Maternal high body mass index, but not gestational diabetes, is associated with poorer educational attainment in mid-childhood

Abstract

Previous studies suggest that gestational diabetes mellitus (GDM) is associated with poorer cognitive outcomes in children, however confounding factors especially maternal BMI have been poorly accounted for. This study aimed to examine the independent associations between maternal BMI, GDM status and educational outcomes. Antenatal data from a prospective birth cohort (Pregnancy Outcome Prediction Study; POPS, 2008-2012, Cambridge, UK) was linked to mid-childhood educational outcomes (Department for Education, UK). 3249 children born at term were stratified by maternal GDM status and BMI at booking (<25 kg/m2 vs. ≥25 kg/m2). Regression models adjusted for relevant maternal, child, and socioeconomic factors were used to determine associations with academic outcomes at ages 5-7. No differences in educational attainment found between children exposed to GDM vs. non-exposed children. Neither maternal glucose levels measured at 11-14 weeks, 24-28 weeks, or acceleration of the fetal abdominal circumference growth velocity were related to educational attainment between ages 5-7. Children of mothers with booking BMI ≥25kg/m2 vs. <25kg/m2 were ∼50% more likely not to meet expected educational standards regardless of GDM status (Age 5: aOR 1.44; 95%CI 1.19-1.74, p<0.001; Age 6: aOR 1.61; 95%CI 1.28-2.02, p<0.001). The association between maternal BMI and offspring educational attainment is dose-dependent and robust to stratification by GDM status and adjustment for socio-economic factors. Mid-childhood educational attainment is not associated with maternal glucose status and this may provide important reassurance for pregnant women and clinicians. However maternal BMI is associated with lower childhood educational attainment and may be modifiable with intervention before or during pregnancy.