Analysis of Maternal Prenatal Weight and Offspring Cognition and Behavior: Results From the Promotion of Breastfeeding Intervention Trial (PROBIT) Cohort | Child Development | JAMA Network Open | JAMA Network
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    Original Investigation
    Nutrition, Obesity, and Exercise
    August 19, 2021

    Analysis of Maternal Prenatal Weight and Offspring Cognition and Behavior: Results From the Promotion of Breastfeeding Intervention Trial (PROBIT) Cohort

    Author Affiliations
    • 1Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
    • 2The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
    • 3Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
    • 4Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
    • 5Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
    • 6Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
    • 7National Institute for Health Research Biomedical Research Centre, University Hospitals Bristol and Weston National Health Service Foundation Trust, University of Bristol, Bristol, United Kingdom
    • 8Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
    JAMA Netw Open. 2021;4(8):e2121429. doi:10.1001/jamanetworkopen.2021.21429
    Key Points

    Question  Is maternal prenatal weight associated with offspring cognitive ability and behavior?

    Findings  In this cohort study of 11 276 Belarusian children, higher maternal body mass index after 35 weeks’ gestation was associated with a slightly lower child intelligence quotient at 6.5 years and lower cognitive scores in multiple domains at 16 years. Associations were not mediated by child weight and were robust to adjustment for sociodemographic characteristics, pregnancy complications, and paternal weight.

    Meaning  These findings suggest that higher maternal body mass index during pregnancy may adversely influence offspring brain development.


    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 self-administered 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.