Article | Published:

Pediatrics

Maternal early pregnancy obesity and related pregnancy and pre-pregnancy disorders: associations with child developmental milestones in the prospective PREDO Study

International Journal of Obesityvolume 42pages9951007 (2018) | Download Citation

Abstract

Background/objectives

Previous studies have linked maternal pre-pregnancy obesity (BMI ≥30 kg/m2) with suboptimal neurodevelopment in her offspring; however, the literature is not entirely consistent. Whether these effects are muddled by maternal self-reports of pre-pregnancy weight and height, or are driven or amplified by the well often comorbid hypertensive and diabetic pregnancy and pre-pregnancy disorders, remains unclear. We examined whether maternal early pregnancy obesity is associated with developmental delay in her offspring, and if the associations are driven or amplified by diabetic and hypertensive pregnancy and pre-pregnancy disorders.

Subjects/methods

A total of 2504 mother-child dyads participated in the Prediction and Prevention of Pre-eclampsia and Intrauterine Growth Restriction (PREDO) study. Data on maternal early pregnancy obesity, pre-pregnancy, and gestational hypertension, pre-eclampsia, type 1 and gestational diabetes were derived from the Finnish Medical Birth Register. At the child’s mean age of 42.1 (SD = 8.2) months the mothers completed the Ages and Stages Questionnaire (ASQ) Third edition for developmental milestones.

Results

Children of obese mothers had 1.81–2.74 (p-values <0.02) higher odds of failing to meet the development that is typical for a child’s age (developmental domain score ≤−2SD below the child’s age) on the communication, fine and gross motor, problem solving and personal/social skills and children of overweight mothers had 2.14 (p = 0.002) higher odds of failing to meet the development that is typical for the child’s age on communication skills. Odds of developmental delay were also higher for children of mothers with pre-eclampsia and gestational diabetes. The associations were robust to covariates and confounders, the effects of overweight/obesity and pre-eclampsia were not driven by the other disorders, and overweight/obesity and hypertensive and diabetic disorders did not show additive effects.

Conclusions

Maternal early pregnancy overweight, obesity, and pre-eclampsia are independently associated with neurodevelopmental delay in her offspring. Further studies unraveling the underlying mechanisms are warranted.

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References

  1. 1.

    NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet. 2016;387:1377–96.

  2. 2.

    Godfrey KM, Reynolds RM, Prescott SL, Nyirenda M, Jaddoe VW, Eriksson JG, et al. Influence of maternal obesity on the long-term health of offspring. Lancet Diabetes Endocrinol. 2016;5:53–64.

  3. 3.

    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:e1121–8.

  4. 4.

    Wylie A, Sundaram R, Kus C, Ghassabian A, Yeung EH. Maternal prepregnancy obesity and achievement of infant motor developmental milestones in the upstate KIDS study. Obesity. 2015;23:907–13.

  5. 5.

    Yeung EH, Sundaram R, Ghassabian A, Xie Y, Buck Louis G. Parental obesity and early childhood development. Pediatrics. 2017;139:e20161459.

  6. 6.

    Bliddal M, Olsen J, Stovring H, Eriksen HL, Kesmodel US, Sorensen TI, et al. Maternal pre-pregnancy BMI and intelligence quotient (IQ) in 5-year-old children: a cohort based study. PLoS ONE. 2014;9:e94498.

  7. 7.

    Casas M, Chatzi L, Carsin AE, Amiano P, Guxens M, Kogevinas M, et al. Maternal pre-pregnancy overweight and obesity, and child neuropsychological development: two Southern European birth cohort studies. Int J Epidemiol. 2013;42:506–17.

  8. 8.

    Pugh SJ, Richardson GA, Hutcheon JA, Himes KP, Brooks MM, Day NL, et al. Maternal obesity and excessive gestational weight gain are associated with components of child cognition. J Nutr. 2015;145:2562–9.

  9. 9.

    Huang L, Yu X, Keim S, Li L, Zhang L, Zhang J. Maternal prepregnancy obesity and child neurodevelopment in the Collaborative Perinatal Project. Int J Epidemiol. 2014;43:783–92.

  10. 10.

    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.

  11. 11.

    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.

  12. 12.

    Van Lieshout RJ, Schmidt LA, Robinson M, Niccols A, Boyle MH. Maternal pre-pregnancy body mass index and offspring temperament and behavior at 1 and 2 years of age. Child Psychiatry Hum Dev. 2013;44:382–90.

  13. 13.

    Rodriguez A. Maternal pre-pregnancy obesity and risk for inattention and negative emotionality in children. J Child Psychol Psychiatry. 2010;51:134–43.

  14. 14.

    Polanska K, Muszynski P, Sobala W, Dziewirska E, Merecz-Kot D, Hanke W. Maternal lifestyle during pregnancy and child psychomotor development - polish mother and child cohort study. Early Hum Dev. 2015;91:317–25.

  15. 15.

    Torres-Espinola FJ, Berglund SK, Garcia-Valdes LM, Segura MT, Jerez A, Campos D, et al. Maternal obesity, overweight and gestational diabetes affect the offspring neurodevelopment at 6 and 18 months of age--a follow up from the PREOBE cohort. PLoS ONE. 2015;10:e0133010.

  16. 16.

    Stommel M, Schoenborn CA. Accuracy and usefulness of BMI measures based on self-reported weight and height: findings from the NHANES & NHIS 2001-2006. BMC Public Health. 2009;9:421.

  17. 17.

    Brunner Huber LR. Validity of self-reported height and weight in women of reproductive age. Matern Child Health J. 2007;11:137–44.

  18. 18.

    Fraser A, Almqvist C, Larsson H, Langstrom N, Lawlor DA. Maternal diabetes in pregnancy and offspring cognitive ability: sibling study with 723,775 men from 579,857 families. Diabetologia. 2014;57:102–9.

  19. 19.

    Fraser A, Nelson SM, Macdonald-Wallis C, Lawlor DA. Associations of existing diabetes, gestational diabetes, and glycosuria with offspring IQ and educational attainment: the Avon Longitudinal Study of Parents and Children. Exp Diabetes Res. 2012;2012:963735.

  20. 20.

    Tearne JE, Allen KL, Herbison CE, Lawrence D, Whitehouse AJ, Sawyer MG, et al. The association between prenatal environment and children’s mental health trajectories from 2 to 14 years. Eur Child Adolesc Psychiatry. 2015;24:1015–24.

  21. 21.

    Ghassabian A, Sundaram R, Wylie A, Bell E, Bello SC, Yeung E. Maternal medical conditions during pregnancy and gross motor development up to age 24 months in the Upstate KIDS study. Dev Med Child Neurol. 2015;58:728–34.

  22. 22.

    Tuovinen S, Raikkonen K, Kajantie E, Leskinen JT, Henriksson M, Pesonen AK, et al. Hypertensive disorders in pregnancy and intellectual abilities in the offspring in young adulthood: the Helsinki Birth Cohort Study. Ann Med. 2012;44:394–403.

  23. 23.

    Tuovinen S, Eriksson JG, Kajantie E, Lahti J, Pesonen AK, Heinonen K, et al. Maternal hypertensive disorders in pregnancy and self-reported cognitive impairment of the offspring 70 years later: the Helsinki Birth Cohort Study. Am J Obstet Gynecol. 2013;208:200.e1–9.

  24. 24.

    Gissler M. Finnish health and social welfare registers in epidemiological research. Nor Epidemiol. 2004;14:113–20.

  25. 25.

    Girchenko P, Hamalainen E, Kajantie E, Pesonen AK, Villa P, Laivuori H, et al. Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction (PREDO) study. Int J Epidemiol. 2016;46:1380–1381g.

  26. 26.

    Squires J, Bricker D, Potter L. Revision of a parent-completed development screening tool: ages and stages questionnaires. J Pediatr Psychol. 1997;22:313–28.

  27. 27.

    Bricker D, Squires J, Kaminski R, Mounts L. The validity, reliability, and cost of a parent-completed questionnaire system to evaluate at-risk infants. J Pediatr Psychol. 1988;13:55–68.

  28. 28.

    Kerstjens JM, Bos AF, ten Vergert EM, de Meer G, Butcher PR, Reijneveld SA. Support for the global feasibility of the Ages and Stages Questionnaire as developmental screener. Early Hum Dev. 2009;85:443–7.

  29. 29.

    Steenis LJ, Verhoeven M, Hessen DJ, van Baar AL. Parental and professional assessment of early child development: the ASQ-3 and the Bayley-III-NL. Early Hum Dev. 2015;91:217–25.

  30. 30.

    Ellenberg A, Sarvilinna N, Gissler M, Ulander VM. New guidelines for screening, diagnosing, and treating gestational diabetes- evaluation of maternal and neonatal outcomes in Finland from 2006 to 2012. Acta Obstet Gynecol Scand. 2016;96:372–81.

  31. 31.

    Bilbo SD, Tsang V. Enduring consequences of maternal obesity for brain inflammation and behavior of offspring. FASEB J. 2010;24:2104–15.

  32. 32.

    Cordner ZA, Tamashiro KL. Effects of high-fat diet exposure on learning & memory. Physiol Behav. 2015;152:363–71.

  33. 33.

    Jing YH, Song YF, Yao YM, Yin J, Wang DG, Gao LP. Retardation of fetal dendritic development induced by gestational hyperglycemia is associated with brain insulin/IGF-I signals. Int J Dev Neurosci. 2014;37:15–20.

  34. 34.

    Catalano PM, Presley L, Minium J, Hauguel-de Mouzon S. Fetuses of obese mothers develop insulin resistance in utero. Diabetes Care. 2009;32:1076–80.

  35. 35.

    Dyer JS, Rosenfeld CR, Rice J, Rice M, Hardin DS. Insulin resistance in Hispanic large-for-gestational-age neonates at birth. J Clin Endocrinol Metab. 2007;92:3836–43.

  36. 36.

    Nehra V, Allen JM, Mailing LJ, Kashyap PC, Woods JA. Gut Microbiota: modulation of host physiology in obesity. Physiology. 2016;31:327–35.

  37. 37.

    Garcia-Mantrana I, Collado MC. Obesity and overweight: impact on maternal and milk microbiome and their role for infant health and nutrition. Mol Nutr Food Res. 2016;60:1865–75.

  38. 38.

    Azad MB, Konya T, Maughan H, Guttman DS, Field CJ, Chari RS, et al. Gut microbiota of healthy Canadian infants: profiles by mode of delivery and infant diet at 4 months. CMAJ. 2013;185:385–94.

  39. 39.

    Papachatzi E, Paparrodopoulos S, Papadopoulos V, Dimitriou G, Vantarakis A. Pre-pregnancy maternal obesity in Greece: a case-control analysis. Early Hum Dev. 2016;93:57–61.

  40. 40.

    Lepe M, Bacardi Gascon M, Castaneda-Gonzalez LM, Perez Morales ME, Jimenez Cruz A. Effect of maternal obesity on lactation: systematic review. Nutr Hosp. 2011;26:1266–9.

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Acknowledgements

The PREDO study would not have been possible without the dedicated contribution of the PREDO Study group members: A Aitokallio-Tallberg, A-M Henry, VK Hiilesmaa, T Karipohja, R Meri, S Sainio, T Saisto, S Suomalainen-Konig, V-M Ulander, T Vaitilo (Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland), L Keski-Nisula, Maija-Riitta Orden (Kuopio University Hospital, Kuopio Finland), E Koistinen, T Walle, R Solja (Northern Karelia Central Hospital, Joensuu, Finland), M Kurkinen (Päijät-Häme Central Hospital, Lahti, Finland), P.Taipale. P Staven (Iisalmi Hospital, Iisalmi, Finland), J Uotila (Tampere University Hospital, Tampere, Finland). We also thank the PREDO cohort mothers, fathers, and children for their enthusiastic participation.

Funding:

This work was supported by the Academy of Finland (K.R., grant numbers 284859, 2848591, 312670), (E.K., grant numbers 127437, 129306, 130326, 134791, 263924 and 274794), (H.L., grant numbers 121196, 134957, and 278941), (M.L.-P., grant number 12853241), (A.-K.P.); University of Helsinki Research Funds (M.L.-P.), (H.L.), British Heart Foundation (R.M.R.); Tommy’s (R.M.R.); European Commission (E.K., K.R., Horizon 2020 Award SC1-2016-RTD-733280 RECAP); Foundation for Pediatric Research (E.K.); Juho Vainio Foundation (E.K.); Novo Nordisk Foundation (E.K.); Signe and Ane Gyllenberg Foundation (K.R., E.K.); Sigrid Jusélius Foundation (E.K.); Finnish Medical Foundation (H.L.); Jane and Aatos Erkko Foundation (H.L.); Päivikki and Sakari Sohlberg Foundation (H.L.); and Doctoral Program of Psychology, Learning, and Communication, (P.G.).

Author information

Affiliations

  1. Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland

    • Polina Girchenko
    • , Soile Tuovinen
    • , Katri Savolainen
    • , Kati Heinonen
    • , Riikka Pyhälä
    • , Anu-Katriina Pesonen
    •  & Katri Räikkönen
  2. Department of Psychology and Logopedics, University of Helsinki, Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK

    • Marius Lahti-Pulkkinen
  3. Department of Psychology and Logopedics, University of Helsinki, Helsinki Collegium of Advanced Studies University of Helsinki, Helsinki, Finland

    • Jari Lahti
  4. Endocrinology Unit, Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK

    • Rebecca M. Reynolds
  5. HUSLAB and Department of Clinical Chemistry, Helsinki University Central Hospital, Helsinki, Finland

    • Esa Hämäläinen
  6. Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland

    • Pia M. Villa
  7. National Institute for Health and Welfare, Helsinki and Oulu, Children’s Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland

    • Eero Kajantie
  8. Medical and Clinical Genetics University of Helsinki and Helsinki University Hospital, Helsinki, Finland

    • Hannele Laivuori
  9. Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland

    • Hannele Laivuori
  10. Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland

    • Hannele Laivuori
  11. Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland

    • Hannele Laivuori

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Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Katri Räikkönen.

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DOI

https://doi.org/10.1038/s41366-018-0061-x

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