Analysis of maternal prenatal weight and offspring cognition and behavior: Results from the Promotion of Breastfeeding Intervention Trial (PROBIT) cohort

Emily Oken *, Jennifer W. Thompson , Sheryl L. Rifas-Shiman , Konstantin Vilchuk , Natalia Bogdanovich , Mikhail Hameza , Seungmi Yang , Rita Patel, Michael S. Kramer , Richard M Martin

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

IMPORTANCE
Prenatal experiences can influence fetal brain development.

OBJECTIVE
To examine associations of maternal prenatal body mass index (BMI) with cognition and behavior of offspring born full-term.

DESIGN, SETTING, AND PARTICIPANTS
This cohort study examined follow-up data from a breastfeeding promotion intervention at 31 hospitals and affiliated polyclinics in the Republic of
Belarus. Participants included 11 276 children who were evaluated from birth (1996-1997) to adolescence (2017-2019), with maternal BMI information available in prenatal medical records.

EXPOSURES
Maternal BMI, calculated as weight in kilograms divided by height in meters squared, after 35 weeks gestation; secondary analyses examined maternal BMI at other time points and paternal BMI.

MAIN OUTCOMES AND MEASURES
Trained pediatricians assessed child cognition with the Wechsler Abbreviated Scales of Intelligence (WASI) at 6.5 years and the computerized selfadministered NeuroTrax battery at 16 years, both with an approximate mean (SD) of 100 (15).
Parents and teachers rated behaviors at 6.5 years using the Strengths and Difficulties Questionnaire (SDQ, range 0-40). Mixed-effects linear regression analyses corrected for clustering, adjusted for the randomized intervention group and baseline parental sociodemographic characteristics, and were considered mediation by child BMI.

RESULTS
Among 11 276 participants, 9355 women (83%) were aged 20 to 34 years, 10 128 (89.8%) were married, and 11 050 (98.0%) did not smoke during pregnancy. Each 5-unit increase in of maternal late-pregnancy BMI (mean [SD], 27.2 [3.8]) was associated with lower offspring WASI performance intelligence quotient (IQ) (−0.52 points; 95% CI, −0.87 to −0.17 points) at 6.5 years and lower scores on 5 of 7 NeuroTrax subscales and the global cognitive score at 16 years (−0.67 points; 95% CI, −1.06 to −0.29 points). Results were similar after adjustment for sociodemographic characteristics, pregnancy complications, and paternal BMI and were not mediated by child weight. Higher late pregnancy maternal BMI was also associated with more behavioral problems reported on the SDQ by teachers but not associated with parent-reported behaviors (externalizing behaviors: 0.13 points; 95% CI, 0.02 to 0.24 points; and total difficulties: 0.14 points, 95% CI, −0.02 to 0.30 points). Results were similar for maternal BMI measured in the first trimester or postpartum. In contrast, higher 6.5-year paternal BMI was associated with slightly better child cognition (WASI verbal IQ: 0.42 points; 95% CI, 0.02 to 0.82 points; NeuroTrax executive function score: 0.68 points; 95% CI, 0.24 to 1.12 points) and fewer teacher-reported behavioral problems (total difficulties: −0.29 points; 95% CI, −0.46 to −0.11 points).

CONCLUSIONS AND RELEVANCE
This cohort study supports findings from animal experiments and human observational studies in settings with higher maternal BMI and obesity rates. Higher maternal prenatal BMI may be associated with poorer offspring brain development, although residual confounding cannot be excluded
Original languageEnglish
Article numbere2121429
JournalJAMA Network Open
Volume4
Issue number8
DOIs
Publication statusPublished - 19 Aug 2021

Bibliographical note

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© 2021 American Institute of Physics Inc.. All rights reserved.

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