Skip to main content
Download PDF

Pre-pregnancy overweight or obesity moderates the association between prenatal maternal depressive symptoms and infant cord blood omega-3 levels

BMC Pregnancy and Childbirth volume 24, Article number: 535 (2024) Cite this article

Abstract

Background

Empirical evidence has demonstrated associations between pre-pregnancy obesity and perinatal maternal depressive symptoms. Omega-3 is an essential fatty acid derived from dietary sources that is critical for fetal brain development. Pre-pregnancy obesity is associated with higher omega-3 intake, but a weaker association between dietary intake and respective maternal and cord blood omega-3 levels. Further, lower intake of omega-3 during pregnancy has been linked to higher depressive symptoms. Yet, prior studies have not examined the interactive effects of pre-pregnancy overweight or obesity (OWOB) and prenatal maternal mental health symptoms on infant cord blood omega-3 levels.

Methods

Participants included 394 maternal-infant dyads from the NIH Environmental influences on Child Health Outcomes (ECHO) - Safe Passage Study in South Dakota. A pre-pregnancy body mass index (BMI) > 25 was used to dichotomize participants as OWOB (54%) vs. non-OWOB (46%). Prenatal maternal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) and prenatal maternal anxiety symptoms were measured using the State-Trait Anxiety Inventory (STAI). We implemented linear regression models to examine the interaction term between pre-pregnancy BMI category and prenatal maternal mental health symptoms on cord blood omega-3 levels. Secondary analyses were stratified by pre-pregnancy BMI category.

Results

We observed a significant interaction between pre-pregnancy BMI category and prenatal maternal depressive symptoms with cord blood omega-3 (F(4,379) = 6.21, p < .0001, adj. R2 = 0.05). Stratified models revealed an association between prenatal maternal depressive symptoms with lower cord blood omega-3 levels only among individuals with pre-pregnancy OWOB (β = -0.06, 95% CI = -0.11, -0.02; F (2,208) = 4.00, p < .05, adj R2 = 0.03). No associations were observed among non-OWOB participants.

Conclusions

Findings suggest maternal-placental transfer of omega-3 may represent one pathway by which maternal metabolic and mental health impacts infant development.

Peer Review reports

Introduction

Empirical evidence has demonstrated an association between pre-pregnancy overweight and obesity (OWOB) and increased perinatal maternal mood symptoms [1,2,3,4]. Pre-pregnancy OWOB affects approximately 24% of individuals in the United States (US) [5]. Studies have shown that up to 20% of women develop a perinatal mental health illness, such as depression or anxiety, either during pregnancy or within a year of giving birth [6]. Further, the prevalence of obesity and mental health concerns during pregnancy has been rapidly increasing over the past 20 years [7,8,9]. Each diagnosis is associated with an increased risk for neurodevelopmental conditions or behavioral problems in the offspring, such as increased early childhood behavioral problems [10,11,12,13] or increased risk for attention deficit hyperactivity disorder (ADHD) [12, 14] and autism spectrum disorder (ASD) [12, 14,15,16] mediated through independent or overlapping fetal programming mechanisms [17,18,19,20,21,22,23].

Omega-3, an essential fatty acid derived from dietary sources critical for healthy fetal brain development [24], has been linked to numerous child health and neurodevelopmental outcomes. For example, higher supply of long-chain polyunsaturated fatty acids (LC-PUFA) in pregnant persons has been found to reduce the risk of preterm birth [25, 26] and is associated with improved sustained attention, working memory, and inhibitory control in infants by 27 months [27,28,29,30]. During the third trimester, the fetal brain undergoes a rapid growth and requires an additional 50–70 mg/day of DHA, in addition to normal maternal needs [31]. Therefore, fetal plasma and brain omega-3 concentrations are highly impacted by maternal diet [32].

Several observational studies have examined dietary FA intake patterns among pregnant persons [31, 33,34,35,36,37,38]. A pilot study in Europe investigated the link between dietary fat intake during early pregnancy and the FA composition of maternal plasma and umbilical cord plasma phospholipids, revealing associations between higher intake of Linoleic acid, Eicosapentaenoic acid (EPA), and Docosahexaenoic acid (DHA) during pregnancy and their increased presence in maternal plasma phospholipids [33]. Subsequent research further confirmed a direct association between dietary FA intake and corresponding concentrations in maternal blood and cord plasma phospholipids, particularly for most PUFAs [36]. Emerging data suggests that pre-pregnancy obesity is associated with higher dietary intake of LC-PUFA during pregnancy [36, 39], but lower plasma concentrations of omega-3 PUFA [40, 41]. These findings align with previous evidence found in both human [42] and animal [43, 44] models that pre-pregnancy obesity may impact the metabolism of FAs during pregnancy with potential downstream effects on infant FA levels.

Emerging literature suggests deficiencies of omega-3 FAs, which result from inadequate intake or depletion during pregnancy, may be implicated in the risk for perinatal mental health symptoms [45,46,47,48].

Cross-sectional analyses have demonstrated that lower concentrations of omega-3 fats in breastmilk (mainly DHA), as well as lower natural rates of seafood consumption, are robustly correlated with high rates of postnatal depression [49]. Other research has suggested that supplementation of EPA-rich oil may reduce some depressive symptoms during pregnancy and after childbirth [50]. Similarly, there is a relationship between the intake of omega-3 FAs and prenatal anxiety in both animal and human models [51,52,53,54]. In humans, Vaz et al. (2013) found that a lower intake of omega-3 FAs and a lower frequency of fish and seafood consumption were associated with a higher incidence of anxiety symptoms in pregnant women [52]. Further, a recent longitudinal study found that lower plasma omega-3 fatty acids and higher omega-6:omega-3 fatty acid ratios were associated with higher antenatal anxiety, but not postpartum anxiety [55].

Despite the wealth of literature on the effects of prenatal obesity or mental health symptoms on adverse offspring health outcomes, prior studies have not examined the interactive effects of pre-pregnancy overweight or obesity (OWOB) and prenatal mental health symptoms on infant cord blood omega-3 levels. In fact, research to date has exclusively focused on associations between maternal omega-3 intake or levels and child neurodevelopmental outcomes [56,57,58]. Thus, our objective was to determine the joint and independent associations of pre-pregnancy OWOB and prenatal mental health symptoms on infant cord blood omega-3 levels. Given the rising interest in the co-occurrence of these conditions [59, 60], there is important public health and clinical value to understanding the interactive effects of maternal metabolic and mental health on infant cord blood omega-3 levels.

Methods

Study design and participants

Participants were a subset of mother-infant dyads enrolled in the NIH funded Safe Passage Study in Rapid City or Sioux Falls, South Dakota sites of the Prenatal Alcohol and SIDS and Stillbirth (PASS) Network (see Dukes et al., 2014 for full study description) [61]. Eligibility criteria for the NIH Safe Passage Study comprised the capability to offer informed consent in English, being aged 16 or above at the time of consent, and a gestational age ranging from 6 weeks to 40 weeks upon consent, as determined by the estimated delivery date [61]. Inclusion criteria for the current study consisted of prior enrollment in the Safe Passage Study clinics in Rapid City or Sioux Falls, South Dakota, available prenatal maternal mental health data, available pre-pregnancy weight data derived from medical record abstractions, and available infant omega-3 data (N = 384). No participants were excluded from this analysis. Institutional review board (IRB) approvals were obtained for all PASS entities (clinical sites and laboratory centers) from the Health Research Ethics Committee of Avera Research Institute.

Pre-pregnancy overweight or obesity

Pre-pregnancy BMI was measured via self-reported pre-pregnancy weight and clinical coordinator measured height, both captured at the recruitment interview. Maternal-infant medical charts were abstracted to obtain maternal and infant health information including maternal age at delivery, infant gestational age at birth, and the infant’s assigned biological sex at birth.

Prenatal maternal depressive symptoms

Information regarding maternal mental health during pregnancy was obtained at 20–24 weeks’ gestation. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS), a screening tool tailored to gauge symptoms of depression in perinatal women, with elevated scores correlating with increased severity of depressive symptoms [62]. Based on prior work, we used a cut-off score of ≥ 11 to indicate elevated maternal depressive symptoms [63].

Prenatal maternal anxiety symptoms

Maternal anxiety symptoms were assessed using the State-Trait Anxiety Inventory (STAI), an anxiety screening tool designed to differentiate anxiety symptoms from depressive symptoms [64]. The STAI incorporates two subscales: state anxiety, indicating the current anxiety level of the participant during questionnaire completion, and trait anxiety, which is believed to remain stable over time and reflect inherent personality traits [65, 66]. Based on prior work, we used a cut- off score of > 40 on the STAI- state subscale to indicate state anxiety and a cut- off score of > 40 on the STAI- trait subscale to indicate trait anxiety [67].

Neonatal cord blood collection

Cord blood was collected after delivery by research nurses. The cord was clamped at both ends and cut in between the clamps. After the infant was handed off to a medical provider or the mother, the research team removed the stopper tube, unclamped the cord and allowed blood to flow from the cord cut end into a K2 EDTA blood collection tube, and replaced the stopper which resulted in collecting a mixture of arterial and venous blood. Next, the sample was labeled and sent to the laboratory for storage and processing. Specimens were labeled and stored in a 4 °C refrigerator in the delivery ward within 60 min of collection. Samples were then aliquoted from the K2 EDTA tubes into cryovials and were stored at -80 °C until processing.

Infant cord blood omega-3 assays

Cord blood samples were received at OmegaQuant and blood was spotted on filter paper that was pre-treated with a cocktail solution (Fatty Acid Preservative Solution, FAPS™) and allowed to dry at room temperature for 15 min. One punch of the dried blood spots was transferred to a screw-cap glass vial followed by addition of BTM (methanol containing 14% boron trifluoride, toluene, methanol; 35:30:35 v/v/v) (Sigma-Aldrich, St. Louis, MO). The vial was briefly vortexed and heated in a hot bath at 100˚C for 45 min. After cooling, hexane (EMD Chemicals, USA) and high-performance liquid chromatography (HPLC) grade water was added, the tubes were recapped, vortexed and centrifuged to separate layers. An aliquot of the hexane layer was transferred to a GC vial. GC was carried out using a GC-2010 Gas Chromatograph (Shimadzu Corporation, Columbia, MD) equipped with a SP-2560, 100-m fused silica capillary column (0.25 mm internal diameter, 0.2 μm film thickness; Supelco, Bellefonte, PA).

Fatty acids were identified by comparison with a standard mixture of fatty acids characteristic of red blood cells (RBC) (GLC OQ-A, NuCheck Prep, Elysian, MN) which was also used to construct individual fatty acid calibration curves. The following 24 fatty acids (by class) were identified: saturated (14:0, 16:0, 18:0, 20:0, 22:0 24:0); cis monounsaturated (16:1, 18:1, 20:1, 24:1); trans (16:1, 18:1, 18:2); cis n-6 polyunsaturated (18:2, 18:3, 20:2, 20:3, 20:4, 22:4, 22:5); cis n-3 polyunsaturated (18:3, 20:5, 22:5, 22:6). Fatty acid composition was expressed as a percent of total identified fatty acids. The omega-3 index is defined as the sum of 20:5n-3 (EPA) and 22:6n-3 (DHA) adjusted by a regression equation (r = .97) to predict the omega-3 index in the RBC.

Statistical analyses

Data were analyzed using R version 4.1.3. Descriptive statistics were used to describe the characteristics of our study population. We dichotomized participants as not overweight or obese prior to pregnancy (non-OWOB) based on a pre-pregnancy BMI of < 25 or as overweight or obese prior to pregnancy (OWOB) based on a pre-pregnancy BMI of ≥ 25 [68]. Next, we conducted a series of three unadjusted linear regression models to examine the interaction term or main effects of pre-pregnancy OWOB (BMI ≥ 25) and (1) prenatal maternal depressive symptoms, (2) prenatal maternal state anxiety symptoms, and (3) prenatal maternal trait anxiety symptoms on the infant cord blood omega index. The final models were adjusted for preterm birth and infant assigned sex at birth. For all models, we report the regression coefficients (β) and the standard error of estimates for each main effect and the significant interaction term.

Results

Sample characteristics

Our final sample comprised of 384 mother-infant dyads (Table 1). Infants were born between 2010 and 2015. Pregnant persons primarily self-identified as White (85%) followed by American Indian or Alaskan Native (13%) and as Non-Hispanic or Latino (95%). Our sample had high levels of educational attainment with 35% of pregnant persons reporting completing college and 25% reporting completing High School. The majority of pregnant persons were Married or Partnered (93%). Median monthly household income per person was $1,160, not adjusted for inflation. The majority of pregnant persons had commercial health insurance or commercial health maintenance organization (HMO) (68%) followed by public assistance (31%). A total of 55% of participants were categorized as overweight or obese prior to pregnancy (OWOB) (N = 211) and a total of 45% of participants were categorized as not overweight or obese prior to pregnancy (non-OWOB) (N = 173). Pregnant participants in this sample had an average depressive symptom score on the EPDS of 4.70 ± 3.83, an average state anxiety score on the STAI of 26.0 ± 6.88, and an average trait anxiety score on the STAI of 30.7 ± 8.15. Using well-established cutoff scores [63, 67] we observed 8.1% of pregnant persons had mild or moderate depressive symptoms (EPDS ≥ 11) [63], 5.7% of pregnant persons had mild or moderate state anxiety symptoms (STAI state scale ≥ 40) [67], and 13.8% of pregnant persons had mild or moderate trait anxiety symptoms (STAI trait scale ≥ 40) [67]. Infants were predominately female (54%) and born at term age (≥ 37 weeks’ gestation) (93.5%). Finally, infant omega-3 levels were normally distributed (Fig. 1).

Table 1 Participant demographic information (N = 384)
Full size table
Fig. 1
figure 1

Distribution of infant Omega-3 levels at birth

Full size image

Association of pre-pregnancy BMI category and prenatal maternal depressive symptoms with the infant cord blood omega-3 index

Linear regression models showed an interaction effect of pre-pregnancy BMI categories and prenatal maternal depressive symptoms on the infant cord blood omega-3 index in the unadjusted model (Interaction β = -0.07 ± 0.03, F (3, 380) = 5.42, p < .005, adj. R2 = 0.03) and adjusted model (Interaction β = -0.07 ± 0.03, F (5, 378) = 4.96, p < .001, adj. R2 = 0.05). Among pregnant people with pre-pregnancy OWOB, increased prenatal maternal depressive symptoms were associated with decreased infant cord blood omega-3 levels (unadjusted β = -0.06 ± 0.02; adjusted β = -0.07 ± 0.02) (Fig. 2). Preterm birth, but not infant assigned sex at birth, was a significant predictor in the adjusted interaction model. Preterm birth was associated with lower infant cord blood omega-3 levels (β = -0.74 ± 0.26).

Fig. 2
figure 2

Association of Prenatal Maternal Depression and Anxiety Stratified by Pre-Pregnancy Body Mass Index Category. Panel A is stratified by pre-pregnancy overweight or obesity and Panel B is stratified by pre-pregnancy non-overweight or obesityThe y-axis depicts prenatal trait anxiety, prenatal state anxiety, and prenatal depressive symptoms. The x-axis depicts the standardized beta coefficient with 95% confidence intervals. 

Full size image

Association of pre-pregnancy BMI category and prenatal maternal state anxiety symptoms with the infant cord blood omega-3 index

We did not observe an interaction effect of pre-pregnancy OWOB and prenatal maternal state anxiety symptoms on the infant cord blood omega-3 index in unadjusted or adjusted models. Main effects of pre-pregnancy BMI category were observed in the unadjusted (F (2, 378) = 5.02, p < .01, adj. R2 = 0.02) and adjusted models (F (4, 376) = 4.38, p < .01, adj. R2 = 0.03). Pre-pregnancy OWOB was associated with decreased infant cord blood omega-3 levels (unadjusted β = -0.34 ± 0.13; adjusted β = -0.35 ± 0.13). We did not observe a main effect of prenatal maternal state anxiety symptoms on infant cord blood omega-3 levels. Preterm birth was associated with lower infant cord blood omega-3 levels (β = -0.69 ± 0.26). Finally, infant assigned sex at birth was not a significant predictor in the adjusted model.

Association of pre-pregnancy BMI category and prenatal maternal trait anxiety symptoms with the infant cord blood omega-3 index

We did not observe an interaction effect of pre-pregnancy OWOB and prenatal maternal trait anxiety symptoms on the infant cord blood omega-3 index in unadjusted or adjusted models. Main effects of pre-pregnancy BMI category were observed in the unadjusted (F (2, 376) = 5.02, p < .01, adj. R2 = 0.02) and adjusted models (F (4, 374) = 4.38, p < .01, adj. R2 = 0.03). Pre-pregnancy OWOB was associated with decreased infant cord blood omega-3 levels (unadjusted β = -0.35 ± 0.13; adjusted β = -0.36 ± 0.13). We did not observe a main effect of prenatal maternal trait anxiety symptoms on infant cord blood omega-3 levels. Preterm birth was associated with lower infant cord blood omega-3 levels (β = -0.70 ± 0.26). Finally, infant assigned sex at birth was not a significant predictor in the adjusted model.

Discussion

To summarize our findings examining the interactive effects of pre-pregnancy overweight or obesity and prenatal maternal mental health symptoms on infant cord blood omega-3 levels, we observed a significant interaction between pre-pregnancy body mass index and prenatal maternal depressive symptoms with cord blood omega-3. Our stratified models revealed that there was an association between prenatal maternal depressive symptoms with lower cord blood omega-3 levels only among individuals with pre-pregnancy overweight or obesity. We did not observe an interaction effect between pre-pregnancy overweight or obesity and prenatal maternal state or trait anxiety on infant cord blood omega-3 levels. Additionally, we did not observe a main effect of prenatal maternal state or trait anxiety on infant cord blood omega-3 levels. Prior research has demonstrated pre-pregnancy obesity is associated with higher intake of LC-PUFA, but a weaker association between dietary intake and respective maternal and infant cord blood LC-PUFA levels [69] whereas other studies have implicated lower prenatal maternal omega-3 intake and plasma levels as a risk factor for perinatal maternal depression [45,46,47,48]. Our findings, along with prior research in this domain suggest that pre-pregnancy obesity may impact the metabolism of FAs during pregnancy, therefore impacting the quantity of FAs neonates receive via the placental transfer in the womb.

Within our current context, low omega-3 in the fetal and neonatal periods have important implications for further development across the lifespan. It is well known that DHAs are an important structural component of the human brain. DHA plays important roles in cell signaling, the regulation of gene expression, and neurotransmission [70,71,72]. In humans, approximately 20% of the dry weight of the brain is made up of polyunsaturated fatty acids and one out of every three fatty acids in the nervous system is a polyunsaturated fatty acid (50% of these being DHAs) [73]. A recent study in humans showed an early association of LCPUFA-related genotypes with cognitive performance at school age after correction for current DHA blood concentrations, demonstrating possible programming effects of these nutrients on the brain development [74]. Recent studies have also found significant associations between higher concentrations of cord blood omega-3 fatty acids with longer birth length and infant growth [28], better hand-eye coordination [75], and lower scores on a parent-completed behavioral screen at age 10 [76].

In light of these findings, our study’s observation of the associations between pre-pregnancy obesity, prenatal maternal mental health symptoms, and infant cord blood omega-3 levels adds a crucial dimension to the existing literature. Specifically, our results highlight the compounded risk factors that can adversely affect fetal omega-3 status and subsequent developmental outcomes. Omega-3 deprivation has been further explored in animal models. It has been demonstrated in rodents that decreased plasma concentrations of DHA during development alter neurobiological pathways, which has long-term negative consequences on behavior [77]. Additionally, low levels of omega-3s in plasma led to altered physiology of neurotransmitters such as serotonin and dopamine [78], as well as decreased neuron size in various areas of the brain such as the hypothalamus and the hippocampus [79]. In additional animal models, omega-3 fatty acid deficiency has been found to lead to low levels of DHA in the cerebral cortex of the offspring and affect learning ability [80, 81]. These varying impacts in individual areas of function in the brain emphasize the importance of ensuring quantity of FA absorption by neonates during pregnancy. In light of our main finding, it is vital for clinicians overseeing the healthcare of pregnant individuals who are overweight, obese, and/or susceptible to prenatal depressive symptoms to counsel them on the critical significance of sufficient maternal dietary intake of omega-3s.

To our knowledge, the present analysis is the first to date to examine associations between pre-pregnancy obesity, prenatal maternal mental health symptoms, and infant cord blood omega-3 levels. Due to the widespread prevalence of overweight and obesity before pregnancy worldwide, the detrimental effects for both mother and offspring constitute a significant public health concern. In the present analysis, the prevalence of pre-pregnancy obesity was 28.2%, mirroring the reported averages of the United States as a whole (30.0%) and of South Dakota specifically (28.0%) [82]. A total of 25.4% of our sample had a BMI classified as overweight prior to pregnancy which aligns with both the estimated national average (25.8%) and South Dakota’s estimated average (25.7%) [83]. As found in the present study, pre-pregnancy BMI negatively affects several fetal LC-PUFA profiles [84, 85]. These findings are consistent with previous research indicating that maternal obesity can influence fetal fatty acid composition, potentially impacting infant development. Longitudinal studies have shown that children born to mothers with obesity have increased risk of cognitive impairments [22]. Compared with children of mothers with BMI classified as normal weight, children of mothers classified as OWOB prior to pregnancy are at increased risk for compromised neurodevelopmental outcomes such as ADHD, autism spectrum disorder, developmental delay, and/or emotional/behavioral problems [12, 86, 87]. The magnitude of the overall effect of pre-pregnancy OWOB on child neurodevelopment is largely unknown, which places a continued emphasis on elucidating the mechanisms by which these associations affect subsequent childhood outcomes.

Strengths and limitations

Significant strengths of our analysis include our moderate sample size and underrepresented research sample of pregnant persons from a rural part of the United States, including a portion who identify as American Indian/Alaskan Indian. However, several limitations and potential sources of bias may have influenced our findings. In the PASS study, the collected cord blood comprised a combination of arterial and venous blood, and it is possible that omega-3 levels may vary depending on the type of cord blood collected. In the current study, we did not have information regarding prenatal maternal diet to examine associations between prenatal maternal omega dietary intake with infant cord blood omega-3 levels. We additionally did not collect prenatal maternal blood samples which resulted in the inability to examine associations between prenatal maternal diet, maternal plasma omega-3 levels, and infant cord blood omega-3 levels. Inclusion in the present analysis required non-missing data on prenatal maternal depressive and anxiety questionnaires and the collection of infant cord blood. It is possible that individuals with complete data do not accurately reflect PASS at large. Further, it is possible that our findings, which draw from a predominately White and American Indian/Alaskan Indian rural sample of pregnant persons, will not generalize to other populations. Additionally, levels of maternal prenatal depressive and anxiety symptoms were low in this sample. Finally, there are several factors which should be explored in future analyses such as the association of infant cord blood omega-3 levels with subsequent infant or childhood health or neurobehavioral outcomes. There may be also factors that confound these results such as socioeconomic status, access to healthy foods, and access to prenatal care.

Conclusions

Despite these limitations, our findings have important clinical and research implications: They underscore the importance of identifying potential pathways by which maternal metabolic and mental health impacts infant development. Additionally, due to the joint association of pre-pregnancy OWOB and perinatal depressive symptoms on infant cord blood omega-3 levels, future studies should continue examine this relation longitudinally to understand the potential mediating role of infant cord blood omega-3 levels on child health or neurodevelopmental outcomes. Further understanding of such mechanisms may inform intervention research to elucidate causal associations between prenatal maternal omega-3 intake among individuals with metabolic or mental health conditions during pregnancy on adverse birth, infant, or child developmental outcomes.

Data availability

Select de-identified data from the ECHO Program are available through NICHD’s Data and Specimen Hub (DASH) [https://dash.nichd.nih.gov/]. Information on study data not available on DASH, such as some Indigenous datasets, can be found on the ECHO study DASH webpage [https://dash.nichd.nih.gov/explore/study?q=echo&filters=%5b%5d&page=1&sortBy=relevance&asc=true&size=50].

Abbreviations

OWOB:

Overweight or obesity

non-OWOB:

Not overweight or obese

LC-PUFA:

Long-chain Polyunsaturated Fatty Acid

PUFA:

Polyunsaturated Fatty Acid

FA:

Fatty acid

EPA:

Eicosapentaenoic acid

DHA:

Docosahexaenoic acid

BMI:

Body Mass Index

EPDS:

Edinburgh Postnatal Depression Scale

STAI:

State-Trait Anxiety Inventory

References

  1. Group LP-MOCOS, Voerman E, Santos S, Inskip H, Amiano P, Barros H, Charles M-A, Chatzi L, Chrousos GP, Corpeleijn E, et al. Association of Gestational Weight Gain with adverse maternal and infant outcomes. JAMA. 2019;321(17):1702.

    Article  Google Scholar 

  2. Singh GK, DiBari JN. Marked disparities in Pre-pregnancy obesity and overweight prevalence among US women by Race/Ethnicity, Nativity/Immigrant status, and Sociodemographic Characteristics, 2012–2014. J Obes. 2019;2019:1–13.

    Article  Google Scholar 

  3. Kumpulainen SM, Girchenko P, Lahti-Pulkkinen M, Reynolds RM, Tuovinen S, Pesonen AK, Heinonen K, Kajantie E, Villa PM, Hamalainen E, et al. Maternal early pregnancy obesity and depressive symptoms during and after pregnancy. Psychol Med. 2018;48(14):2353–63.

    Article  PubMed  Google Scholar 

  4. Holton S, Fisher J, Nguyen H, Brown WJ, Tran T. Pre-pregnancy body mass index and the risk of antenatal depression and anxiety. Women Birth. 2019;32(6):e508–14.

    Article  PubMed  Google Scholar 

  5. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA. 2012;307(5):491–7.

    Article  PubMed  Google Scholar 

  6. Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol. 2005;106(5 Pt 1):1071–83.

    Article  PubMed  Google Scholar 

  7. Haight SC, Byatt N, Moore Simas TA, Robbins CL, Ko JY. Recorded diagnoses of Depression during Delivery hospitalizations in the United States, 2000–2015. Obstet Gynecol. 2019;133(6):1216–23.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Wang MC, Freaney PM, Perak AM, Greenland P, Lloyd-Jones DM, Grobman WA, Khan SS. Trends in Prepregnancy Obesity and Association with Adverse Pregnancy Outcomes in the United States, 2013 to 2018. J Am Heart Assoc. 2021;10(17):e020717.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Dachew BA, Ayano G, Betts K, Alati R. The impact of pre-pregnancy BMI on maternal depressive and anxiety symptoms during pregnancy and the postpartum period: a systematic review and meta-analysis. J Affect Disord. 2021;281:321–30.

    Article  PubMed  Google Scholar 

  10. Madigan S, Oatley H, Racine N, Fearon RMP, Schumacher L, Akbari E, Cooke JE, Tarabulsy GM. A Meta-analysis of maternal prenatal depression and anxiety on child Socioemotional Development. J Am Acad Child Adolesc Psychiatry. 2018;57(9):645–e657648.

    Article  PubMed  Google Scholar 

  11. Shuffrey LC, Morales S, Jacobson MH, Bosquet Enlow M, Ghassabian A, Margolis AE, Lucchini M, Carroll KN, Crum RM, Dabelea D, et al. Association of Gestational Diabetes Mellitus and perinatal maternal depression with early childhood behavioral problems: an Environmental Influences on Child Health Outcomes (ECHO) study. Child Dev. 2023;94(6):1595–609.

    Article  PubMed  Google Scholar 

  12. Sanchez CE, Barry C, Sabhlok A, Russell K, Majors A, Kollins SH, Fuemmeler BF. Maternal pre-pregnancy obesity and child neurodevelopmental outcomes: a meta-analysis. Obes Rev. 2018;19(4):464–84.

    Article  CAS  PubMed  Google Scholar 

  13. Mina TH, Lahti M, Drake AJ, Raikkonen K, Minnis H, Denison FC, Norman JE, Reynolds RM. Prenatal exposure to very severe maternal obesity is associated with adverse neuropsychiatric outcomes in children. Psychol Med. 2017;47(2):353–62.

    Article  CAS  PubMed  Google Scholar 

  14. Chen LC, Chen MH, Hsu JW, Huang KL, Bai YM, Chen TJ, Wang PW, Pan TL, Su TP. Association of parental depression with offspring attention deficit hyperactivity disorder and autism spectrum disorder: a nationwide birth cohort study. J Affect Disord. 2020;277:109–14.

    Article  PubMed  Google Scholar 

  15. Avalos LA, Chandran A, Churchill ML, Gao X, Ames JL, Nozadi SS, Roubinov D, Brennan PA, Bush NR, Camargo CA, et al. Prenatal depression and risk of child autism-related traits among participants in the environmental influences on Child Health outcomes program. Autism Res. 2023;16(9):1825–35.

    Article  PubMed  Google Scholar 

  16. El Marroun H, White TJ, van der Knaap NJ, Homberg JR, Fernandez G, Schoemaker NK, Jaddoe VW, Hofman A, Verhulst FC, Hudziak JJ, et al. Prenatal exposure to selective serotonin reuptake inhibitors and social responsiveness symptoms of autism: population-based study of young children. Br J Psychiatry. 2014;205(2):95–102.

    Article  PubMed  Google Scholar 

  17. Dean DC III, Planalp EM, Wooten W, Kecskemeti SR, Adluru N, Schmidt CK, Frye C, Birn RM, Burghy CA, Schmidt NL, et al. Association of Prenatal Maternal Depression and anxiety symptoms with infant White Matter Microstructure. JAMA Pediatr. 2018;172(10):973–81.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lee JY, Lee HJ, Jang YH, Kim H, Im K, Yang S, Hoh JK, Ahn JH. Maternal pre-pregnancy obesity affects the uncinate fasciculus white matter tract in preterm infants. Front Pediatr. 2023;11:1225960.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Rajasilta O, Hakkinen S, Bjornsdotter M, Scheinin NM, Lehtola SJ, Saunavaara J, Parkkola R, Lahdesmaki T, Karlsson L, Karlsson H, Tuulari JJ. Maternal pre-pregnancy BMI associates with neonate local and distal functional connectivity of the left superior frontal gyrus. Sci Rep. 2021;11(1):19182.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Posner J, Cha J, Roy AK, Peterson BS, Bansal R, Gustafsson HC, Raffanello E, Gingrich J, Monk C. Alterations in amygdala-prefrontal circuits in infants exposed to prenatal maternal depression. Transl Psychiatry. 2016;6(11):e935.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Fenster T, Rao M, Mamzhi Y, Tsou H Jr. Fetal Neurobehavioral Development: the role of maternal psychosocial, pathological, and pharmacological stress. Georgetown Medical Review; 2020.

  22. Howell KR, Powell TL. Effects of maternal obesity on placental function and fetal development. Reproduction. 2017;153(3):R97–108.

    Article  CAS  PubMed  Google Scholar 

  23. Christian LM, Franco A, Glaser R, Iams JD. Depressive symptoms are associated with elevated serum proinflammatory cytokines among pregnant women. Brain Behav Immun. 2009;23(6):750–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Bernardi JR, Escobar RDS, Ferreira CF, Silveira PP. Fetal and neonatal levels of Omega-3: effects on Neurodevelopment, Nutrition, and growth. Sci World J. 2012;2012:1–8.

    Google Scholar 

  25. Cetin I, Carlson SE, Burden C, Da Fonseca EB, Di Renzo GC, Hadjipanayis A, Harris WS, Kumar KR, Olsen SF, Mader S, et al. Omega-3 fatty acid supply in pregnancy for risk reduction of preterm and early preterm birth. Am J Obstet Gynecol MFM. 2024;6(2):101251.

    Article  CAS  PubMed  Google Scholar 

  26. Sun L, Li Y, Xie W, Xue X. Association between omega-3 fatty acid supplementation and lower risk of preterm delivery: a systematic review and meta-analysis. J Maternal-Fetal Neonatal Med. 2022;35(12):2294–303.

    Article  CAS  Google Scholar 

  27. Nevins JEH, Donovan SM, Snetselaar L, Dewey KG, Novotny R, Stang J, Taveras EM, Kleinman RE, Bailey RL, Raghavan R, et al. Omega-3 fatty acid dietary supplements consumed during pregnancy and lactation and child neurodevelopment: a systematic review. J Nutr. 2021;151(11):3483–94.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Thompson M, Ulu A, Yuil-Valdes AG, Mukherjee M, Thoene M, Van Ormer M, Slotkowski R, Lyden E, Anderson Berry A, Hanson CK, et al. Omega-6 and Omega-3 fatty acid-derived oxylipins from the Lipoxygenase Pathway in maternal and umbilical cord plasma at delivery and their relationship with infant growth. Int J Mol Sci. 2022;23(2):708.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Shrestha N, Sleep SL, Cuffe JSM, Holland OJ, Perkins AV, Yau SY, McAinch AJ, Hryciw DH. Role of omega-6 and omega‐3 fatty acids in fetal programming. Clin Exp Pharmacol Physiol. 2020;47(5):907–15.

    Article  CAS  PubMed  Google Scholar 

  30. Larque E, Demmelmair H, Koletzko B. Perinatal supply and metabolism of long-chain polyunsaturated fatty acids: importance for the early development of the nervous system. Ann N Y Acad Sci. 2002;967:299–310.

    Article  CAS  PubMed  Google Scholar 

  31. Innis SM, Elias SL. Intakes of essential n-6 and n-3 polyunsaturated fatty acids among pregnant Canadian women. Am J Clin Nutr. 2003;77(2):473–8.

    Article  CAS  PubMed  Google Scholar 

  32. Makrides M, Neumann MA, Byard RW, Simmer K, Gibson RA. Fatty acid composition of brain, retina, and erythrocytes in breast- and formula-fed infants. Am J Clin Nutr. 1994;60(2):189–94.

    Article  CAS  PubMed  Google Scholar 

  33. De Vriese SR, Matthys C, De Henauw S, De Backer G, Dhont M, Christophe AB. Maternal and umbilical fatty acid status in relation to maternal diet. Prostaglandins Leukot Essent Fat Acids. 2002;67(6):389–96.

    Article  Google Scholar 

  34. Stark KD, Beblo S, Murthy M, Buda-Abela M, Janisse J, Rockett H, Whitty JE, Martier SS, Sokol RJ, Hannigan JH, Salem N Jr. Comparison of bloodstream fatty acid composition from African-American women at gestation, delivery, and postpartum. J Lipid Res. 2005;46(3):516–25.

    Article  CAS  PubMed  Google Scholar 

  35. Olsen SF, Hansen HS, Sandstrom B, Jensen B. Erythrocyte levels compared with reported dietary intake of marine n-3 fatty acids in pregnant women. Br J Nutr. 1995;73(3):387–95.

    Article  CAS  PubMed  Google Scholar 

  36. Donahue SMA, Rifas-Shiman SL, Olsen SF, Gold DR, Gillman MW, Oken E. Associations of maternal prenatal dietary intake of n-3 and n-6 fatty acids with maternal and umbilical cord blood levels. Prostaglandins Leukot Essent Fatty Acids. 2009;80(5–6):289–96.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Larqué E, Demmelmair H, Berger B, Hasbargen U, Koletzko B. In vivo investigation of the placental transfer of (13)C-labeled fatty acids in humans. J Lipid Res. 2003;44(1):49–55.

    Article  PubMed  Google Scholar 

  38. Wilson NA, Mantzioris E, Middleton PF, Muhlhausler BS. Influence of sociodemographic, lifestyle and genetic characteristics on maternal DHA and other polyunsaturated fatty acid status in pregnancy: a systematic review. Prostaglandins Leukot Essent Fatty Acids. 2020;152:102037.

    Article  CAS  PubMed  Google Scholar 

  39. Stewart F, Rodie VA, Ramsay JE, Greer IA, Freeman DJ, Meyer BJ. Longitudinal assessment of erythrocyte fatty acid composition throughout pregnancy and post partum. Lipids. 2007;42(4):335–44.

    Article  CAS  PubMed  Google Scholar 

  40. Karlsson M, Mårild S, Brandberg J, Lönn L, Friberg P, Strandvik B. Serum phospholipid fatty acids, adipose tissue, and metabolic markers in obese adolescents. Obesity. 2006;14(11):1931–9.

    Article  CAS  PubMed  Google Scholar 

  41. Courville AB, Harel O, Lammi-Keefe CJ. Consumption of a DHA-containing functional food during pregnancy is associated with lower infant ponderal index and cord plasma insulin concentration. Br J Nutr. 2011;106(2):208–12.

    Article  CAS  PubMed  Google Scholar 

  42. Enke U, Jaudszus A, Schleussner E, Seyfarth L, Jahreis G, Kuhnt K. Fatty acid distribution of cord and maternal blood in human pregnancy: special focus on individual trans fatty acids and conjugated linoleic acids. Lipids Health Dis. 2011;10(1):247.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Albuquerque KT, Sardinha FL, Telles MM, Watanabe RL, Nascimento CM, Tavares do Carmo MG, Ribeiro EB. Intake of trans fatty acid-rich hydrogenated fat during pregnancy and lactation inhibits the hypophagic effect of central insulin in the adult offspring. Nutrition. 2006;22(7–8):820–9.

    Article  CAS  PubMed  Google Scholar 

  44. Christians JK, Lennie KI, Wild LK, Garcha R. Effects of high-fat diets on fetal growth in rodents: a systematic review. Reprod Biol Endocrinol. 2019;17(1):39.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Rees A-M, Austin M-P, Owen C, Parker G. Omega-3 deficiency associated with perinatal depression: case control study. Psychiatry Res. 2009;166(2–3):254–9.

    Article  CAS  PubMed  Google Scholar 

  46. Otto SJ, van Houwelingen AC, Badart-Smook A, Hornstra G. Changes in the maternal essential fatty acid profile during early pregnancy and the relation of the profile to diet. Am J Clin Nutr. 2001;73(2):302–7.

    Article  CAS  PubMed  Google Scholar 

  47. Freeman MP, Hibbeln JR, Wisner KL, Davis JM, Mischoulon D, Peet M, Keck PE Jr., Marangell LB, Richardson AJ, Lake J, Stoll AL. Omega-3 fatty acids: evidence basis for treatment and future research in psychiatry. J Clin Psychiatry. 2006;67(12):1954–67.

    Article  CAS  PubMed  Google Scholar 

  48. Markhus MW, Rasinger JD, Malde MK, Froyland L, Skotheim S, Braarud HC, Stormark KM, Graff IE. Docosahexaenoic acid status in pregnancy determines the maternal docosahexaenoic acid status 3-, 6- and 12 months Postpartum. Results from a longitudinal observational study. PLoS ONE. 2015;10(9):e0136409.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Hibbeln JR. Seafood consumption, the DHA content of mothers’ milk and prevalence rates of postpartum depression: a cross-national, ecological analysis. J Affect Disord. 2002;69(1–3):15–29.

    Article  CAS  PubMed  Google Scholar 

  50. Hsu M-C, Tung C-Y, Chen H-E. Omega-3 polyunsaturated fatty acid supplementation in prevention and treatment of maternal depression: putative mechanism and recommendation. J Affect Disord. 2018;238:47–61.

    Article  CAS  PubMed  Google Scholar 

  51. Mizunoya W, Ohnuki K, Baba K, Miyahara H, Shimizu N, Tabata K, Kino T, Sato Y, Tatsumi R, Ikeuchi Y. Effect of dietary fat type on anxiety-like and depression-like behavior in mice. SpringerPlus. 2013;2(1):165.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Vaz JDS, Kac G, Emmett P, Davis JM, Golding J, Hibbeln JR. Dietary patterns, n-3 fatty acids intake from Seafood and high levels of anxiety symptoms during pregnancy: findings from the Avon Longitudinal Study of parents and children. PLoS ONE. 2013;8(7):e67671.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Liu JJ, Green P, John Mann J, Rapoport SI, Sublette ME. Pathways of polyunsaturated fatty acid utilization: implications for brain function in neuropsychiatric health and disease. Brain Res. 2015;1597:220–46.

    Article  CAS  PubMed  Google Scholar 

  54. Su K-P, Matsuoka Y, Pae C-U. Omega-3 polyunsaturated fatty acids in Prevention of Mood and anxiety disorders. Clin Psychopharmacol Neurosci. 2015;13(2):129–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Chong MF, Ong YL, Calder PC, Colega M, Wong JX, Tan CS, Lim AL, Fisk HL, Cai S, Pang WW, et al. Long-chain polyunsaturated fatty acid status during pregnancy and maternal mental health in pregnancy and the postpartum period: results from the GUSTO study. J Clin Psychiatry. 2015;76(7):e848–856.

    Article  PubMed  Google Scholar 

  56. Devarshi PP, Grant RW, Ikonte CJ, Hazels Mitmesser S. Maternal Omega-3 Nutrition, placental transfer and fetal Brain Development in Gestational Diabetes and Preeclampsia. Nutrients. 2019;11(5):1107.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Gustafsson HC, Holton KF, Anderson AN, Nousen EK, Sullivan CA, Loftis JM, Nigg JT, Sullivan EL. Increased maternal prenatal adiposity, inflammation, and lower Omega-3 fatty acid levels influence child negative affect. Front NeuroSci. 2019;13:1035.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Morton SU, Vyas R, Gagoski B, Vu C, Litt J, Larsen RJ, Kuchan MJ, Lasekan JB, Sutton BP, Grant PE, Ou Y. Maternal dietary intake of Omega-3 fatty acids correlates positively with Regional Brain volumes in 1-Month-Old Term infants. Cereb Cortex. 2020;30(4):2057–69.

    Article  PubMed  Google Scholar 

  59. Steinig J, Nagl M, Linde K, Zietlow G, Kersting A. Antenatal and postnatal depression in women with obesity: a systematic review. Arch Womens Ment Health. 2017;20(4):569–85.

    Article  PubMed  Google Scholar 

  60. Rees A-M, Austin M-P, Parker G. Role of Omega-3 fatty acids as a treatment for Depression in the Perinatal Period. Australian New Z J Psychiatry. 2005;39(4):274–80.

    Article  Google Scholar 

  61. Dukes KA, Burd L, Elliott AJ, Fifer WP, Folkerth RD, Hankins GDV, Hereld D, Hoffman HJ, Myers MM, Odendaal HJ et al. The < scp > S> afe < scp > P assage < scp > S tudy: Design, Methods, Recruitment, and Follow-Up Approach. Paediatric and Perinatal Epidemiology 2014, 28(5):455–465.

  62. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry. 1987;150:782–6.

    Article  CAS  PubMed  Google Scholar 

  63. Levis B, Negeri Z, Sun Y, Benedetti A, Thombs BD, Group DESDE. Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: systematic review and meta-analysis of individual participant data. BMJ. 2020;371:m4022.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Spielberger CD. Manual for the state-trait anxiety inventory: STAI. In. Palo Alto, CA: Consulting Psychologists; 1983.

    Google Scholar 

  65. Bieling PJ, Antony MM, Swinson RP. The state-trait anxiety inventory, trait version: structure and content re-examined. Behav Res Ther. 1998;36(7–8):777–88.

    Article  CAS  PubMed  Google Scholar 

  66. Barnes LLB, Harp D, Jung WS. Reliability generalization of scores on the Spielberger state-trait anxiety inventory. Educ Psychol Meas. 2002;62(4):603–18.

    Article  Google Scholar 

  67. Skapinakis P. Spielberger State-Trait Anxiety Inventory. In: Encyclopedia of Quality of Life and Well-Being Research edn. Edited by Michalos AC. Dordrecht: Springer Netherlands; 2014: 6261–6264.

  68. Obesity. Preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:i–xii.

    Google Scholar 

  69. Donahue SM, Rifas-Shiman SL, Olsen SF, Gold DR, Gillman MW, Oken E. Associations of maternal prenatal dietary intake of n-3 and n-6 fatty acids with maternal and umbilical cord blood levels. Prostaglandins Leukot Essent Fat Acids. 2009;80(5–6):289–96.

    Article  CAS  Google Scholar 

  70. Kitajka K, Puskas LG, Zvara A, Hackler L Jr., Barcelo-Coblijn G, Yeo YK, Farkas T. The role of n-3 polyunsaturated fatty acids in brain: modulation of rat brain gene expression by dietary n-3 fatty acids. Proc Natl Acad Sci U S A. 2002;99(5):2619–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Innis SM. Perinatal biochemistry and physiology of long-chain polyunsaturated fatty acids. J Pediatr. 2003;143(4 Suppl):S1–8.

    Article  CAS  PubMed  Google Scholar 

  72. Koletzko B, Lien E, Agostoni C, Bohles H, Campoy C, Cetin I, Decsi T, Dudenhausen JW, Dupont C, Forsyth S, et al. The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations. J Perinat Med. 2008;36(1):5–14.

    Article  CAS  PubMed  Google Scholar 

  73. Logan AC. Neurobehavioral aspects of omega-3 fatty acids: possible mechanisms and therapeutic value in major depression. Altern Med Rev. 2003;8(4):410–25.

    PubMed  Google Scholar 

  74. Lauritzen L, Sørensen LB, Harsløf LB, Ritz C, Stark KD, Astrup A, Dyssegaard CB, Egelund N, Michaelsen KF, Damsgaard CT. Mendelian randomization shows sex-specific associations between long-chain PUFA–related genotypes and cognitive performance in Danish schoolchildren. Am J Clin Nutr. 2017;106(1):88–95.

    Article  CAS  PubMed  Google Scholar 

  75. Dunstan JA, Simmer K, Dixon G, Prescott SL. Cognitive assessment of children at age 2½ years after maternal fish oil supplementation in pregnancy: a randomised controlled trial. Archives Disease Child - Fetal Neonatal Ed. 2008;93(1):F45–50.

    Article  CAS  Google Scholar 

  76. Kohlboeck G, Glaser C, Tiesler C, Demmelmair H, Standl M, Romanos M, Koletzko B, Lehmann I, Heinrich J. Effect of fatty acid status in cord blood serum on children’s behavioral difficulties at 10 y of age: results from the LISAplus Study. Am J Clin Nutr. 2011;94(6):1592–9.

    Article  CAS  PubMed  Google Scholar 

  77. McNamara RK, Vannest JJ, Valentine CJ. Role of perinatal long-chain omega-3 fatty acids in cortical circuit maturation: mechanisms and implications for psychopathology. World J Psychiatry. 2015;5(1):15–34.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Delion S, Chalon S, Herault J, Guilloteau D, Besnard JC, Durand G. Chronic dietary alpha-linolenic acid deficiency alters dopaminergic and serotoninergic neurotransmission in rats. J Nutr. 1994;124(12):2466–76.

    Article  CAS  PubMed  Google Scholar 

  79. Ahmad A, Moriguchi T, Salem N. Decrease in neuron size in docosahexaenoic acid-deficient brain. Pediatr Neurol. 2002;26(3):210–8.

    Article  PubMed  Google Scholar 

  80. Neuringer M, Connor WE, Lin DS, Barstad L, Luck S. Biochemical and functional effects of prenatal and postnatal omega 3 fatty acid deficiency on retina and brain in rhesus monkeys. Proc Natl Acad Sci U S A. 1986;83(11):4021–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  81. Yamamoto N, Hashimoto A, Takemoto Y, Okuyama H, Nomura M, Kitajima R, Togashi T, Tamai Y. Effect of the dietary alpha-linolenate/linoleate balance on lipid compositions and learning ability of rats. II. Discrimination process, extinction process, and glycolipid compositions. J Lipid Res. 1988;29(8):1013–21.

    Article  CAS  PubMed  Google Scholar 

  82. Driscoll AK, Gregory ECW. Increases in prepregnancy obesity: United States, 2016–2019. NCHS Data Brief 2020(392):1–8.

  83. Deputy NP, Dub B, Sharma AJ. Prevalence and Trends in Prepregnancy Normal weight – 48 states, New York City, and District of Columbia, 2011–2015. MMWR Morb Mortal Wkly Rep. 2018;66(51–52):1402–7.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Cinelli G, Fabrizi M, Ravà L, Ciofi Degli Atti M, Vernocchi P, Vallone C, Pietrantoni E, Lanciotti R, Signore F, Manco M. Influence of Maternal Obesity and gestational weight gain on maternal and foetal lipid Profile. Nutrients. 2016;8(6):368.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Cazzola R, Rondanelli M, Russo-Volpe S, Ferrari E, Cestaro B. Decreased membrane fluidity and altered susceptibility to peroxidation and lipid composition in overweight and obese female erythrocytes. J Lipid Res. 2004;45(10):1846–51.

    Article  CAS  PubMed  Google Scholar 

  86. Li M, Fallin MD, Riley A, Landa R, Walker SO, Silverstein M, Caruso D, Pearson C, Kiang S, Dahm JL, et al. The Association of Maternal Obesity and diabetes with autism and other Developmental Disabilities. Pediatrics. 2016;137(2):e20152206.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Jo H, Schieve LA, Sharma AJ, Hinkle SN, Li R, Lind JN. Maternal prepregnancy body Mass Index and Child Psychosocial Development at 6 years of age. Pediatrics. 2015;135(5):e1198–209.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors wish to thank the medical, nursing, and program staff of the ECHO-Safe Passage Study; and the children and families participating.

Funding

Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health, under Award Number UH3OD023279 (AJE). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Institutes of Health.

Author information

Author notes

  1. Drs. Christine Hockett and Lauren C. Shuffrey contributed equally as co-senior authors 

Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA

    Lauren A. Costello, Anahid Akbaryan, Julianna Collazo Vargas & Lauren C. Shuffrey

  2. Avera Research Institute, Sioux Falls, SD, 57108, USA

    Katherine Ziegler, Lacey McCormack, Maria Barber, Amy J. Elliott & Christine Hockett

  3. Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, 57108, USA

    Katherine Ziegler, Lacey McCormack, Maria Barber, Amy J. Elliott & Christine Hockett

  4. Department of Internal Medicine, University of South Dakota School of Medicine, Sioux Falls, SD, 57108, USA

    Katherine Ziegler & William S. Harris

  5. Fatty Acid Research Institute, Sioux Falls, SD, 57106, USA

    William S. Harris & Kristina H. Jackson

  6. OmegaQuant Analytics, LLC, Sioux Falls, SD, 57106, USA

    Kristina H. Jackson

  7. Department of Psychology, University of Southern California, Los Angeles, CA, 90007, USA

    Santiago Morales

Authors
  1. Lauren A. Costello
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katherine Ziegler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lacey McCormack
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anahid Akbaryan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Julianna Collazo Vargas
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. William S. Harris
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kristina H. Jackson
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Maria Barber
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Santiago Morales
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Amy J. Elliott
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Christine Hockett
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Lauren C. Shuffrey
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LAC and LCS contributed to the conception and design of the work. KZ, LM, CH, and AJE contributed to data acquisition. LAC, LCS, WSH, KHJ contributed to data analysis and interpretation. All authors (LAC, KZ, LM, AA, JCV, WSH, KHJ, MB, SM, AJE, CH, LCS) contributed to drafting and revising the article for intellectual content. All authors approve the final version of the manuscript.

Corresponding author

Correspondence to Lauren A. Costello.

Ethics declarations

Ethics approval and consent to participate

The study protocol was approved by the single ECHO institutional review board, WCG IRB. Written informed consent or parent’s/guardian’s permission was obtained along with child assent as appropriate, for the ECHO Cohort Data and Biospecimen Collection Protocol participation and for participation in specific study sites.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Costello, L.A., Ziegler, K., McCormack, L. et al. Pre-pregnancy overweight or obesity moderates the association between prenatal maternal depressive symptoms and infant cord blood omega-3 levels. BMC Pregnancy Childbirth 24, 535 (2024). https://doi.org/10.1186/s12884-024-06732-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12884-024-06732-4

Keywords

BMC Pregnancy and Childbirth

ISSN: 1471-2393

Contact us