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We would like to thank Mr Scott Macintyre for his unreserved professional guidance during electronic database searching pregnancy obesity and gross motor ...
Maternal Pre-pregnancy Obesity and Childhood Physical and Cognitive Development of Children: a Systematic Review 1Akilew

Awoke Adane, 1Gita D Mishra and 1Leigh Tooth 1School of Pubic Health, Faculty of Medicine, The University of Queensland

Introduction • Pre-pregnancy obesity, usually associated with adverse birth outcomes, has been a serious public health concern. • Studies examining its effect on the physical and cognitive development of children have only recently emerged and the findings are inconsistent.

Objective This review aimed to systematically examine the role of pre-pregnancy obesity on children’s physical and cognitive development using the available evidence

Methods Electronic searches • The CINAHL, EMBASE, PSYCINFO, PUBMED and SCOPUS databases were searched • Restricted to English language, but no time limit Participants • Studies addressing children’s (≤12 years) physical and cognitive development as outcome and pre-pregnancy body mass index (BMI) as an exposure were included Data analysis • Data were extracted and evaluated for quality by two independent reviewers • Meta-analysis was not undertaken because of the heterogeneous measures • Results were qualitative summarised.

Results Records identified through database searching (n=11109) Records removed (n=10926)

Table1:Summary of the association of pre-pregnancy obesity and offspring outcomes Outcome type Association IQ/intellectual disability (IQ < ↓ 70) ↓ ↓ ↓ ↔ ↔ General cognitive ability ↓ Mental development ↓ index/cognitive composite ↓ score ↓ ↔ ↔ ↔ ↑ Language ↓ ↓ ↓ ↔ ↔ ↔ ↑ Executive function ↔ Math Z score ↔ Fine motor ↔ ↔ ↔ ↔ ↔ Gross motor ↓ ↓ ↓ ↓ ↔ ↔ ↔ Psychomotor ↓ development/motor ↔ composite score ↔

Age (years) 7 5 Up to 11.5 5 10 8 5&7 14 & 18 m 24 m 24 m 24 m 12 & 24 m 12 m 6m 24 m 5 to 7 ~6 5 12 & 24 m 30 & 38 m 6m 10 ~6 18 m 6 & 18 m 5 24 m ~6 5 6 to 24 m 18 m 24 m ~6 18 m 5 24 m 24 m 12 & 24 m

Reference Huang et al 2014 Neggers et al 2003 Heikura et al 2008≠ Bliddal et al 2014ϲ Pugh et al 2015 Brion et al 2011* Basatemur et al 2013ϲ Casas et al 2013 Van Der Burg-2015 Hinkle et al 2012 Reynolds et al 2014 Polańska et al 2015* Islam 2000# Torres-Espinola 2015** Reynolds et al 2014† Tanda 2012 Hinkle et al 2013 Neggers et al 2003 Polańska et al 2015* Brion et al 2011 Torres-Espinola 2015 Pugh et al 2015 Hinkle et al 2013 Casas et al 2013 Torres-Espinola 2015 Islam 2000# Reynolds et al 2014† Hinkle et al 2013 Islam 2000# Wylie et al 2015‡ Torres-Espinola 2015$ Reynolds et al 2014† Hinkle et al 2013 Casas et al 2013 Neggers et al 2003 Van Der Burg-2015 Hinkle et al 2012 Polańska et al 2015*

*Pre-pregnancy overweight and obesity collapsed to same group; ** no association at the age of 18 months,; # used median BMI (>22); ↓ negative association; ↑ positive association; ↔ null association; ≠ no association in NFBC 1966 birth Cohort; ‡ negative associations were observed only in physical motor milestones of sitting without support and crawling on hands and knees; † used reference group other than normal weight mothers; $ no association at the age of 6 months; ϲ used BMI as a continuous variable

Records screened by abstract (n=183) Other source (n=2)

Records removed (n=139)

Screened by full document (n=46) Excluded (n=29) with reasons Studies included in the qualitative review (n=17) Fig 1: PRISMA flow chart

• 10 of 17 studies were birth cohorts from the USA • 9 of 14 studies supported an adverse association between prepregnancy obesity and childhood cognitive development (Table 1). • A few studies also demonstrated a negative association between prepregnancy obesity and gross motor function in children (5 of 10) but not with fine motor function (none out of five studies). • Whether the observed negative association between maternal obesity and children’s cognitive and gross motor abilities is casual or due to residual confounding effects is unclear.

Conclusion • From the available evidence, it appears that exposure to pre-pregnancy obesity in the intrauterine environment has a detrimental effect on children’s cognitive development. • However, evidence of the association between maternal obesity and physical development of children is too scarce to offer a conclusion. • More research work is required to delineate the intrauterine effect of maternal obesity from the residual confounding effects.

Acknowledgements A.A.A supported by International Postgraduate Research Scholarship (IPRS) and UQ Centennial scholarship. G.D.M. holds NHMRC Principal Research Fellowship (APP1121844). We would like to thank Mr Scott Macintyre for his unreserved professional guidance during electronic database searching

Address correspondence to Akilew Adane| Email: [email protected] |Tel: +61470301690