In a recent publication in Clinical Nutrition ESPEN, researchers have delved into the complex associations between maternal pre-pregnancy weight status, gestational weight gain, and behavioral outcomes in children. Their work, based on data from the Alberta Pregnancy Outcomes and Nutrition (APrON) study, sheds light on potential sex-specific connections and the investigative role of prenatal systemic inflammation as a mediator. This news article delves into the findings and the wider implications for maternal and child health.

Understanding Maternal Pre-Pregnancy Obesity and Gestational Weight Gain

The study, led by Elnaz Vaghef-Mehrabani and colleagues at various Canadian institutions, aimed to understand if prenatal factors like maternal obesity and excessive gestational weight gain (EGWG) heighten the risk of behavioral problems in children by instigating an inflammatory response during pregnancy. Published online on January 16, 2024, the article is available with the DOI: 10.1016/j.clnesp.2023.12.006 and in the February 2024 issue of the journal.

The research team used a sample of 1137 mothers and their children from the longitudinal cohort study and analyzed data that included self-reported pre-pregnancy Body Mass Index (BMI), estimated gestational weight gain (GWG), and maternal serum C-reactive protein (CRP) levels measured in the third trimester. Child behavior was assessed at three years of age using the parent-reported Child Behavior Checklist (CBCL), focusing on internalizing and externalizing behaviors.

The study’s primary aim was to investigate the association between maternal BMI and GWG and child behavioral problems. Concurrently, a secondary aim sought to discern if elevated levels of prenatal inflammation, signified by CRP levels, served as a mediator in these associations.

Highlights and Conclusions of the Study

Notably, the research findings suggested that maternal obesity, EGWG, and their combination were significantly associated with increased CRP levels during the third trimester, though these did not directly correlate to child behavioral issues in the complete sample. However, interesting sex-specific associations emerged:

1. Maternal underweight status corresponded with higher withdrawal problems in all children and heightened aggressive behaviors in female children.
2. Maternal obesity was linked to externalizing behaviors in female children, even after adjusting for CRP levels.
3. Inadequate and excessive GWG were both associated with somatic complaints in male children.
4. The combination of maternal obesity and EGWG correlated strongly with externalizing and aggressive behaviors in female children.

Significantly, the results indicated that the CRP level, while increased in cases of obesity and EGWG, did not mediate the relationship between maternal pre-pregnancy BMI, GWG, and child behavioral outcomes.

Implications for Maternal-Child Health Interventions

The study’s findings underscore the necessity of a targeted approach when addressing the potential implications of maternal weight on child development. Healthcare providers may need to consider maternal BMI and GWG as part of a broader strategy to support the early development of children, especially noting the sex-specific differences that call for distinct interventions.

Implications for Future Research

This investigation invites further inquiries into the mechanisms underlying the revealed associations. Why did prenatal CRP, an inflammation marker, not serve as a mediator as hypothesized? Are there other biological or environmental factors at play in the maternal weight-child behavior nexus that require exploration? Subsequent research must continue to unravel these questions to inform more effective preventive measures and interventions.

Key Takeaway and Supporting References

This study contributes valuable insights into how maternal weight factors may shape child behavioral outcomes without being directly mediated by systemic inflammation marked by CRP levels during pregnancy. As maternal obesity and EGWG prevalence continue to rise globally, understanding these dynamics becomes increasingly urgent.

For further reading, several studies have explored related topics:
1. Robinson, S., Fall, C. (2012). “Infant obesity and cognitive development.” Arch Pediatr Adolesc Med, 166(1), 41–47. DOI:10.1001/archpediatrics.2011.784
2. Heslehurst, N., Rankin, J., Wilkinson, J. R., & Summerbell, C. D. (2010). “A nationally representative study of maternal obesity in England, UK: trends in incidence and demographic inequalities in 619 323 births, 1989–2007.” Int J Obes (Lond), 34(3), 420–428. DOI:10.1038/ijo.2009.250
3. Van Lieshout, R.J. (2013). “Role of maternal adiposity prior to and during pregnancy in cognitive and psychiatric problems in offspring.” Nutr Rev, 71(Suppl 1), S95–S101. DOI:10.1111/nure.12059
4. Gaillard, R., Durmuş, B., Hofman, A., Mackenbach, J. P., Steegers, E. A., & Jaddoe, V. W. (2013). “Risk factors and outcomes of maternal obesity and excessive weight gain during pregnancy.” Obesity (Silver Spring), 21(5), 1046-1055. DOI:10.1002/oby.20088
5. Tanda, R., Salsberry, P. J., Reagan, P. B., & Fang, M. Z. (2013). “The impact of prepregnancy obesity on children’s cognitive test scores.” Matern Child Health J., 17(2), 222–229. DOI:10.1007/s10995-012-0973-0


1. Maternal Obesity
2. Gestational Weight Gain
3. Child Behavioral Problems
4. Prenatal Inflammation
5. Early Childhood Development

Declaration of competing interest: The authors of the original study have declared no conflicts of interest.

This comprehensive look at the APrON study’s findings contributes to a deeper understanding of the intricate interplay between maternal health and child development, with implications that reach far into the public health domain.