etiological causes of ASD have not been fully clarified; however, prenatal activation of the innate immune system by external stimuli might infiltrate peripheral immune cells into the fetal CNS and activate cytokine secretion by microglia and astrocytes. For instance, genomic and postmortem histological analysis has identified proinflammatory gene signatures, microglia-related expressed genes, and neuroinflammatory markers in the brain during ASD diagnosis. Active neuroinflammation might also occur during the developmental stage, promoting the establishment of a defective brain connectome and increasing susceptibility to ASD after birth. While still under investigation, we tested the hypothesis whether the monocyte chemoattractant protein-1 (MCP-1) signaling is prenatally programmed to favor peripheral immune cell infiltration and activate microglia into the fetal CNS, setting susceptibility to autism-like behavior. In this review, we will comprehensively provide the current understanding of the prenatal activation of MCP-1 signaling by external stimuli during the developmental stage as a new selective node to promote neuroinflammation, brain structural alterations, and behavioral defects associated to ASD diagnosis.

Maternal Weight Gain in Early Pregnancy with Healthy Live Offspring: Based on the China Birth Cohort Study

BACKGROUND

Research on maternal weight gain in early pregnancy with healthy live offspring is lacking for Chinese women. Based on the China birth cohort study (CBCS), we aimed to explore maternal weight gain in different groups.

METHODS

Singleton pregnancies of 6 + 0~13 + 6 weeks of gestation from the CBCS were considered, not including missing data or outliers, those lost at follow-up, or those with non-typical conditions of the offspring. Maternal first-trimester weight and body mass index (BMI) gain was considered as the early pregnancy weight minus the pre-pregnancy weight. Using Pearson's or Spearman's correlation and linear regression models to explore the relationship between maternal weight and BMI gain and gestational age (GA), stratified and sensitivity analyses were carried out to identify the study's robustness.

RESULTS

There were 25,292 singleton pregnancies with healthy live offspring who were ultimately enrolled, and there was a linear correlation between GA and maternal weight gain (=0.55 + 0.05 × GA (weeks), p < 0.001, r2 = 0.002) and BMI change (=0.21 + 0.02 × GA (weeks), p < 0.001, r2 = 0.002). The association remained robust in the stratified and sensitivity analyses of the subgroups.

CONCLUSIONS

Although the association between GA and maternal pre-pregnancy weight and BMI gain is weak, a slight correlation was shown, especially in pregnant women with a typical or low pre-pregnancy BMI, Han ethnicity, moderate levels of physical activity, natural conception, and folic acid (FA) and/or multivitamin supplementation.

The impact of excessive maternal weight on the risk of neuropsychiatric disorders in offspring-a narrative review of clinical studies

The global prevalence of overweight and obesity is a significant public health concern that also largely affects women of childbearing age. Human epidemiological studies indicate that prenatal exposure to excessive maternal weight or excessive gestational weight gain is linked to various neurodevelopmental disorders in children, including attention deficit hyperactivity disorder, autism spectrum disorder, internalizing and externalizing problems, schizophrenia, and cognitive/intellectual impairment. Considering that inadequate maternal body mass can induce serious disorders in offspring, it is important to increase efforts to prevent such outcomes. In this paper, we review human studies linking excessive maternal weight and the occurrence of mental disorders in children.

Association of gestational weight gain rate in pregnant women with children's cognitive and behavioral development: A birth cohort study

BACKGROUND

The evidences on the relationship between gestational weight gain rate (GWGR) and children's cognitive and behavioral development have been limited.

METHODS

A total of 3273 singleton live birth mother-child pairs from the Ma'anshan Birth Cohort in China were included in the study. Maternal GWGR was calculated based on the weights measured at multiple antenatal checkups. Children's cognitive and behavioral development were assessed by Chinese version of Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition and Achenbach Child Behavior Checklist 1.5-5. Then generalized linear models were performed for analyses.

RESULTS

In the field of children's cognitive development, excessive GWGR in the second trimester was associated with increased visual space index (VSI), fluid reasoning index (FRI) and full scale intelligence quotient (FSIQ) scores, while excessive GWGR in the third trimester was associated with decreased VSI, working memory index (WMI) and FSIQ scores. In the field of children's behavioral development, excessive GWGR in the second trimester was associated with decreased aggressive behaviors and externalizing problems scores.

LIMITATIONS

Children's behavioral development was assessed by main caregivers and might cause a certain degree of bias. There might be other potential confounders that we did not take into account.

CONCLUSIONS

A high GWGR in the second trimester might be beneficial for children's cognitive and behavioral development, while a high GWGR in the third trimester might be harmful.

Gestational Weight Gain, Pregnancy Related Complications and the Short-Term Risks for the Offspring

BACKGROUND AND OBJECTIVES

Maternal obesity influences pregnancy course in several different manners, and imbalanced nutrition during pregnancy may lead to various adverse pregnancy outcomes. Additionally, nutritional status during pregnancy may have implications for the health of the offspring and may possibly influence early motor development in children. The aim of this study was to assess the impact of excessive gestational weight gain (EGWG) on pregnancy outcomes and infant's motor development within the first twelve months of life.

MATERIALS AND METHODS

The study included 200 participants divided in two groups based on their gestational weight gain. Maternal, perinatal, and neonatal factors were analyzed, and early motor development was assessed using the Alberta infant motor scale (AIMS).

RESULTS

EGWG was significantly associated with: pre-pregnancy BMI (p < 0.001), family history for cardiovascular diseases (p = 0.013) and diabetes mellitus (p = 0.045), hypertensive disorder of pregnancy (p = 0.003), gestational diabetes mellitus (p < 0.001), gestational anemia (p = 0.001), vitamin D deficiency (p = 0.001), metformin use (p = 0.045), pre-labor premature rupture of membranes (p = 0.031), amniotic fluid index (p = 0.047), and APGAR score in the first five min of life (p = 0.007). Scored by AIMS, EGWG was significantly associated with parameters of early motor development at the age of three AIMS total (p < 0.001), six AIMS total (p < 0.001), nine AIMS total (p < 0.001), and twelve AIMS total (p < 0.001) months of infant's life.

CONCLUSIONS

The link between EGWG and adverse neurodevelopmental outcomes in offspring is a complex and multifaceted issue. Our results imply significant alterations in early motor development in the group of infants born from mothers who gained weight excessively during pregnancy. Further studies are needed to unravel the intricacies of this relationship and inform strategies for preventive interventions and supportive care during pregnancy and infancy.

Maternal gestational weight gain and offspring's neurodevelopmental outcomes: A systematic review and meta-analysis

Abnormal gestational weight gain (GWG) has been increasing globally, up to 47% of all pregnancies. Multiple studies have focused on the association between GWG and adverse neurodevelopmental outcomes in the offspring, however with inconsistent results. We performed a systematic review and meta-analysis to evaluate associations between excessive or insufficient GWG and offspring's neurodevelopmental outcomes. Meta-analysis of these 23 studies using a random-effects model revealed associations between excessive GWG and neurodevelopmental disorders (ASD & ID & ADHD together: OR=1.12 [95% CI 1.06-1.19]), ASD (OR=1.18 [95% CI 1.08-1.29]), ADHD (OR=1.08 [95% CI 1.02-1.14]), ASD with ID (OR=1.15 [95% CI 1.01-1.32]), and ASD without ID (OR=1.12 [95% CI 1.06-1.19]). Insufficient GWG was associated with higher risk for ID (OR=1.14 [95% CI 1.03-1.26]). These results emphasize the significant impact, though of small effect size, of GWG across multiple neurodevelopmental disorders. It is important to note that these results do not establish causality. Other factors such as genetic factors, gene-environment interactions may confound the relationship between GWG and neurodevelopmental outcomes. To better understand the role of GWG in neurodevelopmental disorders, future studies should consider using genetically sensitive designs that can account for these potential confounders.

3' UTR Deletion of FBXO28 in a Patient with Brain Abnormalities and Developmental Delay

Constitutional deletions of chromosome 1q42 region are rare. The phenotype spectrum associated with this copy number change is variable, including developmental delay, intellectual disability, seizures, and dysmorphology. This study describes a patient with developmental delays and brain abnormalities. G-banded karyotype, FISH, SNP oligonucleotide microarray analysis (SOMA), and whole exome sequencing analysis were performed. Postnatal reanalysis of prenatal SOMA and follow-up parental testing revealed a paternally inherited 63 kb deletion at 1q42.11 in the patient. We characterized the clinical features of this patient, providing insight into the clinical phenotype associated with deletions of the 1q42.11 sub-band. Our study provides new evidence supporting the potential functional importance of the FBXO28 3' UTR region and the hypothesis that FBXO28 is a critical gene in the pathogenesis of chromosome 1q41q42 microdeletion syndrome. It also highlights the different goals and reporting criteria between prenatal and postnatal microarray tests.