Child academic achievement in association with pre-pregnancy obesity and gestational weight gain

Abstract

Background Recent data suggest that children of mothers who are obese before pregnancy, or who gain too much weight during pregnancy, may be at an increased risk of cognitive impairments. Methods Mother–infant dyads enrolled in a birth cohort study in Pittsburgh, Pennsylvania (1983–1986), were followed from early pregnancy to 14 years postpartum (n=574). Math, reading and spelling achievements were assessed at ages 6 and 10 years using the Wide Range Achievement Test-Revised, and at age 14 years using the Wechsler Individual Achievement Test Screener. Self-reported total GWG was converted to gestational age-standardised z-scores. Generalised estimating equations were used to estimate the effects of GWG and pre-pregnancy body mass index (BMI) on academic achievement at 6, 10 and 14 years, while adjusting for maternal race, child sex, parity, employment, family income, maternal intelligence, maternal depression, pre-pregnancy BMI (in GWG models only) and the home environment. Results The mean (SD) BMI was 23.4 (5.7) kg/m2 and the mean (SD) GWG reported at delivery was 14.4 (5.9) kg. There was a significant non-linear association between pre-pregnancy BMI and an offspring’s academic achievement. At 6, 10 and 14 years, an offspring’s academic scores were inversely associated with pre-pregnancy BMI beyond 22 kg/m2. High GWG (>1 SD) was associated with approximately 4-point lower reading (adjusted β (adjβ) −3.75, 95% CI −7.1 to −0.4) and spelling scores (adjβ −3.90, 95% CI −7.8 to −0.2), compared with GWG −1 to +1 SD. Conclusions Future studies in larger and socioeconomically diverse populations are needed to confirm maternal weight and weight gain as causal determinants of a child’s academic skills, and whether this effect persists into adulthood.

Effects of physical exercise during pregnancy on maternal and infant outcomes in overweight and obese pregnant women: A meta‐analysis

“…16 Another recent meta-analysis aimed to evaluate the possible effect of exercise on the risk of preterm birth and found that exercise reduced the risk of preterm birth by 38% (RR = 0.62, 95% CI = [0.41-0.95]). Consistent with other studies, 13,[37][38][39]41,42,44 the current meta-analysis found no significant effect of exercise during pregnancy in overweight and obese pregnant women, on birthweight, preterm birth, small for gestational age, large for gestational age, or macrosomia at birth. The current meta-analysis examined the impact of exercise intervention alone for overweight and obese pregnant women.…”

“…2 Many studies have shown the adverse effects of maternal overweight and obesity during pregnancy. 12,13 Moreover, studies also found that overweight and obese women had low rates of breastfeeding initiation and duration with indirect disadvantage to their infant's growth and development. [5][6][7][8][9][10][11] In addition, children born to obese pregnant women have a higher risk of cardiovascular disease in later life than those born to normal-weight women.…”

Prepregnancy overweight and obesity are associated with impaired child neurodevelopment

“…In addition, gestational age was assessed from the last menstrual period, as ultrasound was not common at the time of the study, which could result in bias of our last maternal weight measurement timing due to measurement error, which would likely be nondifferential and bias results towards the null (Savitz et al, ). Finally, the cognitive tests reported are domain‐specific measures and are not direct measures of academic skills; however, our results for prepregnancy BMI are similar to another report with academic outcomes in childhood (Pugh et al, ). Strengths include our ability to examine two cognitive outcomes, reflecting different cognitive domains, with a relatively large sample size and with adjustment for a range of confounders, including maternal education and, in a subset, maternal IQ.…”

“…Two studies reported results consistent with ours for prepregnancy body size, but in contrast to our report, observed associations between GWG and child outcomes. In a Pittsburgh cohort, maternal prepregnancy BMI values above 22 kg/m 2 and high GWG were each associated with lower reading, math, and spelling scores ages 6, 10, and 14 years (Pugh et al, ). In a United Kingdom cohort, prepregnancy weight was inversely associated with IQ at age 8 years, and GWG from early to mid‐pregnancy (0–28 weeks) was positively associated with child IQ (Gage et al, ).…”

“…Overweight and obesity affect 60% of women of childbearing age in the United States (Flegal, Kruszon‐Moran, Carroll, Fryar, & Ogden, ; Ogden, Carroll, Kit, & Flegal, ) and are associated with several adverse health outcomes for mothers and children (Gilmore, Klempel‐Donchenko, & Redman, ; Marchi, Berg, Dencker, Olander, & Begley, ). Recently, maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) have emerged as potentially modifiable risk factors for adverse child cognitive development (Hinkle, Albert, Sjaarda, Grewal, & Grantz, ; Hinkle, Sharma, Kim, & Schieve, ; Hinkle et al, ; Huang et al, ; Jo et al, ; Keim & Pruitt, ; Pugh et al, ; Pugh et al, ; Pugh et al, ). Several non‐mutually exclusive biological mechanisms are postulated to be involved in these associations.…”