Maternal pre-pregnancy obesity and offspring hyperactivity-inattention symptoms at 5 years in preterm and term children: a multi-cohort analysis

Abstract

The objective of this study was to determine the relationship between maternal pre-pregnancy body mass index (BMI) and child hyperactivity-inattention symptoms (HIS) at 5 years, including preterm and term-born children, and to determine whether this association varied with gestational age. Maternal pre-pregnancy BMI and offspring HIS were assessed in 10,898 participants born ≥ 33 weeks of gestation from the ELFE cohort and 2646 children born between 23 and 34 weeks from the EPIPAGE 2 cohort. Reported pre-pregnancy weight (kg) and measured height (m) were collected from mothers at inclusion and used to classify BMI (kg/m²). Child HIS were evaluated using the Strengths and Difficulties Questionnaire around 5 years of age. Logistic regression estimated odds ratios (OR) of a high HIS score (≥ 90th percentile) in the ELFE cohort and generalized estimated equations were used in EPIPAGE 2 to account for non-independence of multiple births. As a negative control, paternal BMI was also considered as an exposure of interest in sensitivity analyses. Maternal pre-pregnancy obesity and overweight were associated with child HIS at 5 years in ELFE (adjusted OR [aOR] for obesity 1.27 [1.06, 1.53]; overweight aOR 1.16 [1.00, 1.36]) and pre-pregnancy obesity was associated with high HIS scores in preterm infants of EPIPAGE 2 (aOR 1.48 [1.06, 2.08]). In ELFE, the magnitude of the association increased with decreasing gestational age (interaction p = 0.02). High maternal pre-pregnancy BMI is associated with greater likelihood of high HIS scores in both at-term and preterm children at 5 years of age.

Figure 1

(A) Flowchart of study participation in the ELFE cohort study. (B) Flowchart of study participation in the EPIPAGE 2 cohort study.

Figure 2

Adjusted odds ratios for a high hyperactivity-inattention symptom score (≥ 7) in 5.5 year old children of the ELFE (n = 10,898; black points) and EPIPAGE 2 cohorts (n = 2646; grey points). ^aAdjusted for maternal age at birth, maternal education, household income (ELFE), household socioeconomic category (EPIPAGE 2), parity, sex, psychological problems during pregnancy (ELFE), anxiety symptoms (EPIPAGE 2), singleton pregnancy (EPIPAGE 2), maternal physical activity during pregnancy (ELFE), maternal healthy diet score during pregnancy (ELFE), maternal alcohol intake during pregnancy (ELFE), maternal smoking during pregnancy, child age at evaluation, gestational age, breastfeeding, cause of prematurity (EPIPAGE 2) childcare at 2 years, screentime at 2 years (ELFE), HOME score (EPIPAGE 2), difficulties falling asleep at 2 years (ELFE) and frequent night waking at 2 years (EPIPAGE 2). ^bMissing covariates are imputed and weighted using IPW.

Figure 3

Adjusted Odds ratios for maternal pre-pregnancy obesity and high hyperactivity-inattention symptom scores (≥ 7) by gestational age group in children 5 years old from the ELFE (n = 10,898) and EPIPAGE 2 (n = 2646) cohort studies .^aAdjusted for maternal age at birth, maternal education, household income (ELFE), household socioeconomic category (EPIPAGE 2), parity, sex, psychological problems during pregnancy (ELFE), anxiety symptoms (EPIPAGE 2), singleton pregnancy (EPIPAGE 2), maternal physical activity during pregnancy (ELFE), maternal healthy diet score during pregnancy (ELFE), maternal alcohol intake during pregnancy (ELFE), maternal smoking during pregnancy, child age at evaluation, gestational age, breastfeeding, cause of prematurity (EPIPAGE 2) childcare at 2 years, screentime at 2 years (ELFE), HOME score (EPIPAGE 2), difficulties falling asleep at 2 years (ELFE) and frequent night waking at 2 years (EPIPAGE 2). ^bMissing covariates are imputed and weighted using IPW.