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Maternal prepregnancy weight status and associations with children’s development and disabilities at kindergarten

International Journal of Obesity volume 37, pages 1344–1351 (2013)Cite this article

Subjects

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 m2): 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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References

  1. Sun S, Ji Y, Kersten S, Qi L . Mechanisms of inflammatory responses in obese adipose tissue. Annu Rev Nutr 2012; 32: 261–286.

    Article  CAS  Google Scholar 

  2. Fisher SC, Kim SY, Sharma AJ, Rochat R, Morrow B . Is obesity still increasing among pregnant women? Prepregnancy obesity trends in 20 states, 2003-2009. Prev Med 2013; 56: 372–378.

    Article  CAS  Google Scholar 

  3. Lain KY, Catalano PM . Metabolic changes in pregnancy. Clin Obstet Gynecol 2007; 50: 938–948.

    Article  Google Scholar 

  4. Denison FC, Roberts KA, Barr SM, Norman JE . Obesity, pregnancy, inflammation, and vascular function. Reproduction 2010; 140: 373–385.

    Article  CAS  Google Scholar 

  5. Heerwagen MJ, Miller MR, Barbour LA, Friedman JE . Maternal obesity and fetal metabolic programming: a fertile epigenetic soil. Am J Physiol Regul Integr Comp Physiol 2010; 299: R711–R722.

    Article  CAS  Google Scholar 

  6. Stothard K, Tennant PWG, Bell R, Rankin J . Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA (Chicago, Ill) 2009; 301: 636–650.

    CAS  Google Scholar 

  7. Bowers K, Zhang C . Maternal diabetes and autism spectrum disorders in the offspring: a review of epidemiological evidence and potential biologic mechanisms. N Am J Med Sci 2011; 4: 217–221.

    Article  Google Scholar 

  8. Onore C, Careaga M, Ashwood P . The role of immune dysfunction in the pathophysiology of autism. Brain Behav Immun 2012; 26: 383–392.

    Article  CAS  Google Scholar 

  9. Bilbo SD, Schwarz JM . Early-life programming of later-life brain and behavior: a critical role for the immune system. Front Behav Neurosci 2009; 3: 14.

    Article  Google Scholar 

  10. Rees S, Inder T . Fetal and neonatal origins of altered brain development. Early Hum Dev 2005; 81: 753–761.

    Article  Google Scholar 

  11. Huleihel M, Golan H, Hallak M . Intrauterine infection/inflammation during pregnancy and offspring brain damages: possible mechanisms involved. Reprod Biol Endocrinol 2004; 2: 17.

    Article  Google Scholar 

  12. Van Lieshout RJ, Taylor VH, Boyle MH . Pre-pregnancy and pregnancy obesity and neurodevelopmental outcomes in offspring: a systematic review. Obes Rev 2011; 12: e548–e559.

    Article  CAS  Google Scholar 

  13. Brion MJ, Zeegers M, Jaddoe V, Verhulst F, Tiemeier H, Lawlor DA et al. Intrauterine effects of maternal prepregnancy overweight on child cognition and behavior in 2 cohorts. Pediatrics 2011; 127: e202–e211.

    Article  Google Scholar 

  14. Heikura U, Taanila A, Hartikainen AL, Olsen P, Linna SL, von Wendt L et al. Variations in prenatal sociodemographic factors associated with intellectual disability: a study of the 20-year interval between two birth cohorts in northern Finland. Am J Epidemiol 2008; 167: 169–177.

    Article  Google Scholar 

  15. Rodriguez A, Miettunen J, Henriksen TB, Olsen J, Obel C, Taanila A et al. Maternal adiposity prior to pregnancy is associated with ADHD symptoms in offspring: evidence from three prospective pregnancy cohorts. Int J Obes (Lond) 2008; 32: 550–557.

    Article  CAS  Google Scholar 

  16. Rodriguez A . Maternal pre-pregnancy obesity and risk for inattention and negative emotionality in children. J Child Psychol Psychiatry 2010; 51: 134–143.

    Article  Google Scholar 

  17. Basatemur E, Gardiner J, Williams C, Melhuish E, Barnes J, Sutcliffe A . Maternal prepregnancy BMI and child cognition: a longitudinal cohort study. Pediatrics 2013; 131: 56–63.

    Article  Google Scholar 

  18. Buss C, Entringer S, Davis EP, Hobel CJ, Swanson JM, Wadhwa PD et al. Impaired executive function mediates the association between maternal pre-pregnancy body mass index and child ADHD symptoms. PLoS One 2012; 7: e37758.

    Article  CAS  Google Scholar 

  19. Neggers YH, Goldenberg RL, Ramey SL, Cliver SP . Maternal prepregnancy body mass index and psychomotor development in children. Acta Obstet Gynecol Scand 2003; 82: 235–240.

    Article  Google Scholar 

  20. Krakowiak P, Walker CK, Bremer AA, Baker AS, Ozonoff S, Hansen RL et al. Maternal metabolic conditions and risk for autism and other neurodevelopmental disorders. Pediatrics 2012; 129: e1121–e1128.

    Article  Google Scholar 

  21. Mann JR, McDermott SW, Hardin J, Pan C, Zhang Z . Pre-pregnancy body mass index, weight change during pregnancy, and risk of intellectual disability in children. BJOG 2013; 120: 309–319.

    Article  CAS  Google Scholar 

  22. Tanda R, Salsberry PJ, Reagan PB, Fang MZ . The impact of prepregnancy obesity on children’s cognitive test scores. Matern Child Health J 2012; 17: 222–229.

    Article  Google Scholar 

  23. Hinkle SN, Schieve LA, Stein AD, Swan DW, Ramakrishnan U, Sharma AJ . Associations between maternal prepregnancy body mass index and child neurodevelopment at 2 years of age. Int J Obes (Lond) 2012; 36: 1312–1319.

    Article  CAS  Google Scholar 

  24. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000; 894, i-xii 1–253.

  25. Andreassen C, Fletcher P . Early Childhood Longitudinal Study, Birth Cohort (ECLS–B) Psychometric Report for the 2-Year Data Collection (NCES 2007–084). National Center for Education Statistics, Institute of Education Sciences, U.S. Department of Education: Washington, DC, 2007.

    Google Scholar 

  26. Najarian M, Snow K, Lennon J, Kinsey S . Early Childhood Longitudinal Study, Birth Cohort (ECLS-B), Preschool–Kindergarten 2007 Psychometric Report (NCES 2010-009). National Center for Education Statistics, Institute of Education Sciences, U.S. Department of Education: Washington, DC, 2010.

    Google Scholar 

  27. Nord C, Edwards B, Andreassen C, Green JL, Wallner-Allen K . Early Childhood Longitudinal Study, Birth Cohort (ECLS-B), User’s Manual for the ECLS-B Longitudinal 9-Month–2-Year Data File and Electronic Codebook (NCES 2006–046). National Center for Education Statistics, Institute of Education Sciences, U.S. Department of Education: Washington, DC, 2006.

    Google Scholar 

  28. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R et al. CDC growth charts: United States. Adv Data 2000; 314: 1–27.

    Google Scholar 

  29. Bieler GS, Brown GG, Williams RL, Brogan DJ . Estimating model-adjusted risks, risk differences, and risk ratios from complex survey data. Am J Epidemiol 2010; 171: 618–623.

    Article  Google Scholar 

  30. Greenland S, Pearl J, Robins JM . Causal diagrams for epidemiologic research. Epidemiology 1999; 10: 37–48.

    Article  CAS  Google Scholar 

  31. Textor J, Hardt J, Knüppel S . DAGitty: a graphical tool for analyzing causal diagrams. Epidemiology 2011; 22: 745.

    Article  Google Scholar 

  32. Wilcox AJ, Weinberg CR, Basso O . On the pitfalls of adjusting for gestational age at birth. Am J Epidemiol 2011; 174: 1062–1068.

    Article  Google Scholar 

  33. Weight Gain During Pregnancy: Reexamining the Guidelines. Institute of Medicine and National Research Council: Washington, DC, 2009.

  34. Boyle CA, Boulet S, Schieve LA, Cohen RA, Blumberg SJ, Yeargin-Allsopp M et al. Trends in the prevalence of developmental disabilities in US children, 1997-2008. Pediatrics 2011; 127: 1034–1042.

    Article  Google Scholar 

  35. Levy S, Giarelli E, Lee L-C, Scheive LA, Kirby RS, Cunniff C et al. Autism spectrum disorder and co-occurring developmental, psychiatric, and medical conditions among children in multiple populations of the United States. J Dev Behav Pediatr 2010; 31: 267–275.

    Article  Google Scholar 

  36. Kral JG, Kava RA, Catalano PM, Moore BJ . Severe obesity: the neglected epidemic. Obes Facts 2012; 5: 254–269.

    Article  Google Scholar 

  37. Sullivan EL, Nousen EK, Chamlou KA . Maternal high fat diet consumption during the perinatal period programs offspring behavior. Physiol Behav 2012. e-pub ahead of print 17 October 2012; doi: 10.1016/j.physbeh.2012.07.014.

    Article  CAS  Google Scholar 

  38. Moore G, Kneitel A, Walker C, Gilbert W, Xing G . Autism risk in small- and large-for-gestational-age infants. Am J Obstet Gynecol 2012; 206: 314e1–31e9e.

    Article  Google Scholar 

  39. Keim SA, Pruitt NT . Gestational weight gain and child cognitive development. Int J Epidemiol 2012; 41: 414–422.

    Article  Google Scholar 

  40. Gage SH, Lawlor DA, Tilling K, Fraser A . Associations of maternal weight gain in pregnancy with offspring cognition in childhood and adolescence: findings from the Avon Longitudinal Study of Parents and Children. Am J Epidemiol 2013; 177: 402–410.

    Article  Google Scholar 

  41. Burkhalter T, Hillman C . A narrative review of physical activity, nutrition, and obesity to cognition and scholastic performance across the human lifespan. Adv Nutr 2011; 2: 201S–206SS.

    Article  Google Scholar 

  42. Bodnar LM, Siega-Riz AM, Simhan HN, Diesel JC, Abrams B . The impact of exposure misclassification on associations between prepregnancy BMI and adverse pregnancy outcomes. Obesity (Silver Spring) 2010; 18: 2184–2190.

    Article  Google Scholar 

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Acknowledgements

This research was performed in part under an appointment to the Centers for Disease Control and Prevention, administered by the Oak Ridge Institute for Science and Education under contract number DE-AC05–06OR23100 between the US Department of Energy and Oak Ridge Associated Universities.

DISCLAIMER

The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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Authors and Affiliations

  1. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA

    S N Hinkle, A J Sharma & S Y Kim

  2. US Public Health Service Commissioned Corps, Atlanta, GA, USA

    A J Sharma

  3. Division of Birth Defects and Development Disabilities, National Center for Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA

    L A Schieve

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  1. S N Hinkle
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Correspondence to A J Sharma.

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Hinkle, S., Sharma, A., Kim, S. et al. Maternal prepregnancy weight status and associations with children’s development and disabilities at kindergarten. Int J Obes 37, 1344–1351 (2013). https://doi.org/10.1038/ijo.2013.128

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