Association Of Pre-pregnancy BMI,Gestational Blood Glucose Status And Offspring’s Neuropsychological Development

Objective:Based on a hospital-based birth cohort study,this study discusses the association of pre-pregnancy body mass index（BMI）,blood glucose status during pregnancy and the neuropsychological development of offspring at the age of 2.Methods:In this study,2639 pregnant women with singleton full-term live births were included as the research objects,and the relevant information of their registration,prenatal examination and delivery were collected respectively,and their offspring were followed up to2 years old to evaluate their neuropsychological development with Bayley Scales of Infant Development.Judging pregnant women’s pre-pregnancy weight status according to pre-pregnancy BMI,judging whether they are gestational diabetes mellitus according to oral glucose tolerance test at 24-28 weeks of pregnancy,fitting different patterns of OGTT blood glucose changes during pregnancy with group-based trajectory modeling,and defining mental retardation and motor retardation when Mental Development Index and Psychomotor Development Index in BSID evaluation results are lower than 90 respectively.The general linear regression model was used to study the influence of blood glucose values of BMI and OGTT at 0,1 and 2 hours before pregnancy on the neuropsychological development index of offspring.Using binary Logistic regression model to study the influence of pre-pregnancy weight status,GDM and OGTT blood glucose change patterns during pregnancy on the risk of neuropsychological dysplasia in offspring;Multiplied transactional analysis was used to further study the possible interaction of overweight/obesity before pregnancy and the fastest increase of OGTT blood glucose in increasing the risk of neuropsychological development in offspring.The above analysis adjusted the potential confounding factors,and further stratified analysis was made based on the sex of the offspring.Results:（1）The average age of 2639 pregnant women is 29.0±3.6 years old,the average pre-pregnancy BMI is 21.0±2.9（kg/m2）,367（13.9%）are overweight/obese before pregnancy,and237（9.0%）have GDM.The change pattern of OGTT blood glucose can be divided into 1291（48.9%）people in the stable rising group,1148（43.5%）people in the fast rising group and200（7.6%）people in the fastest rising group.（2）There are 2578 offspring children who have completed the evaluation of intellectual development,with an average MDI of 108.1±22.5,and 491（19.0%）children with mental retardation.There are 2549 offspring children who have completed the evaluation of motor development,with an average PDI of 107.5±18.4,and 399（15.7%）children with poor motor development.（3）When the maternal pre-pregnancy BMI increased by 1 kg/m²,the MDI of offspring decreased by 0.272 points（95%CI:-0.577～0.032）and the PDI increased by 0.200 points（95%CI:-0.054～0.455）,and the correlation was not statistically significant.（4）When the mother is overweight/obese before pregnancy,the risk of mental retardation of offspring is higher（OR:1.290;95%CI:0.973～1.709）,and the risk of poor motor development is lower（OR:0.820;95%CI:0.587～1.146）,the correlation was not statistically significant.（5）There was a positive correlation between the blood glucose level of OGTT 1h hour during pregnancy and the neuropsychological development of offspring（MDI,β:1.136,95%CI:0.448～1.824,P=0.001;PDI,β:0.812,95%CI:0.234～1.390,P=0.006）,and the 2-hour blood glucose level was negatively correlated with the neuropsychological development of offspring（MDI,β:-0.977,95%CI:-1.831～-0.123,P=0.025;PDI,β:-0.860,95%CI:-1.578～-0.142,P=0.019）,while GDM of mother has nothing to do with the poor neuropsychological development of offspring（MDI,OR:0.905,95%CI:0.632～1.296,P=0.586;PDI,OR:0.921,95%CI:0.623～1.361,P=0.680）.（6）No correlation was found between OGTT’s blood glucose change pattern and the neuropsychological development of offspring.For example,in boys,the risk of mental retardation is 1.062 times（95%CI:0.812～1.391,P=0.659）when the blood glucose of mother OGTT rises more steadily than that of mother OGTT.（7）Transactional analysis suggested that compared with pregnant women with normal pre-pregnancy weight and non-fastest blood glucose rising mode,when the mother is overweight/obese before pregnancy and the blood glucose rising mode is the fastest,the MDI of girls will be reduced by 13.112 points(95%CI:-22.449～-3.776,P=0.006,P_交互=0.018),and the risk of mental retardation will be 3.073 times(95%CI:1.066～8.864,P=0.038,P_交互=0.058).Conclusion:OGTT 2h blood glucose during pregnancy was negatively correlated with the intelligence development of offspring.Especially for pregnant women who are overweight/obese before pregnancy and whose OGTT 1h hour blood glucose rises fastest,their offspring girls are at higher risk of mental retardation at the age of 2.These results suggest that we need to strengthen the health care for pregnant women in order to avoid the occurrence of adverse neurodevelopmental outcomes in offspring.