Maternal pre-pregnancy obesity and child neurodevelopmental outcomes: a meta-analysis

Abstract

This review examined evidence of the association between maternal pre-pregnancy overweight/obesity status and child neurodevelopmental outcomes. PubMed and PsycINFO databases were systematically searched for empirical studies published before April 2017 using keywords related to prenatal obesity and children's neurodevelopment. Of 1483 identified papers, 41 were included in the systematic review, and 32 articles representing 36 cohorts were included in the meta-analysis. Findings indicated that compared with children of normal weight mothers, children whose mothers were overweight or obese prior to pregnancy were at increased risk for compromised neurodevelopmental outcomes (overweight: OR = 1.17, 95% CI [1.11, 1.24], I² = 65.51; obese: OR = 1.51; 95% CI [1.35, 1.69], I² = 79.63). Pre-pregnancy obesity increased the risk of attention deficit-hyperactivity disorder (OR = 1.62; 95% CI [1.23, 2.14], I² = 70.15), autism spectrum disorder (OR = 1.36; 95% CI [1.08, 1.70], I² = 60.52), developmental delay (OR = 1.58; 95% CI [1.39, 1.79], I² = 75.77) and emotional/behavioural problems (OR = 1.42; 95% CI [1.26, 1.59], I² = 87.74). Given the current obesity prevalence among young adults and women of childbearing age, this association between maternal obesity during pregnancy and atypical child neurodevelopment represents a potentially high public health burden.

Keywords: Child neurodevelopment; maternal weight; meta-analysis; prenatal obesity.

Figure 1. Study Identification and Selection

Figure 2. Forest plot for Obese Mothers and Their Offsprings’ Risk of ADHD

^aThe attention deficit hyperactivity problem subscale consists of 7 statements about the child that reflect attention deficit hyperactivity problems (in accordance with the DSM-IV). ^b30–35 kg/m². ^c35–40 kg/m². ^d>40 kg/m². Note: ADHD = Attention Deficit Hyperactivity Disorder. CBCL = Child Behavior Checklist. ICD-9, 10 = International Statistical Classification of Diseases and Related Health Problems, 9^th Edition, 10^th Edition. TRF = Teacher Report Form. ASD = Autism Spectrum Disorder. DSM-IV = Diagnostic and Statistical Manual for Mental Disorders, 5^th Edition.

Figure 3. Forest plot for Obese Mothers and Their Offsprings’ Risk of ASD

^aRisi et al. criteria uses combined information from the Autism Diagnostic Interview, Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS) to diagnose ASD. Note: ASD = Autism Spectrum Disorder, ICD-9, 10 = International Statistical Classification of Diseases and Related Health Problems, 9^th Edition, 10^th Edition, DSM-IV = Diagnostic and Statistical Manual for Mental Disorders, 5^th Edition, ADI-R = Autism Diagnostic Interview, Revised, ADOS = Autism Diagnostic Observation Schedule.

Figure 4. Forest plot for Obese Mothers and Their Offsprings’ Risk of Cognitive and Intellectual Delay

^aFSIQ < 80. ^bComposite score < 85 ^cSS < 70. ^dOther developmental disorder based on diagnosis of language delay, coordination disorders or learning disorders (315.0–315.5, ICD-9). ^eDefined as Intellectual Disability of any severity. ^fIQ < 89. Note: WPPSI-R = Wechsler Preschool and Primary Scale of Intelligence-Revised, ICD-9= International Statistical Classification of Diseases and Related Health Problems, 9^th Edition, BSID-II= Bayley Scales of Infant and Toddler Development, 2^nd Edition, BSF-R = Bayley Short Form-Revised, WISC-I = Wechsler intelligence Scale for Children, 1^st Edition, ASQ = Ages and Stages Questionnaire, MSEL = Mullen Scales of Early Learning, VABS = Vineland Adaptive Behavior Scales, SBIS-4 = Stanford Binet Intelligence Scale 4th Edition. WHO (2000) defines obese categories as obese class I = BMI 30.0–34.9, obese class II = BMI 35–39.99, and obese class III = BMI > 40.

Figure 5. Forest plot for Obese Mothers and Their Offsprings’ Risk of Emotional/Behavioral Problems

^a>6 symptoms present. ^b>7 symptoms present. ^c>6 month duration. ^dTotal Behavioral Scores ≥ 90th percentile Note: CBCL = Child Behavior Checklist, SDQ = Strength and Difficulties Questionnaire. WHO (2000) defines obese categories as obese class I = BMI 30.0–34.9, obese class II = BMI 35–39.99, and obese class III = BMI > 40.