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Maternal pre-pregnancy BMI and offspring hyperactivity–inattention trajectories from 3 to 8 years in the EDEN birth cohort study


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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Fig. 1

Availability of the data and materials

Anonymized individual participant research data could be made available for subsequent analyses with investigator support after the approval of a proposal.



Attention-deficit/hyperactivity disorder


Brain-derived neurotrophic factor


Body mass index


Confidence interval (95%)


Gestational diabetes


Gestational weight gain


Hyperactivity–inattention symptom(s)


Home Observation for Measurement of Environment-Short Form


Inverse probability weighting


Multiple imputation


Mendelian randomization


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.

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Correspondence to Courtney Dow.

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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).

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