Maternal Metabolic Complications in Pregnancy and Offspring Behavior Problems at 2 Years of Age

Matern Child Health J. 2019 Jun;23(6):746-755. doi: 10.1007/s10995-018-2691-y.


Objectives Prenatal maternal metabolic problems such as pre-pregnancy adiposity, excess gestational weight gain, and gestational diabetes mellitus (GDM) are associated with an increased risk of psychopathology in offspring. We examined whether these exposures were linked to symptoms of emotional and behavioral problems in offspring at 2 years of age, or if associations were due to confounding variables. Methods Data from 815 mother-child pairs enrolled at the Edmonton site of the Canadian Healthy Infant Longitudinal Development cohort were used to examine associations between gestational metabolic complications and scores on the externalizing and internalizing scales of the Child Behavior Checklist (CBCL-1½ to 5) at age two. Associations between maternal metabolic complications and offspring psychopathology were assessed before and after adjustment for gestational diet, socioeconomic status (SES), postpartum depression (PPD), prenatal smoking and breastfeeding. Results Pre-pregnancy body mass index and GDM, but not gestational weight gain, predicted more offspring externalizing and internalizing problems. However, after adjustment for confounding variables, these associations were no longer statistically significant. Post-hoc analyses revealed that gestational diet accounted for unique variance in both externalizing (semi-partial rdiet = - 0.20, p < 0.001) and internalizing (semi-partial rdiet = - 0.16, p = 0.01) problems. PPD and SES also accounted for a similar amount of variance for both externalizing (semi-partial rPPD = 0.17, p < 0.001; rses = - 0.11, p = 0.03) and internalizing problems (semi-partial rPPD = 0.21, p < 0.001; rses = - 0.14, p = 0.004). Conclusions for Practice Since the confounding effect of gestational diet persisted after adjustment for, and was similar in magnitude to, SES and PPD, future research should consider the impact of unhealthy prenatal diets on offspring neurodevelopment.

Keywords: Child Behavior Checklist; Gestational diabetes mellitus; Obesity; Prenatal nutrition; Prenatal programming; Preschool.

MeSH terms

  • Adiposity / physiology*
  • Adult
  • Blood Glucose
  • Body Mass Index
  • Canada
  • Checklist
  • Child
  • Child Behavior / psychology*
  • Child Behavior Disorders / epidemiology
  • Child Behavior Disorders / etiology*
  • Child Behavior Disorders / psychology
  • Child, Preschool
  • Cohort Studies
  • Diabetes, Gestational / epidemiology*
  • Female
  • Humans
  • Infant
  • Longitudinal Studies
  • Male
  • Mental Disorders / epidemiology
  • Mental Disorders / etiology*
  • Mental Disorders / psychology
  • Obesity / complications
  • Obesity / epidemiology*
  • Pregnancy
  • Prenatal Exposure Delayed Effects / epidemiology
  • Prenatal Exposure Delayed Effects / etiology*
  • Prenatal Exposure Delayed Effects / physiopathology
  • Problem Behavior
  • Psychopathology*
  • Risk Factors


  • Blood Glucose