Maternal Obesity and Related Conditions: Risk Factors for Childhood Delays

OBJECTIVE: To evaluate and characterize neurodevelopmental and long-term academic delays associated with maternal obesity and related conditions including diabetes.;METHODS: Using New York City Departments of Health and Mental Hygiene and Education linked data warehouse which contains birth, Early Intervention, and educational records of children born in New York City from 1994-2001, we assessed associations and relative risks for not meeting proficiency on standards-based mathematics and English language arts assessments administered at third grade and need for special education for children of mothers who were obese and children of mothers who had the related conditions of diabetes and hypertension (Paper 1).;Next, we characterized risks identifiable in early childhood. We assessed the risk for early childhood delays for children of mothers who were obese, detailing risk for being suspected of having a delay and referred to Early Intervention, risk for being found significantly delayed and eligible for Early Intervention, and risk for each type of neurodevelopmental delay across five functional domains: communication, cognitive, physical, social-emotional, and adaptive (Paper 2).;Finally, we considered whether a common perinatal complication of obese and diabetic pregnancies, being born large for gestational age, could be an indicator for long-term delays among children born of obese or diabetic mothers. We assessed if being born large for gestational age was associated with increased risks for long-term delays in childhood and if this risk was modified by maternal obesity or diabetes. In cases where the risk was modified, we assessed the association between utilization of prenatal care and children being born large for gestational age (Paper 3).;We used chi-square to assess associations and relative risks were assessed unadjusted and adjusting for maternal characteristics such as race/ethnicity, age, education, nativity, marital status, Medicaid use, substance use during pregnancy, and other maternal conditions, as well as child characteristics such as year of birth, sex, birthweight, and preterm birth, using the genmod procedure with binomial distribution in SAS version 9.3; Poisson distribution was used when models did not converge.;RESULTS: Children of mothers who were obese evidenced increased risk for being recommended for special education (ARR: 1.26 [95% CI: 1.21-1.31]), and for not meeting proficiency on the mathematics (ARR: 1.13 [95% CI: 1.09-1.16]) and English language arts (ARR: 1.11 [95% CI: 1.08-1.13]) assessments at third grade. Children of mothers with diabetes evidenced increased risk for being recommended for special education (ARR: 1.10 [95% CI: 1.04-1.16]), increased risk for not meeting proficiency on the mathematics assessment (ARR: 1.11 [95% CI: 1.06-1.15]), and a weak but significant risk for not meeting proficiency on the English language arts assessment (ARR: 1.04 [95% CI: 1.0045-1.07]).;Considering identification of delays in early childhood, children of mothers who were obese were at increased risk for being suspected of a developmental delay and referred to Early Intervention (ARR: 1.19 [95% CI: 1.15-1.22]). They also had a higher risk for a moderate-to-severe cognitive (ARR: 1.04 [95% CI: 1.02-1.07]) and physical (ARR: 1.04 [95% CI: 1.01-1.08]) delay and for a global developmental delay (ARR: 1.05 [95% CI: 1.01-1.08]).;Assessed as a potentially early indicator of risk, being born large for gestational age evidenced a protective effect for academic delays (mathematics ARR: 0.96 [95% CI: 0.92-0.99]); English language arts ARR: 0.97 [95% CI: 0.95-0.99]), an effect which was modified by gestational diabetes. Children born large for gestational age of mothers with gestational diabetes evidenced an increased risk for not meeting proficiency on the mathematics assessment (ARR: 1.18 [95% CI: 1.07-1.31]) and for being recommended for special education (ARR: 1.18 [95% CI: 1.02-1.37]).;CONCLUSION: Children of mothers who are obese and/or diabetic during pregnancy may be at increased risk for neurodevelopmental and academic delays. Among children born to a mother with gestational diabetes, children born large for gestational age may be at even greater risk than children born appropriate weight for gestational age. While risks may seem small, the outcomes are meaningful and, at the population level, the small effect could have a large impact. This adds to the growing body of research on effects of maternal obesity and related conditions during pregnancy on offspring and, although this research does not assume causality, interventions to address this increased risk may be considered.