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Association of maternal pre-pregnancy or first trimester body mass index with neurodevelopmental impairment or death in extremely low gestational age neonates

Journal of Perinatology (2024)Cite this article

Subjects

Abstract

Objective

To compare the rates of death or survival with severe neurodevelopmental impairment (sNDI) at 2 years among extremely preterm infants in relation to pre-pregnancy or first-trimester maternal body mass index (BMI).

Methods

This retrospective cohort study included extremely preterm infants (gestational age 220/7–266/7 weeks). The study was conducted at National Institute of Child Health and Human Development Neonatal Research Network sites. The primary outcome was death or sNDI at 2 years.

Results

Data on the primary outcome were available for 1208 children. Death or sNDI was not different among the three groups: 54.9% in normal, 56.1% in overweight, and 53.4% in obese group (p = 0.39). There was no significant difference in mortality, sNDI, moderate/severe cerebral palsy, Bayley Scales of Infant Development (BSID)-III cognitive composite score <70, BSID-III language composite score <70 in adjusted models.

Conclusion

Neurodevelopmental outcome was not significantly associated with maternal pre-pregnancy BMI among extreme preterm infants.

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Data availability

Data reported in this paper may be requested through a data use agreement. Further details are available at https://neonatal.rti.org/index.cfm?fuseaction=DataRequest.Home.

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Acknowledgements

The National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) provided grant support for the Neonatal Research Network for the Generic Database and the Follow-up Study. NICHD staff provided input into the study design, conduct, analysis, and manuscript drafting; NCATS cooperative agreements provided infrastructure support to the NRN. While NICHD staff had input into the study design, conduct, analysis, and manuscript drafting, the comments and views of the authors do not necessarily represent the views of NICHD, the National Institutes of Health, the Department of Health and Human Services, or the U.S. Government. Data collected at participating sites of the NICHD Neonatal Research Network were transmitted to RTI International, the data coordinating center (DCC) for the network, which stored, managed, and analyzed the data included in this study. On behalf of the NRN, RTI International had full access to all the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We are indebted to our medical and nursing colleagues and the infants and their parents who agreed to take part in this study. The following investigators, in addition to those listed as authors, participated in this study: NRN Steering Committee Chair: Richard A. Polin, MD, Division of Neonatology, College of Physicians and Surgeons, Columbia University. Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island (UG1 HD27904) – Martin Keszler, MD; Angelita M. Hensman, PhD RNC-NIC; Elisa Vieira, BSN RN; Lucille St. Pierre, BS; Barbara Alksninis, RNC PNP; Andrea Knoll; Mary L. Keszler, MD; Teresa M. Leach, MEd CAES; Elisabeth C. McGowan, MD; Victoria E. Watson, MS CAS. Case Western Reserve University, Rainbow Babies & Children’s Hospital (UG1 HD21364) – Michele C. Walsh, MD MS; Anna Maria Hibbs, MD MSCE; Nancy S. Newman, RN; Deanne E. Wilson-Costello, MD; Bonnie S. Siner, RN; Elizabeth Roth, MD. Children’s Mercy Hospital (UG1 HD68284) – William E. Truog, MD; Eugenia K. Pallotto, MD MSCE; Howard W. Kilbride MD; Cheri Gauldin, RN BS CCRC; Anne Holmes RN MSN MBA-HCM CCRC; Allison Scott, BSN RNC-NIC; Prabhu S. Parimi, MD; Lisa Gaetano, RN MSN. Cincinnati Children’s Hospital Medical Center, University Hospital, and Good Samaritan Hospital (UG1 HD27853, UL1 TR77) – Stephanie L. Merhar, MD MS; Brenda B. Poindexter, MD MS; Kurt Schibler, MD; Tanya E. Cahill, MD; David Russell, JD; Cathy Grisby, BSN CCRC; Kristin Kirker, CRC; Sandra Wuertz, RN BSN CLC; Juanita Dudley, RN BSN; Julia Thompson, RN BSN; Sara Stacey, BA; Devan Hayes, BS. Duke University School of Medicine, University Hospital, University of North Carolina, Duke Regional Hospital, and WakeMed Health & Hospitals (UG1 HD40492, UL1 TR1117) – C. Michael Cotten, MD MHS; Ronald N. Goldberg, MD; William F. Malcolm, MD; Patricia L. Ashley, MD; Deesha Mago-Shah, MD; Mollie Warren, MD; Joanne Finkle, RN JD; Kimberley A. Fisher, PhD FNP-BC IBCLC; Kathryn E. Gustafson, PhD; Matthew M. Laughon, MD MPH; Carl L. Bose, MD; Janice Bernhardt, MS RN; Gennie Bose, RN; Janice Wereszczak, CPNP-AC/PC; Andrea Trembath, MD MPH; Jennifer Talbert, MS RN; Stephen D. Kicklighter, MD; Alexandra Bentley, MD; Laura Edwards, MD; Ginger Rhodes-Ryan, ARNP MSN, NNP-BC; Donna White, RN-BC BSN. Emory University, Children’s Healthcare of Atlanta, Grady Memorial Hospital, and Emory University Hospital Midtown (UG1 HD27851, UL1 TR454) – Ravi M. Patel, MD MSc; David P. Carlton, MD; Ira Adams-Chapman, MD (deceased); Yvonne Loggins, RN; Diane Bottcher, RN; Sheena L. Carter, PhD; Salathiel Kendrick-Allwood, MD; Maureen Mulligan LaRossa, RN; Judith Laursen, RN; Colleen Mackie, RRT; Amy Sanders, PsyD; Gloria Smikle, PNP; Lynn Wineski, NNP. Eunice Kennedy Shriver National Institute of Child Health and Human Development – Andrew A. Bremer, MD PhD; Rosemary D. Higgins, MD; Stephanie Wilson Archer, MA. Indiana University, Methodist Hospital, and Riley Hospital for Children (UG1 HD27856, UL1 TR6) – Gregory M. Sokol, MD; Abbey C. Hines, PsyD; Dianne E. Herron, RN CCRC; Donna Watkins, MSN NNP-BC; Susan Gunn, NNP-BC CCRC; Jeff Joyce, CCRC (deceased). McGovern Medical School at The University of Texas Health Science Center at Houston, Children’s Memorial Hermann Hospital, and Memorial Hermann Southwest Hospital (U10 HD21373, UG1 HD87229) – Jon E. Tyson, MD MPH; Amir M. Khan, MD; Kathleen A. Kennedy, MD MPH; Barbara J. Stoll, MD; Elizabeth Eason, MD; Ricardo A. Mosquera, MD MS; Andrea F. Duncan, MD MS; Nora I. Alaniz, BS; Fatima Boricha, MD; Allison G. Dempsey, PhD; Donna J. Hall, RN; Janice John, CPNP; Karen Martin, RN; Georgia E. McDavid, RN; Shannon L. McKee, EdS; Kimberly Rennie, PhD; Tina Reddy, MD; Debasree Sana Boral, IMG; Daniel K. Sperry, RN; Emily Stephens, BSN RNC-NIC; Sharon L. Wright, MT (ASCP). Nationwide Children’s Hospital, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Center for Perinatal Research, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, and Riverside Methodist Hospital (UG1 HD68278) – Pablo J. Sánchez, MD; Leif D. Nelin, MD; Jonathan L. Slaughter, MD MPH; Sudarshan R. Jadcherla, MD; Nathalie L. Maitre, MD PhD; Christopher Timan, MD; Keith O. Yeates, MD PhD; Patricia Luzader, RN; Julie Gutentag, RN BSN; Jennifer L. Grothause, BA RN BSN; Melanie Stein, RRT BBS; Rox Ann Sullivan, RN BSN; Cole D. Hague, BA MS; Helen Carey, PT DHSc PCS; Michelle Chao, BS; Stephanie Burkhardt, BS MPH; Margaret Sullivan, BS; Lina Yossef-Salameh, MD; Mary Ann Nelin, MD; Erna Clark, BA; Julie C. Shadd, BSN RD; Courtney Park, RN BSN; Courtney Cira, BS; Erin Fearns; Kristi Small, BS; Sarah A. Keim, PhD MA MS; Christine A. Fortney, RN PhD; Aubrey Fowler, BS, Jacqueline McCool; Lindsay Pietruszewski, PT DPT; Jessica Purnell, BS CCRC; Kyrstin Warnimont, BS; Laura Marzec, MD; Bethany Miller, RN BSN; Demi R. Beckford, MHS; Hallie Baugher, BS MSN; Julia Newton, MPH; Katelyn Levengood, PT DPT; Nancy Batterson, OT/L; Brittany DeSantis, BS. RTI International (UG1 HD36790) – Carla M. Bann, PhD; Dennis Wallace, PhD; Marie G. Gantz, PhD; Jeanette O’Donnell Auman, BS; Barry Eggleston, MS; Margaret Crawford, BS; Jenna Gabrio, BS MPH; Jamie E. Newman, PhD MPH; Lindsay Parlberg, BS; Carolyn M. Petrie Huitema, MS; Kristin M. Zaterka-Baxter, RN BSN. Stanford University, El Camino Hospital, and Lucile Packard Children’s Hospital (UG1 HD27880, UL1 TR93) – Valerie Chock, MD MS Epi; David K. Stevenson, MD; M. Bethany Ball, BS CCRC; Barbara Bentley, PsychD MSEd; Maria Elena DeAnda, PhD; Anne M. DeBattista, RN PNP PhD; Beth Earhart, PhD; Lynne C. Huffman, MD; Casey E. Krueger, PhD; Ryan E. Lucash, PhD; Melinda S. Proud, RCP; Elizabeth N. Reichert, MA CCRC; Heather Taylor, PhD; Hali E. Weiss, MD; R. Jordan Williams, MD. University of Alabama at Birmingham Health System and Children’s Hospital of Alabama (UG1 HD34216) – Waldemar A. Carlo, MD; Myriam Peralta-Carcelen, MD MPH; Kirstin J. Bailey, PhD; Fred J. Biasini, PhD; Stephanie A. Chopko, PhD; Monica V. Collins, RN BSN MaEd; Shirley S. Cosby, RN BSN; Kristy A. Domnanovich, PhD; Chantel J. Jno-Finn, PT DPT; Morissa Ladinsky, MD; Mary Beth Moses, PT MS PCS; Tara E. McNair, RN BSN; Vivien A. Phillips, RN BSN; Julie Preskitt, MSOT MPH; Richard V. Rector, PhD; Kimberlly Stringer, MD MPH; Sally Whitley, MA OTR-L FAOTA; Sheree York Chapman, PT DPT PCS. University of California - Los Angeles, Mattel Children’s Hospital, Santa Monica Hospital, Los Robles Hospital and Medical Center, and Olive View Medical Center (UG1 HD68270) – Uday Devaskar, MD; Meena Garg, MD; Isabell B. Purdy, PhD CPNP; Teresa Chanlaw, MPH; Rachel Geller, RN BSN. University of Iowa, Mercy Medical Center, and Sanford Health (UG1 HD53109, UL1 TR442) – Tarah T. Colaizy, MD MPH; Jane E. Brumbaugh, MD; Heidi M. Harmon, MD MS; Karen J. Johnson, RN BSN; Mendi L. Schmelzel, RN MSN; Jacky R. Walker, RN; Claire A. Goeke, DNP ARNP; Sarah E. Faruqui, RN MSN; Diane L. Eastman, RN CPNP MA; Michelle L. Baack, MD; Laurie A. Hogden, MD; Megan M. Henning, RN; Chelsey Elenkiwich, NNP APRN CNP; Megan Broadbent, RN BSN; Sarah Van Muyden, RN BSN; Dan L. Ellsbury, MD; Tracy L. Tud, RN. University of New Mexico Health Sciences Center (UG1 HD53089, UL1 TR41) – Kristi L. Watterberg, MD; Janell Fuller, MD; Robin K. Ohls, MD; Conra Backstrom Lacy, RN; Carol Hartenberger, BSN MPH; Sandra Sundquist Beauman, MSN RNC; Mary Ruffner Hanson, RN BSN; Jean R. Lowe, PhD; Elizabeth Kuan, RN BSN. University of Pennsylvania, Hospital of the University of Pennsylvania, Pennsylvania Hospital, and Children’s Hospital of Philadelphia (UG1 HD68244) – Sara B. DeMauro, MD MSCE; Barbara Schmidt, MD MSc; Haresh Kirpalani, MB MSc; Soraya Abbasi, MD; Aasma S. Chaudhary, BS RRT; Toni Mancini, RN BSN CCRC; Jonathan Snyder, RN BSN, Kristina Ziolkowski, CMA(AAMA) CCRP. University of Rochester Medical Center, Golisano Children’s Hospital, and the University of Buffalo Women’s and Children’s Hospital of Buffalo (UG1 HD68263, UL1 TR42) – Carl T. D’Angio, MD; Ronnie Guillet, MD PhD; Satyan Lakshminrusimha, MD; Gary J. Myers, MD; Anne Marie Reynolds, MD; Holly I.M. Wadkins; Michael G. Sacilowski, BS; Rosemary L. Jensen; Joan Merzbach, LMSW; William Zorn, PhD; Osman Farooq, MD; Stephanie Guilford, BS; Kelley Yost, PhD; Mary Rowan, RN; Diane Prinzing; Ann Marie Scorsone, MS CCRC; Michelle Hartley-McAndrew, MD; Kyle Binion, BS; Constance Orme; Premini Sabaratnam, MPH; Alison Kent, BMBS FRACP MD; Rachel Jones; Elizabeth Boylin, BA; Daisy Rochez, BS MHA; Emily Li, BA; Jennifer Kachelmeyer, BS; Kimberly G. McKee, BS; Kelly R. Coleman, PsyD; Deanna Maffett, RN. University of Texas Southwestern Medical Center, Parkland Health & Hospital System, and Children’s Medical Center Dallas (UG1 HD40689) – Luc P. Brion, MD; Roy J. Heyne, MD; Diana M. Vasil, MSN BSN RNC-NIC; Maria M. De Leon, RN BSN; Frances Eubanks, RN BSN; E. Rebecca McDougald, MSN APRN CPNP-PC/AC; Pollieanna Sepulveda, RN; Alicia Guzman; Elizabeth Heyne, PsyD PA-C; Lizette E. Lee, RN; Azucena Vera, AS; Jillian Waterbury, DNP RN CPNP-PC; Cathy Twell Boatman, MS CIMI; Kristine Tolentino-Plata, MS. University of Utah Medical Center, Intermountain Medical Center, McKay-Dee Hospital, Utah Valley Hospital, and Primary Children’s Medical Center (UG1 HD87226, UL1 TR105) – Bradley A. Yoder, MD; Mariana Baserga, MD MSCI; Roger G. Faix, MD; Sarah Winter, MD; Stephen D. Minton, MD; Mark J. Sheffield, MD; Carrie A. Rau, RN BSN CCRC; Shawna Baker, RN; Jill Burnett, RNC BSN; Susan Christensen, RN; Sean D. Cunningham, PhD; Brandy Davis, RN BSN; Jennifer O. Elmont, RN BSN; Becky Hall, APRN; Erika R. Jensen, APRN; Jamie Jordan, RN BSN; Manndi C. Loertscher, BS CCRP; Trisha Marchant, RNC BSN; Earl Maxson, RN CCRN; Kandace M. McGrath, BS; Hena G. Mickelsen, BA; Galina Morshedzadeh, BSN APRN; D. Melody Parry, RN BSN; Susan T. Schaefer, RN BSN RRT; Kelly Stout, PhD; Ashley L. Stuart, PhD; Katherine Tice, RN BSN; Kimberlee Weaver-Lewis, RN MS; Kathryn D. Woodbury, RN BSN. Wayne State University, Hutzel Women’s Hospital, and Children’s Hospital of Michigan (UG1 HD21385) – Beena G. Sood, MD MS; Athina Pappas, MD; Monika Bajaj, MD; Melissa February, MD; Prashant Agarwal, MD; Rebecca Bara, RN BSN; Kirsten Childs, RN BSN; Eunice Hinz Woldt, RN MSN; Laura Goldston, MA, John Barks, MD; Stephanie A. Wiggins, MS; Mary K. Christensen, BA RRT; Martha Carlson, MD; Diane F. White, RRT CCRP.

Funding

The National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (U10 HD21373, UG1 HD21364, UG1 HD21385, UG1 HD27851, UG1 HD27853, UG1 HD27856, UG1 HD27880, UG1 HD27904, UG1 HD34216, UG1 HD36790, UG1 HD40492, UG1 HD40689, UG1 HD53089, UG1 HD53109, UG1 HD68244, UG1 HD68270, UG1 HD68278, UG1 HD68263, UG1 HD68284; UG1 HD87226, UG1 HD87229) and the National Center for Advancing Translational Sciences (NCATS) (UL1 TR6, UL1 TR41, UL1 TR42, UL1 TR77, UL1 TR93, UL1 TR105, UL1 TR442, UL1 TR454, UL1 TR1117, provided grant support for the Neonatal Research Network, including for the Follow-up Study. Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA. All authors have indicated they have no financial relationships relevant to this article to disclose.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Central Michigan University, Wayne State University, Children’s Hospital of Michigan, Detroit, MI, USA

    Sanjay Chawla & Girija Natarajan

  2. Department of Pediatrics, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI, USA

    Abbot R. Laptook & Betty R. Vohr

  3. RTI International, Washington, DC, USA

    Emily A. Smith & Sylvia Tan

  4. Department of Pediatrics, UT Southwestern Medical Center at Dallas, Dallas, TX, USA

    Myra H. Wyckoff

  5. Department of Pediatrics, Duke University, Durham, NC, USA

    Rachel G. Greenberg & C. Michael Cotten

  6. Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA

    Namasivayam Ambalavanan & Waldemar A. Carlo

  7. Department of Pediatrics, University of Iowa, Iowa City, IA, USA

    Edward F. Bell & Tarah T. Colaizy

  8. Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA

    Krisa P. Van Meurs & Susan R. Hintz

  9. Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA, USA

    Erika F. Werner

  10. Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, MA, USA

    Abhik Das

  11. Department of Pediatrics, University of Texas, Austin, TX, USA

    Seetha Shankaran

  12. Department of Pediatrics, Case Western University, Ohio, USA

    Anna Maria Hibbs

  13. Department of Pediatrics, Cincinnati Children’s Hospital, Cincinnati, OH, USA

    Stephanie Merhar

  14. Department of Pediatrics, Emory University, Atlanta, GA, USA

    Ravi M. Patel

  15. Ann and Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Aaron Hamvas

  16. Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA

    Abhay J. Bhatt

  17. Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA

    Janell Fuller

  18. Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA

    Sara DeMauro

  19. Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA

    Anup C. Katheria

  20. Department of Neonatology, Intermountain Healthcare, Murray, UT, USA

    Robin K. Ohls

  21. Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA

    Jon E. Tyson

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  1. Sanjay Chawla
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  2. Abbot R. Laptook
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Consortia

NICHD Neonatal Research Network

  • Waldemar A. Carlo
  • , Anna Maria Hibbs
  • , Stephanie Merhar
  • , C. Michael Cotten
  • , Ravi M. Patel
  • , Tarah T. Colaizy
  • , Aaron Hamvas
  • , Abhay J. Bhatt
  • , Janell Fuller
  • , Sara DeMauro
  • , Anup C. Katheria
  • , Robin K. Ohls
  •  & Jon E. Tyson

Contributions

1. Sanjay Chawla, MD: Developed the protocol, created the data collection form, reviewed the analysis, and drafted the first version of the manuscript. 2. Abbot R. Laptook, MD: Contributed to the conception and design, reviewed the protocol, contributed to the analysis, and revised the manuscript critically. 3. Emily A. Smith, MPH: Reviewed the protocol, conducted the data analysis, and revised the manuscript critically. 4. Sylvia Tan, MS: Reviewed the protocol, conducted the data analysis, and revised the manuscript critically. 5. Girija Natarajan: Contributed to the conception and design, reviewed the protocol, contributed to the analysis, and revised the manuscript critically. 6. Myra H. Wyckoff, MD: Contributed to the conception and design, reviewed the protocol, contributed to the analysis, and revised the manuscript critically. 7. Rachel G. Greenberg, MD, MB, MHS: Contributed to the conception and design, reviewed the protocol, contributed to the analysis, and revised the manuscript critically. 8. Namasivayam Ambalavanan, MD: Contributed to the conception and design, reviewed the protocol, contributed to the analysis, and revised the manuscript critically. 9. Edward F. Bell, MD: Contributed to the conception and design, reviewed the protocol, contributed to the analysis, and revised the manuscript critically. 10. Krisa P. Van Meurs, MD: Contributed to the conception and design, reviewed the protocol, contributed to the analysis, and revised the manuscript critically 11. Susan Hintz, MD: Contributed to the conception and design, reviewed the protocol, contributed to the analysis, and revised the manuscript critically. 12. Betty R. Vohr MD: Contributed to the conception and design, reviewed the protocol, contributed to the analysis, and revised the manuscript critically. 13. Erika F. Werner, MD, MS: Contributed to the conception and design, reviewed the protocol, contributed to the analysis, and revised the manuscript critically. 14. Abhik Das, PhD: Contributed to the conception and design, supervised the analysis, reviewed the protocol and revised the manuscript critically. 15. Seetha Shankaran, MD: Contributed to the conception and design, reviewed the protocol, contributed to the analysis, and revised the manuscript critically. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Sanjay Chawla.

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Chawla, S., Laptook, A.R., Smith, E.A. et al. Association of maternal pre-pregnancy or first trimester body mass index with neurodevelopmental impairment or death in extremely low gestational age neonates. J Perinatol (2024). https://doi.org/10.1038/s41372-024-01905-7

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  • DOI: https://doi.org/10.1038/s41372-024-01905-7

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