Objective To assess offspring attention-deficit hyperactivity disorder (ADHD) symptoms and emotional/behavioral impairments at age 10 in relation to maternal gestational weight gain (GWG) and pre-pregnancy body mass index (BMI). Design and Setting Longitudinal birth cohort from Magee-Womens Hospital, Pittsburgh, Pennsylvania (enrolled 1983-1986). Population Mother-infant dyads (n=511) were followed through pregnancy to 10 years. Methods Self-reported total GWG was converted to gestational-age-standardised z-scores. Multivariable linear and negative binomial regressions were used to estimate effects of GWG and BMI on outcomes. Main outcome measures Child ADHD symptoms were assessed with the Conners’ Continuous Performance Test. Child behavior was assessed by parent and teacher ratings on the Child Behavior Checklist (CBCL) and Teacher Report Form, respectively. Results The mean(SD) total GWG(kg) was 14.5(5.9), and 10% of women had a pregravid BMI ≥30. Pre-pregnancy obesity (BMI of 30kg/m2) was associated with increased offspring problem behaviors including internalizing behaviors (adjusted β: 3.3 points, 95% CI: 1.7, 4.9), externalizing behaviors (adjusted β: 2.9 points, 95% CI: 1.4, 4.6), and attention problems (adjusted β: 2.3 points, 95% CI: 1.1, 3.4) on the CBCL, compared with normal weight mothers (BMI of 22 kg/m2). There were non-significant trends towards increased offspring impulsivity with low GWG among lean mothers (adjusted IRR: 1.2, 95% CI: 0.9, 1.5) and high GWG among overweight mothers (adjusted IRR: 1.7, 95% CI: 0.9, 2.8), but additional outcomes did not differ by GWG z-score. Results were not meaningful different after excluding high-substance users. Conclusions In a low-income and high-risk sample, we observed a small increase in child behavior problems among children of obese mothers, which could have an impact on child behavior in the population.

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