Abstract
Higher maternal prepregnancy body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) is associated with adverse long-term outcomes for offspring, including obesity, poorer cognitive and social abilities, and increased risk of psychiatric disorders. Less clear is whether higher maternal BMI disrupts fetal growth and brain development. To investigate the association of maternal prepregnancy BMI with fetal growth and neonatal functional connectivity. This prospective longitudinal cohort study was conducted from 2012 to 2017. Participants included nulliparous pregnant adolescent and young adult women, aged 14 to 19 years who were recruited in the second trimester through Columbia University Irving Medical Center and Weill Cornell Medical College. Women received routine prenatal care and had no major health problems at the time of recruitment. Data were analyzed from January 2018 to March 2020. Maternal prepregnancy BMI. The main outcomes were fetal growth, measured as estimated fetal weight, and neonatal functional connectivity, measured using magnetic resonance imaging. Prepregnancy BMI and fetal ultrasonographic measurements were obtained from electronic health record review. Resting-state brain imaging data were acquired in infants within the first month of postnatal life. Functional connectivity was measured using intrinsic functional distribution and seed-based methods. Among 129 women recruited, 105 had ultrasonographic data from at least 2 points and were included in analyses. The mean (SD) age at delivery was 17.82 (1.31) years. Maternal prepregnancy BMI was positively associated with the slope of estimated fetal weight (β = 0.668; 95% CI, 0.163 to 1.175; P = .01) but not with fetal head circumference (β = -0.004; 95% CI, -0.024 to 0.016; P = .70). In a subsample of 45 infants with magnetic resonance imaging data, maternal prepregnancy BMI was positively correlated with global connectivity in the left thalamus. Using this thalamic region as a seed, higher maternal BMI was associated with greater local thalamic (both hemispheres) and lower frontothalamic connectivity. These results suggest that maternal prepregnancy BMI was associated with the development of regulation of body weight and thalamic functional brain connectivity in offspring even during fetal development.
Highlights
In the United States, 37% of women of childbearing age have overweight or obesity.[1]
Maternal prepregnancy body mass index (BMI) was positively associated with the slope of estimated fetal weight (β = 0.668; 95% CI, 0.163 to 1.175; P = .01) but not with fetal head circumference (β = −0.004; 95% CI, −0.024 to 0.016; P = .70)
These results suggest that maternal prepregnancy BMI was associated with the development of regulation of body weight and thalamic functional brain connectivity in offspring even during fetal development
Summary
In the United States, 37% of women of childbearing age have overweight or obesity.[1] Higher prepregnancy body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), occurring mainly in the context of prepregnancy or gestational diabetes, has been associated with worse cognitive development, socialization, and verbal communication in offspring from preschool to school age.[2,3,4,5] The association of maternal prepregnancy obesity with increased risk in offspring of psychiatric disorders, including attention-deficit/hyperactivity disorder and autism spectrum disorder, has been inconsistent.[6,7,8] findings from nonhuman primate and rodent studies of fetuses exposed to maternal high-fat diets and thereby to increased maternal weight include reduced attention and increased appetite, anxiety, hyperactivity, and aggression in offspring.[9,10] The findings suggest that maternal BMI before or during pregnancy has significant longterm effects on developing offspring. Very few studies consider the early antecedents of poor future outcomes,[11] at a time when prevention is more feasible, despite widespread recognition that prenatal or fetal programming and fetal adaptations to the environment, play an integral role in future disease risk. Our study seeks to determine whether prepregnancy BMI is associated with fetal growth and brain development as an essential step to fill this gap in knowledge
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