Abstract
BackgroundIncreasing evidence suggests exposure to adverse conditions in intrauterine life may increase the risk of developing attention-deficit/hyperactivity disorder (ADHD) in childhood. High maternal pre-pregnancy body mass index (BMI) has been shown to predict child ADHD symptoms, however the neurocognitive processes underlying this relationship are not known. The aim of the present study was to test the hypothesis that this association is mediated by alterations in child executive function.Methodology/Principal FindingsA population-based cohort of 174 children (mean age = 7.3±0.9 (SD) yrs, 55% girls) was evaluated for ADHD symptoms using the Child Behavior Checklist, and for neurocognitive function using the Go/No-go task. This cohort had been followed prospectively from early gestation and birth through infancy and childhood with serial measures of maternal and child prenatal and postnatal factors. Maternal pre-pregnancy BMI was a significant predictor of child ADHD symptoms (F(1,158) = 4.80, p = 0.03) and of child performance on the Go/No-go task (F(1,157) = 8.37, p = 0.004) after controlling for key potential confounding variables. A test of the mediation model revealed that the association between higher maternal pre-pregnancy BMI and child ADHD symptoms was mediated by impaired executive function (inefficient/less attentive processing; Sobel Test: t = 2.39 (±0.002, SEM), p = 0.02).Conclusions/SignificanceTo the best of our knowledge this is the first study to report that maternal pre-pregnancy BMI-related alterations in child neurocognitive function may mediate its effects on ADHD risk. The finding is clinically significant and may extrapolate to an approximately 2.8-fold increase in the prevalence of ADHD among children of obese compared to those of non-obese mothers. These results add further evidence to the growing awareness that neurodevelopmental disorders such as ADHD may have their foundations very early in life.
Highlights
Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood
A feature common across these previous studies is that child attention-deficit/hyperactivity disorder (ADHD) symptoms have been assessed using subjective teacher and/or parent ratings, and that child neurocognitive deficits that accompany behavioral excesses have not been examined in this context
No symptoms were reported for 19% of the children, the symptom score was between 0 and 1 for 81% of the children, and greater than 1 for 10% of the children. This observed distribution of scores is consistent with expected norms, in that patients diagnosed with ADHD typically have a T score of .60 [27], which corresponds approximately with a Child Behavior Checklist (CBCL) subscale score
Summary
Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood. It has been suggested that an increased inflammatory milieu during gestation represents a biological condition that may be common across and underlie the effects of these disparate risk factors [15]. One potent condition that produces an increased inflammatory milieu during gestation is maternal obesity [19,20,21] Consistent with this line of reasoning, maternal obesity before and during pregnancy has been associated with deficits in neurodevelopmental outcomes during childhood and adulthood, including inattention and hyperactivity [8,22]. Increasing evidence suggests exposure to adverse conditions in intrauterine life may increase the risk of developing attention-deficit/hyperactivity disorder (ADHD) in childhood. The aim of the present study was to test the hypothesis that this association is mediated by alterations in child executive function
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