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Table 2 Summary of the studies examining associations of maternal anthropometry with offspring cognitive function

From: Association between maternal nutritional status in pregnancy and offspring cognitive function during childhood and adolescence; a systematic review

Author, Year, Sample size, Age, Country, Study design Maternal anthropometry Cognitive function Results after adjustment for confounders QS and RB
8Neggers YH; 2003
 N = 355
 Age 5.3 years
 USA
 Prospective Low income African- Americans; mothers participated in Zinc supplementation trial
Pre-pregnancy BMI (kg/m2)
BMI 4 categories
Underweight (BMI < 19.8): 6.5 %
Normal (19.8-26.0): 39.2
Overweight (26.1-29.0): 14.4 %
Obese(>29): 39.9 %
Gestational weight gain (kg)
Differential Ability Scale –general IQ (intelligence quotient), verbal and non-verbal abilities
Peabody Gross Motor Scales
↑Pre-pregnancy BMI -↓ general IQ (β = -0.25) and non-verbal score (β = 0.29)
Compared to children of normal weight mothers, children of obese mothers scored lower in general IQ (β = -4.7) and non-verbal abilities (β = -5.6) but not in verbal or motor skills
Compared to children of normal weight mothers, children of underweight mothers scored lower in general IQ, verbal and non-verbal abilities but not significant
No association between pregnancy weight gain and cognitive or motor skills
Confounders adjusted for: Child’s BWT, GA, current age, MA, MS, maternal alcohol intake, MIQ, HE, child care status, zinc supplementation status
14 Medium
9Heikura U; 2008
 Two birth cohorts
 1966
 N = 12058
 Age 11.5 years
 Finland
 1986 birth cohort
 N = 9432
 Age 11.5 years
 Finland
Pre-pregnancy BMI (kg/m2)
BMI 4 Categories
1966 cohort
Thin (BMI < 20): 13.4 %
Normal (BMI 20-24.9): 65 %
Overweight (BMI 25.0–29.9): 17.9 %
Obese (BMI ≥30): 3.8 %
1986 cohort
Thin (BMI < 20): 24.3 %
Normal (BMI 20-24.9): 58.7 %
Overweight (BMI 25.0–29.9): 13.1 %
Obese (BMI ≥30): 3.8 %
IQ (Standardised psychometric test or clinical developmental assessment): Test battery used not reported
Intellectual disability (ID)-IQ < 70 severe ID (IQ < 50) mild (IQ 50-70)
Maternal pre-pregnancy obesity predicted ID in 1986 cohort (OR = 2.8) but not in 1966 birth cohort
Low BMI associated with mild ID in 1966 cohort (OR = 2.1)
Interaction between parity*BMI in 1966 cohort
Higher risk of ID (OR = 2.9) in children of multiparous mothers with low BMI in 1986 cohort
Confounders adjusted for: MA, SES (occupation), parity, place of residence, marital status
15 Medium
10Tanda R; 2012
 N = 3412
 Age 5-7 years
 USA
 Longitudinal
Pre-pregnancy BMI (kg/m2) and gestational weight gain (kg)
BMI 4 categories
Underweight (BMI < 18.5): 7.2 % Normal (BMI 18.5-24.9): 65.6 %
Overweight (BMI 25.0-29.9): 17.6 %
Obese (BMI ≥30): 9.6 %
Peabody Individual Achievement Test Reading and Mathematics scores Pre-pregnancy obesity, but not overweight, was negatively associated with cognitive skills Compared to children of normal weight mothers, children of obese mothers scored 3 points lower (0.23 SD) in reading and 2 points lower (0.16 SD) in mathematics score ↑gestational weight gain - ↓ cognitive skills but not significant
Confounders adjusted for: the child’s sex, GA, current age and body size, ethnicity, parity, SES (income), MA, ME, MIQ, HE
15 Medium
11Hinkle SN; 2012
 N = 6850
 Age 2 years
 USA
 Population based  Longitudinal-Birth cohort
Pre-pregnancy BMI (kg/m2) and Gestational weight gain (kg)
BMI 5 categories
Underweight (BMI < 18.5): 5 %
Normal (BMI 18.5-24.9): 56 %
Overweight (BMI 25.0-29.9): 25 % Obese1(BMI 30.0-34.9): 8 %.
Obese2 and 3(BMI > =35.0-39.9): 6 %
Bayley Scales of Infant Development –II (Mental Development Index (MDI) and Psychomotor Development Index (PDI)) Compared to the children of normal BMI mothers, children of mothers in all the other categories scored lower MDI, but significant in obese2 and 3 categories (β = 2.13 points)
Risk of delayed mental development (<-1SD v > 1SD) observed in children of mothers with underweight (RR = 1.36) and extreme obese (RR = 1.38) categories
No association between pre-pregnancy BMI and PDI
Confounders adjusted for: the child’s sex, BWT, GA, BF, MA, ethnicity, marital status, parity, DM, PIH, ME, MS, SES (income)
16 Medium
12Basatemur E; 2012
 Age 5 years (n = 11025)
 Age 7 years (n = 9882)
 UK
 Prospective population based birth cohort
Pre-pregnancy BMI (kg/m2)
BMI continuous and categories
BMI 4 categories
Underweight (BMI < 18.5): 5.3 %
Normal (BMI 18.5-24.9): 65.6 %
Overweight (BMI 25.0-29.9): 20.1 %
Obese (BMI ≥30): 9 %
Excluded BMI < 16
5 Y-British ability scales-II
Expressive language, nonverbal reasoning and spatial visualization 7 Y- British ability scales-II spatial visualization, verbal ability, and number skills test (National foundation for educational research progress in Math tests)
Children of underweight, overweight and obese mothers scored lower mean scores (0.1-0.3 SD)
Maternal pre-pregnancy BMI is negatively associated with children’s general cognitive ability at 5 years (β = -0.075) and 7 years (β = -0.17) 5 years - ↑maternal BMI -↓Spatial visualization but no association with expressive language and nonverbal reasoning 7 years- ↑maternal BMI -↓Spatial visualization, verbal ability and number skills
Confounders adjusted for: The child’s sex, current age, BWT, BMI, ethnicity, MA, ME, PE, SES, income, MS, DM
15 Medium
13Buss C; 2012
 N = 174
 Age 7.3 years
 USA
 Population based prospective
 Longitudinal-Birth cohort
Pre-pregnancy BMI (kg/m2) and Gestational weight gain (kg)
BMI continuous and categories
BMI 3 categories
Normal (BMI 18.5-24.9): 58 %
Overweight (BMI 25.0-29.9): 25.9 % Obese (BMI ≥30): 16.1 %
Excluded underweight mothers
Executive function Continuous Performance Task (Go/No go task) Higher pre-pregnancy BMI (continuous and categorical) was associated with impaired performance on the Go/No go task (F1.157 = 8.37 and F2.156 = 3.57 respectively)
Children of obese mothers scored higher in performance measure (higher score indicates poor performance) compared to children of normal weight mothers. No difference in scores of performance efficiency between children of obese mothers vs children of overweight/normal weight mothers (Chen’s d effect size 0.62 SD)
Gestational weight gain was not associated with child performance on the Go/No go task (F1.157 = 0.27)
Confounders adjusted for: The child’s sex, current age, BMI, ethnicity, GA, parity, BWT, ME, MIQ, depression, obstetric risk (PIH, DM)
13 Medium
14Brion M; 2011
 ALSPAC: population based prospective cohort UK
 N = ~5000
 Age 38 months; Age 8 years
 Generation R: Population based pregnancy cohort Netherlands.
 N = ~2500
 Age 30 Months
Pre-pregnancy BMI (kg/m2)
Underweight (BMI < 18.5)
Normal (BMI 18.5-24.9)
Overweight (BMI 25.0-29.9)
Obese (BMI ≥30)
ALSPAC
Normal BMI: 78.7 %
Overweight/obese: 21.3 %
Generation R
Normal BMI: 77.9 %
Overweight/obese: 22.1 %
Excluded obese group (cognitive assessment at age 30-38 months)
ALSPAC-Verbal skills-MacArthur Toddler Communication Questionnaire maternal report
Non-verbal skills-Diagnostic Analysis of Non-verbal Accuracy Test
General intelligence-Wechsler Intelligence Scale for Children-II at 8-years
Generation-R-Verbal skills-Dutch translation of the Language Development Survey
Non-verbal-Dutch version of parent report of children’s abilities
ALSPAC: No association of maternal overweight with verbal and non-verbal skills.
Maternal obesity was associated with ↓IQ (OR = 0.84) at 8 years
Generation-R: no association between maternal overweight with verbal and non-verbal skills.
Confounders adjusted for: ME, PE, occupation, income, social class (ALSPAC only), MS, BF
15 Medium
15Casas M; 2013
 INMA: population based prospective birth cohort Spain
 N = ~1967
 Age 11-22 months
 RHEA: Population based prospective cohort
 Greece
 N = 412
 Age 17-20 months
Pre-pregnancy BMI (kg/m2)
Underweight (BMI < 18.5)
Normal (BMI 18.5-24.9)
Overweight (BMI 25.0-29.9)
Obese (BMI ≥30)
INMA: 72.9 %, 19.2 % and 8 % normal, overweight and obese respectively
RHEA: 68.3 %, 20.1 %, and 11 % normal, overweight and obese respectively
Excluded underweight
INMA: Bayley Scales of Infant Development –I (Mental and Psychomotor scale)
RHEA: Bayley Scales of Infant Development –III (Cognitive and fine and gross motor development scale)
Pre-pregnancy obesity, but not overweight, was negatively associated with cognitive skills Compared to children of normal weight mothers, children of obese mothers scored 2.67 points lower (INMA) and 3.57 points lower (RHEA and not significant) in mental (INMA) and cognitive development (RHEA)
Cognitive score ↓ with increasing BMI (INMA -0.17 per kg/m2; RHEA -0.26 per kg/m2(not significant)
No association of overweight/obesity with motor development in both cohorts
Confounders adjusted for: gender, parental education, age, social class (only in INMA), maternal country of birth, breast-feeding duration, MS, employment status during pregnancy and after birth, parity, nursery attendance and main child minder
14 Medium
16Craig WY; 2013
 Study 1- USA
 Population based cohort
 N = 101
 Age 2 years
 Study 2- USA
 Population based cohort
 N = 118
 Age 8 years
 In both studies participants were from control group of a case–control study
Pregnancy BMI (kg/m2; 2nd trimester)
Normal (BMI 18.5-24.9)
Overweight (BMI 25.0-29.9)
Obese (BMI ≥30)
Study 1: 31.6 %, 38.6 % and 29.7 % normal, overweight and obese respectively
Study 2: 64.4 %, 25.4 %, and 10.2 % normal, overweight and obese respectively
No underweight category
Study 1- Bayley Scales of Infant Development –III
Cognitive, language and motor (gross and fine) domains
Study 2-Wechsler Intelligence Scale for Children (WISC)-III
Full-scale IQ, verbal and performance IQ
Study 1: ↑BMI categories- ↓scores for cognitive, language and motor domains (not significant)
Percentage of children with ≥ 1 score below BSID-III score of 85 increased with BMI category and was higher among children of obese mothers compared to children of normal BMI mothers (OR 3.9)
Study 2: ↑BMI categories- ↓scores for performance IQ but not for full-scale and verbal IQ
Percentage of children with ≥ 1 score below WISC-III score of 85 increased with BMI category and was higher among children of obese mothers compared to children of normal BMI mothers (OR 5.2)
Confounders adjusted for: gender, maternal age, smoking, number of prior births, SES (based on occupation and education)
14 Medium
17Huang L; 2014
 N = 30212
 Age 7 years
 USA
 Population based prospective cohort
Pre-pregnancy BMI (kg/m2)
Gestational weight gain (lb)
Underweight (BMI < 18.5)-9.1 %
Normal (BMI 18.5-24.9)-69.2 %
Overweight (BMI 25.0-29.9)-16.0 %
Obese (BMI ≥30)-5.7 %
Wechsler Intelligence Scale for Children-I
Full-scale, verbal and performance IQ
Pre-pregnancy obesity, but not overweight, was negatively associated with offspring IQ
Compared to children of normal mothers, children of obese mothers scored 2 points lower in full-scale IQ and 2.5 points lower verbal IQ; compared to normal mothers children of underweight mothers scored ~0.6 points lower in full-scale IQ Suboptimal, inadequate or excessive weight gain in normal mothers-↓ full-scale IQ scores (~1-3 points) in children
Excessive, but not inadequate, weight gain in obese mothers-↓ IQ scores in children Compared to children of normal mothers who gained 21-25 lb, children of obese mothers who gained >40 lb scored 6.5 points lower in full-scale IQ scores
Confounders adjusted for: Maternal race, parity, MA, ME, MS, SES, marital status
15 Medium
18Tavris DR; 1982
 N = 2789
 Age 5 years
 USA
 Prospective longitudinal
Maternal gestational weight gain (difference in weight between first and last prenatal visits)
3 categories of weight gain
1) -24 to 4 lb,
2) 5 to 29 lb
3) ≥30 lb
Raven’s Coloured Progressive Matrices
Details of cognitive domains assessed not mentioned
Children of mothers who gained <5 lb and >30 lb scored poorly compared to 2nd category (F = 3.23)
Compared to 1st and 2nd category – no difference.
Compared to 2nd and 3rd category- second category scored better (F = 4.31)
Confounders adjusted for: Ethnicity, MA, parity, pre-pregnancy weight/height ratio, GA, ME, PE, income
13 Medium
19Gage SH; 2013
 ALSPAC: population based prospective cohort-UK.
 N = 5832: Age 4 years
 N = 5191; Age 8 years
 N = 7339; Age 16 years
Maternal gestational weight gain (kg)
3 categories of weight gain
1: less than recommended
2: As recommended
3: more than recommended
Pre-pregnancy weight (kg)
School Entry Assessment Score-4 years
IQ- Wechsler Intelligence Scale for Children -III-8 years
Adequate final exam results-16 years
Children of women gained weight < expected-↓ school entry assessment score (-0.075 SD) and adequate final-exam results (OR = 0.88); ↑Weight gain - early and mid pregnancy -↑school entry assessment score (0.072 and 0.077 SD)
↑ Weight gain in all three periods of pregnancy-↑ IQ at 8 years (0.070 to 0.078 SD) and ↑Pre-pregnancy weight-↓ school entry assessment score (-0.004 SD/kg), IQ (-0.004 SD) and the odds (OR = 0.99) of achieving adequate final exam results
Confounders adjusted for: the child’s sex, current age, MA; ME, parity, pre-pregnancy BMI, smoking and mode of delivery
16 Medium
  1. BMI body mass index, QS quality score, RB risk of bias, GA gestational age, MA maternal age, BWT birthweight, SES socio-economic status, ME maternal education, PE paternal education, MIQ maternal intelligence, HE home environment, MS maternal smoking, BF breast-feeding, DM maternal diabetes, PIH pregnancy induced hypertension