Evidence suggests obesity during pregnancy is associated with offspring attention-deficit hyperactivity disorder. However, studies have been limited to evaluating the association at a single age with inadequate data on important maternal lifestyle confounders and unmeasured familial confounding. The objective of this study was to examine the association between maternal pre-pregnancy body mass index (BMI) and child hyperactivity–inattention symptoms (HIS) at 3, 5 and 8 years. Data came from the EDEN mother–child cohort. Maternal pre-pregnancy BMI status (kg/m2) was calculated using pre-pregnancy weight and height (self-reported by mothers or measured by midwives). HIS were assessed by parental-report on the Strengths and Difficulties Questionnaire at 3, 5 and 8 years of age and used to derive developmental trajectories of HIS (n = 1428). Multivariate models were adjusted for confounders including socioeconomic status, maternal lifestyle behaviours (exercise, diet, smoking, alcohol), childcare and a stimulating home environment. Paternal BMI was used as a negative control. Compared to a normal pre-pregnancy BMI, pre-pregnancy maternal obesity was positively associated with increased odds of a high HIS trajectory between 3 and 8 years old in both unadjusted and adjusted logistic regression (adjusted odds ratio [aOR] 1.87 [95% CI 1.12, 3.12]). Pre-pregnancy overweight was not significantly associated after adjustment for confounders (aOR 1.32 [0.87, 2.01]). Maternal pre-pregnancy obesity, but not overweight, was associated with increased likelihood of a high HIS trajectory in children from 3 to 8 years old. This association persisted despite controlling for many important maternal lifestyle factors and paternal BMI. Further research is warranted to identify possible mediators involved.
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Brain-derived neurotrophic factor
Body mass index
Confidence interval (95%)
Gestational weight gain
Home Observation for Measurement of Environment-Short Form
Inverse probability weighting
Strengths and Difficulties Questionnaire
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This study was supported by the Fondation pour la Recherche Médicale (the French Foundation for Medical Research; Grant Number: SPF201909009122). We are grateful to all the participants of EDEN for their continued involvement in our study.
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Below is the link to the electronic supplementary material.
Supplementary file1 Supplementary Fig. 1 Flowchart of the study participants in the EDEN cohort study. Supplementary Fig. 2 Hypothetical DAG for the relationship between maternal pre-pregnancy BMI and child hyperactivity. Supplementary Table 1 Missing data in the EDEN cohort study (n = 2002). Supplementary Table 2 Descriptive characteristics of the EDEN population by dropout status (n = 2002). Supplementary Table 3 Complete case analysis for hyperactivity-inattention trajectories between 3–8 years in the EDEN cohort study. Supplementary Table 4 Association between maternal pre-pregnancy BMI and hyperactivity-inattention symptoms at 3, 5, and 8 years in the EDEN cohort study. (DOCX 350 KB)
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Dow, C., Galera, C., Charles, MA. et al. Maternal pre-pregnancy BMI and offspring hyperactivity–inattention trajectories from 3 to 8 years in the EDEN birth cohort study. Eur Child Adolesc Psychiatry 32, 2057–2065 (2023). https://doi.org/10.1007/s00787-022-02047-x