Skip to main content
SpringerLink
Log in

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

European Child & Adolescent Psychiatry volume 32, pages 2057–2065 (2023)Cite this article

Abstract

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

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.

Abbreviations

ADHD:

Attention-deficit/hyperactivity disorder

BDNF:

Brain-derived neurotrophic factor

BMI:

Body mass index

CI:

Confidence interval (95%)

GDM:

Gestational diabetes

GWG:

Gestational weight gain

HIS:

Hyperactivity–inattention symptom(s)

HOME-SF:

Home Observation for Measurement of Environment-Short Form

IPW:

Inverse probability weighting

MI:

Multiple imputation

MR:

Mendelian randomization

SDQ:

Strengths and Difficulties Questionnaire

References

  1. Banik A, Kandilya D, Ramya S et al (2017) Maternal factors that induce epigenetic changes contribute to neurological disorders in offspring. Genes (Basel) 8:150. https://doi.org/10.3390/genes8060150

    Article  CAS  PubMed  Google Scholar 

  2. Hall CL, Guo B, Valentine AZ, et al (2019) The validity of the strengths and difficulties questionnaire (SDQ) for children with ADHD symptoms. PLoS ONE 14. https://doi.org/10.1371/journal.pone.0218518

  3. Harpin V (2005) The effect of ADHD on the life of an individual, their family, and community from preschool to adult life. Arch Dis Child 90:i2–i7. https://doi.org/10.1136/adc.2004.059006Attention

    Article  PubMed  PubMed Central  Google Scholar 

  4. Sciberras E, Mulraney M, Silva D, Coghill D (2017) Prenatal risk factors and the etiology of ADHD—review of existing evidence. Curr Psychiatry Rep 19:1. https://doi.org/10.1007/s11920-017-0753-2

    Article  PubMed  Google Scholar 

  5. Jenabi E, Bashirian S, Khazaei S, Basiri Z (2019) The maternal prepregnancy body mass index and the risk of attention deficit hyperactivity disorder among children and adolescents: a systematic review and meta-analysis. Korean J Pediatr 62:374–379. https://doi.org/10.3345/kjp.2019.00185

    Article  PubMed  PubMed Central  Google Scholar 

  6. Casas M, Forns J, Martínez D et al (2017) Maternal pre-pregnancy obesity and neuropsychological development in pre-school children: a prospective cohort study. Pediatr Res 82:596–606. https://doi.org/10.1038/pr.2017.118

    Article  PubMed  Google Scholar 

  7. Li M, Fallin MD, Riley A et al (2016) The association of maternal obesity and diabetes with autism and other developmental disabilities. Pediatrics 137. https://doi.org/10.1542/peds.2015-2206

  8. Jo H, Schieve LA, Sharma AJ et al (2015) Maternal prepregnancy body mass index and child psychosocial development at 6 years of age. Pediatrics 135:e1198–e1209. https://doi.org/10.1542/peds.2014-3058

    Article  PubMed  PubMed Central  Google Scholar 

  9. Mina TH, Lahti M, Drake AJ et al (2017) Prenatal exposure to maternal very severe obesity is associated with impaired neurodevelopment and executive functioning in children. Pediatr Res 82:47–54. https://doi.org/10.1038/pr.2017.43

    Article  PubMed  Google Scholar 

  10. Rodriguez A (2010) Maternal pre-pregnancy obesity and risk for inattention and negative emotionality in children. J Child Psychol Psychiatry 51:134–143. https://doi.org/10.1111/j.1469-7610.2009.02133.x

    Article  PubMed  Google Scholar 

  11. Edlow AG (2017) Maternal obesity and neurodevelopmental and psychiatric disorders in offspring. Prenat Diagn 37:95–110. https://doi.org/10.1002/pd.4932

    Article  PubMed  Google Scholar 

  12. McPherson NO, Fullston T, Aitken RJ, Lane M (2014) Paternal obesity, interventions, and mechanistic pathways to impaired health in offspring. Ann Nutr Metab 64:231–238. https://doi.org/10.1159/000365026

    Article  CAS  PubMed  Google Scholar 

  13. Ness AR, Griffiths AE, Howe LD, Leary SD (2011) Drawing causal inferences in epidemiologic studies of early life influences. Am J Clin Nutr 94:1959S-1963S. https://doi.org/10.3945/ajcn.110.001461

    Article  CAS  PubMed  Google Scholar 

  14. Bénard M, Camilleri G, Etilé F et al (2017) Association between impulsivity and weight status in a general population. Nutrients 9:217. https://doi.org/10.3390/nu9030217

    Article  PubMed  PubMed Central  Google Scholar 

  15. Galera C, Heude B, Forhan A et al (2018) Prenatal diet and children’s trajectories of hyperactivity-inattention and conduct problems from 3 to 8 years: the EDEN mother-child cohort. J Child Psychol Psychiatry 59:1003–1011. https://doi.org/10.1111/jcpp.12898

    Article  PubMed  Google Scholar 

  16. Sagiv SK, Epstein JN, Bellinger DC, Korrick SA (2013) Pre- and postnatal risk factors for ADHD in a nonclinical pediatric population. J Atten Disord 17:47–57. https://doi.org/10.1177/1087054711427563

    Article  PubMed  Google Scholar 

  17. Heude B, Forhan A, Slama R et al (2016) Cohort Profile: the EDEN mother-child cohort on the prenatal and early postnatal determinants of child health and development. Int J Epidemiol 45:353–363. https://doi.org/10.1093/ije/dyv151

    Article  PubMed  Google Scholar 

  18. Goodman R (2001) Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry 40:1337–1345. https://doi.org/10.1097/00004583-200111000-00015

    Article  CAS  PubMed  Google Scholar 

  19. Nagin D (2005) Group-based modeling of development. Harvard University Press

    Book  Google Scholar 

  20. Baïz N, Just J, Chastang J et al (2019) Maternal diet before and during pregnancy and risk of asthma and allergic rhinitis in children. Allergy Asthma Clin Immunol 15:40. https://doi.org/10.1186/s13223-019-0353-2

    Article  PubMed  PubMed Central  Google Scholar 

  21. Bradley RH, Caldwell BM, Corwyn RF (2003) The Child Care HOME Inventories: assessing the quality of family child care homes. Early Childhood Research Quarterly 18:294–309. https://doi.org/10.1016/S0885-2006(03)00041-3

    Article  Google Scholar 

  22. Mikkelsen SH, Hohwü L, Olsen J et al (2017) Parental body mass index and behavioral problems in their offspring: a Danish national birth cohort study. Am J Epidemiol 186:593–602. https://doi.org/10.1093/aje/kwx063

    Article  PubMed  Google Scholar 

  23. Daraki V, Roumeliotaki T, Koutra K et al (2017) Effect of parental obesity and gestational diabetes on child neuropsychological and behavioral development at 4 years of age: the Rhea mother–child cohort, Crete, Greece. Eur Child Adolesc Psychiatry 26:703–714. https://doi.org/10.1007/s00787-016-0934-2

    Article  PubMed  Google Scholar 

  24. Brion MJ, Zeegers M, Jaddoe V et al (2011) Intrauterine effects of maternal prepregnancy overweight on child cognition and behavior in 2 cohorts. Pediatrics 127. https://doi.org/10.1542/peds.2010-0651

  25. Robinson SL, Ghassabian A, Sundaram R et al (2020) Parental weight status and offspring behavioral problems and psychiatric symptoms. J Pediatr 220:227-236.e1. https://doi.org/10.1016/j.jpeds.2020.01.016

    Article  PubMed  PubMed Central  Google Scholar 

  26. Chen Q, Sjölander A, Långström N et al (2014) Maternal pre-pregnancy body mass index and offspring attention deficit hyperactivity disorder: a population-based cohort study using a sibling-comparison design. Int J Epidemiol 43:83–90. https://doi.org/10.1093/ije/dyt152

    Article  CAS  PubMed  Google Scholar 

  27. Musser ED, Willoughby MT, Wright S et al (2017) Maternal prepregnancy body mass index and offspring attention-deficit/hyperactivity disorder: a quasi-experimental sibling-comparison, population-based design. J Child Psychol Psychiatry 58:240–247. https://doi.org/10.1111/jcpp.12662

    Article  PubMed  Google Scholar 

  28. Biederman J, Faraone SV, Keenan K et al (1991) Familial association between attention deficit disorder and anxiety disorders. Am J Psychiatry 148:251–256. https://doi.org/10.1176/ajp.148.2.251

    Article  CAS  PubMed  Google Scholar 

  29. Frisell T, Öberg S, Kuja-Halkola R, Sjölander A (2012) Sibling comparison designs. Epidemiology 23:713–720. https://doi.org/10.1097/EDE.0b013e31825fa230

    Article  PubMed  Google Scholar 

  30. Cortese S (2019) The Association between ADHD and Obesity: intriguing, progressively more investigated, but still puzzling. Brain Sci 9:256. https://doi.org/10.3390/brainsci9100256

    Article  PubMed  PubMed Central  Google Scholar 

  31. Karhunen V, Bond TA, Zuber V et al (2021) The link between attention deficit hyperactivity disorder ( ADHD ) symptoms and obesity-related traits : genetic and prenatal explanations. Transl Psychiatry 1–8. https://doi.org/10.1038/s41398-021-01584-4

  32. McAree T (2010) Obesity and vitamin D deficiency—current concepts on their impact on pregnancy. Eur Endocrinol 9:125. https://doi.org/10.17925/EE.2013.09.02.125

    Article  Google Scholar 

  33. Hollis BW, Wagner CL (2017) New insights into the vitamin D requirements during pregnancy. Bone Res 5:17030. https://doi.org/10.1038/boneres.2017.30

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Barbosa S, Khalfallah O, Forhan A et al (2020) Serum cytokines associated with behavior: a cross-sectional study in 5-year-old children. Brain Behav Immun 87:377–387. https://doi.org/10.1016/j.bbi.2020.01.005

    Article  CAS  PubMed  Google Scholar 

  35. Shojaei T, Wazana A, Pitrou I, Kovess V (2009) The strengths and difficulties questionnaire: validation study in French school-aged children and cross-cultural comparisons. Soc Psychiatry Psychiatr Epidemiol 44:740–747. https://doi.org/10.1007/s00127-008-0489-8

    Article  PubMed  Google Scholar 

Download references

Funding

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.

Author information

Authors and Affiliations

  1. INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), ORCHAD Team, Paris, France

    Courtney Dow, Marie-Aline Charles & Barbara Heude

  2. Univ. Bordeaux, Inserm, Bordeaux Population Health Center, UMR 1219, 33000, Bordeaux, France

    Cédric Galera

  3. Centre Hospitalier Perrens, Bordeaux, France

    Cédric Galera

Authors
  1. Courtney Dow
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cédric Galera
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marie-Aline Charles
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Barbara Heude
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Courtney Dow.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Supplementary Information

Below is the link to the electronic supplementary material.

787_2022_2047_MOESM1_ESM.docx

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)

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-022-02047-x

Keywords

search

Navigation