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Matern Child Health J. 2019 Jun;23(6):746-755. doi: 10.1007/s10995-018-2691-y.

Maternal Metabolic Complications in Pregnancy and Offspring Behavior Problems at 2 Years of Age.

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Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.
Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
Department of Medicine, McMaster University, Hamilton, ON, Canada.
Manitoba Institute of Child Health, University of Manitoba, Winnipeg, MB, Canada.
Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada.
Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
Department of Pediatrics, 4-590 Edmonton Clinic Health Academy (ECHA), University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada.


Objectives Prenatal maternal metabolic problems such as pre-pregnancy adiposity, excess gestational weight gain, and gestational diabetes mellitus (GDM) are associated with an increased risk of psychopathology in offspring. We examined whether these exposures were linked to symptoms of emotional and behavioral problems in offspring at 2 years of age, or if associations were due to confounding variables. Methods Data from 815 mother-child pairs enrolled at the Edmonton site of the Canadian Healthy Infant Longitudinal Development cohort were used to examine associations between gestational metabolic complications and scores on the externalizing and internalizing scales of the Child Behavior Checklist (CBCL-1½ to 5) at age two. Associations between maternal metabolic complications and offspring psychopathology were assessed before and after adjustment for gestational diet, socioeconomic status (SES), postpartum depression (PPD), prenatal smoking and breastfeeding. Results Pre-pregnancy body mass index and GDM, but not gestational weight gain, predicted more offspring externalizing and internalizing problems. However, after adjustment for confounding variables, these associations were no longer statistically significant. Post-hoc analyses revealed that gestational diet accounted for unique variance in both externalizing (semi-partial rdiet = - 0.20, p < 0.001) and internalizing (semi-partial rdiet = - 0.16, p = 0.01) problems. PPD and SES also accounted for a similar amount of variance for both externalizing (semi-partial rPPD = 0.17, p < 0.001; rses = - 0.11, p = 0.03) and internalizing problems (semi-partial rPPD = 0.21, p < 0.001; rses = - 0.14, p = 0.004). Conclusions for Practice Since the confounding effect of gestational diet persisted after adjustment for, and was similar in magnitude to, SES and PPD, future research should consider the impact of unhealthy prenatal diets on offspring neurodevelopment.


Child Behavior Checklist; Gestational diabetes mellitus; Obesity; Prenatal nutrition; Prenatal programming; Preschool

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