Associations of maternal pre-pregnancy body mass index and gestational weight gain with risk of offspring neurodevelopment at 2 years: A Chinese birth cohort study

Maternal Obesity and Neurodevelopment of the Offspring

BACKGROUND

An increasing amount of evidence, derived from both human epidemiological studies and animal research, suggests that exposure to maternal obesity in utero is linked to adverse neurodevelopmental outcomes in the offspring. These can include attention deficit hyperactivity disorder, autism spectrum disorders, intellectual disability, and cerebral palsy.

METHODS

A thorough search in Medline/PubMed and Google Scholar databases was performed by two independent reviewers in order to investigate the link between the exposure to maternal obesity and neurodevelopmental outcomes in the offspring. A list of keywords, including maternal obesity, maternal overweight, maternal diet, neurodevelopment, and neuropsychiatric disorders, was used in the search algorithm.

RESULTS

The existing evidence regarding the potential mechanisms through which maternal obesity may impact offspring neurodevelopment and programming, such as inflammation, hormone dysregulation, alterations to the microbiome, and epigenetics, as well as evidence from animal studies, was summarized in this narrative review.

CONCLUSIONS

Maternal obesity seems to be overall associated with various neuropsychiatric and neurodevelopmental disorders. However, more robust data from future studies are needed to establish this association, which will take into account the role of potential confounders such as genetic factors and gene-environment interactions.

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.

Contributions of subjective status to eating behaviors, obesity, and metabolic health across development

Subjective status is the evaluation of one's social or socioeconomic status relative to others. Lower subjective status has been associated with risk of overweight/obesity, poorer metabolic health, and obesogenic food preferences and eating behaviors. However, these findings are predominantly based on studies of adolescents and young adults. This indicates major gaps in knowledge and application of this social determinant of obesity and metabolic health, given that perceived status develops throughout the life course along with food environments and eating habits. Here, we review the relationships that subjective status shares with the outcomes of eating behaviors, obesity, and metabolic health across milestones and periods of development: during the prenatal period, as caregivers who feed children, during childhood (prior to age 10) and from adolescence into emerging adulthood (until mid-20's). For each developmental period, we explore why the period critically contributes to these outcomes and how subjective status may affect eating behaviors and metabolic health. We propose that subjective status contributes to eating/feeding behaviors and metabolic health both within and across developmental periods, such that the effect of low subjective status at an earlier period may contribute to obesogenic eating behaviors and metabolic health in later developmental periods and intergenerationally. The influence of low subjective status on higher body weight may also threaten subjective status later in development through heightened vulnerability to social stressors, such as weight-based stigma. Overall, subjective status may be a broadly influential factor to consider when examining social determinants of obesity and metabolic health across development.

Associations between maternal body mass index and childhood infections in UK primary care: findings from the Born in Bradford birth cohort study

OBJECTIVE

To explore associations between maternal body mass index (BMI) in early pregnancy and childhood infections.

DESIGN

Birth cohort study linked to primary care records.

SETTING

Bradford, UK.

PARTICIPANTS

Live singleton births within the Born in Bradford cohort study between 2007 and 2011.

EXPOSURES

Maternal BMI in early pregnancy.

MAIN OUTCOME MEASURES

The total number of infections between birth and ~14 years of age with subgroup analysis by infection type and age.

RESULTS

A total of 9037 mothers and 9540 children were included in the main analysis. 45% of women were of Pakistani ethnicity and 6417 women (56%) were overweight or obese. There was an overall trend for an increasing infection rate with increasing maternal BMI. In adjusted models, only those with obesity grade 2-3 had offspring with significantly higher rates of infection during the first year of life (RR 1.12 (95% CI 1.05 to 1.20)) compared with women of healthy weight. However, by age 5 to <15 years, children born to overweight women (RR 1.09 (95% CI 1.02 to 1.16)), obese grade 1 women (RR 1.18 (95% CI 1.09 to 1.28)) or obese grade 2 women (RR 1.31 (95% CI 1.16 to 1.48)) all had significantly higher rates of infection compared with those born to healthy weight mothers. Respiratory tract and skin/soft tissue infections made up the majority of excess infections.

CONCLUSIONS

Maternal BMI was positively associated with rates of offspring infection in this study cohort, and suggests that we should be supporting women to achieve a healthy weight for pregnancy. Future research should investigate whether this is replicated in other populations, whether there is a causal association and the potential mechanisms and areas for intervention.

Effect modification of pre-pregnancy body mass index on association of gestational weight gain with birth weight

Background

Maternal weight status, before or during pregnancy, is a significant determinant of fetus development, birth weight, and the short-term and long-term health outcomes of the offspring.

Objective

This study aimed to evaluate the effect modification of pre-pregnancy body mass index (BMI) on the associations of gestational weight gain (GWG) and birth weight, as per the latest guidelines from the Chinese Nutrition Society.

Methods

This is a retrospective cohort study performed in a tertiary hospital with the largest deliveries in Shanghai, China. This study included all women who had singleton live births from 2021 to 2022 (n = 50,391). Data on pre-pregnancy weight, GWG, and birth weight were extracted from the medical register system. Logistic regression models were used to estimate the associations of pre-pregnancy BMI and GWG with the risks of being small for gestational age (SGA) and large for gestational age (LGA). The potential for effect modification by BMI on the associations of GWG and birth weight was assessed using both additive and multiplicative scales.

Results

Pre-pregnancy BMI and GWG were consistently associated with birth weight. We observed a positive effect modification by underweight on the relationships between insufficient GWG and SGA both in multiplicative (adjusted odds ratio (OR), 2.49, 95 % confidence interval (CI): 2.06-2.99), and additive (relative excess risk due to interaction (RERI), 3.04, 95 % CI: 1.70-4.37) scales. Similarly, obesity was found to modify the effect of excessive GWG on the risk of LGA (adjusted OR, 3.82, 95 % CI, 3.14-4.63; RERI, 14.67, 95 % CI: 7.92-21.41).

Conclusion

Our findings indicate that increased GWG is associated with a higher risk of abnormal birth weight in singleton pregnancies. Additionally, there is evidence of an additive interaction between pre-pregnancy BMI and GWG on the risk of small for gestational age or large for gestational age.

Pre-pregnancy maternal obesity and infant neurodevelopmental outcomes in Latino infants

OBJECTIVE

This study explores the impact of maternal pre-pregnancy BMI on infant neurodevelopment at 24 months in low-income Latino families. It also investigates whether infant diet mediates this relationship.

METHODS

Latino mother-infant pairs (n = 163) were enrolled at 1 month post partum and were followed for 2 years, with assessments at 6-month intervals. Maternal pre-pregnancy anthropometrics were self-reported at baseline, and child neurodevelopment was assessed at 24 months using the Bayley Scales of Infant Development. Diet quality of infants was measured using the Healthy Eating Index (HEI)-2015 and HEI-Toddlers-2020 scores at multiple time points. Mediation and regression models that adjust for maternal factors were used to examine the associations.

RESULTS

Pre-pregnancy BMI showed significant negative associations with child cognitive scores (β = -0.1, 95% CI: -0.2 to -0.06, p < 0.001) and language scores (β = -0.1, 95% CI: -0.2 to -0.03, p = 0.01) at 24 months. Infant HEI-2015 scores at 24 months partly mediated these associations, explaining 23% and 30% of the total effect on cognitive and language subscales, respectively. No specific dietary components in infants mediated the relationship, except for the total HEI-2015 score.

CONCLUSIONS

Managing maternal obesity pre-pregnancy is crucial for improving infant neurodevelopmental outcomes, especially in low-income Latino families. Promoting healthy weight and enhancing infant diet quality can enhance neurodevelopment in these populations.