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      Maternal pre-pregnancy obesity and child neurodevelopmental outcomes: a meta-analysis.

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          Abstract

          This review examined evidence of the association between maternal pre-pregnancy overweight/obesity status and child neurodevelopmental outcomes. PubMed and PsycINFO databases were systematically searched for empirical studies published before April 2017 using keywords related to prenatal obesity and children's neurodevelopment. Of 1483 identified papers, 41 were included in the systematic review, and 32 articles representing 36 cohorts were included in the meta-analysis. Findings indicated that compared with children of normal weight mothers, children whose mothers were overweight or obese prior to pregnancy were at increased risk for compromised neurodevelopmental outcomes (overweight: OR = 1.17, 95% CI [1.11, 1.24], I2  = 65.51; obese: OR = 1.51; 95% CI [1.35, 1.69], I2  = 79.63). Pre-pregnancy obesity increased the risk of attention deficit-hyperactivity disorder (OR = 1.62; 95% CI [1.23, 2.14], I2  = 70.15), autism spectrum disorder (OR = 1.36; 95% CI [1.08, 1.70], I2  = 60.52), developmental delay (OR = 1.58; 95% CI [1.39, 1.79], I2  = 75.77) and emotional/behavioural problems (OR = 1.42; 95% CI [1.26, 1.59], I2  = 87.74). Given the current obesity prevalence among young adults and women of childbearing age, this association between maternal obesity during pregnancy and atypical child neurodevelopment represents a potentially high public health burden.

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          Most cited references58

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          Maternal metabolic conditions and risk for autism and other neurodevelopmental disorders.

          We examined whether metabolic conditions (MCs) during pregnancy (diabetes, hypertension, and obesity) are associated with autism spectrum disorder (ASD), developmental delays (DD), or impairments in specific domains of development in the offspring. Children aged 2 to 5 years (517 ASD, 172 DD, and 315 controls) were enrolled in the CHARGE (Childhood Autism Risks from Genetics and the Environment) study, a population-based, case-control investigation between January 2003 and June 2010. Eligible children were born in California, had parents who spoke English or Spanish, and were living with a biological parent in selected regions of California. Children's diagnoses were confirmed by using standardized assessments. Information regarding maternal conditions was ascertained from medical records or structured interview with the mother. All MCs were more prevalent among case mothers compared with controls. Collectively, these conditions were associated with a higher likelihood of ASD and DD relative to controls (odds ratio: 1.61 [95% confidence interval: 1.10-2.37; odds ratio: 2.35 [95% confidence interval: 1.43-3.88], respectively). Among ASD cases, children of women with diabetes had Mullen Scales of Early Learning (MSEL) expressive language scores 0.4 SD lower than children of mothers without MCs (P < .01). Among children without ASD, those exposed to any MC scored lower on all MSEL and Vineland Adaptive Behavior Scales (VABS) subscales and composites by at least 0.4 SD (P < .01 for each subscale/composite). Maternal MCs may be broadly associated with neurodevelopmental problems in children. With obesity rising steadily, these results appear to raise serious public health concerns.
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            Small sample adjustments for robust variance estimation with meta-regression.

            Although primary studies often report multiple outcomes, the covariances between these outcomes are rarely reported. This leads to difficulties when combining studies in a meta-analysis. This problem was recently addressed with the introduction of robust variance estimation. This new method enables the estimation of meta-regression models with dependent effect sizes, even when the dependence structure is unknown. Although robust variance estimation has been shown to perform well when the number of studies in the meta-analysis is large, previous simulation studies suggest that the associated tests often have Type I error rates that are much larger than nominal. In this article, I introduce 6 estimators with better small sample properties and study the effectiveness of these estimators via 2 simulation studies. The results of these simulations suggest that the best estimator involves correcting both the residuals and degrees of freedom used in the robust variance estimator. These studies also suggest that the degrees of freedom depend on not only the number of studies but also the type of covariates in the meta-regression. The fact that the degrees of freedom can be small, even when the number of studies is large, suggests that these small-sample corrections should be used more generally. I conclude with an example comparing the results of a meta-regression with robust variance estimation with the results from the corrected estimator.
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              Gestational weight gain and child adiposity at age 3 years.

              The purpose of this study was to examine the associations of gestational weight gain with child adiposity. Using multivariable regression, we studied associations of total gestational weight gain and weight gain according to 1990 Institute of Medicine guidelines with child outcomes among 1044 mother-child pairs in Project Viva. Greater weight gain was associated with higher child body mass index z-score (0.13 units per 5 kg [95% CI, 0.08, 0.19]), sum of subscapular and triceps skinfold thicknesses (0.26 mm [95% CI, 0.02, 0.51]), and systolic blood pressure (0.60 mm Hg [95% CI, 0.06, 1.13]). Compared with inadequate weight gain (0.17 units [95% CI, 0.01, 0.33]), women with adequate or excessive weight gain had children with higher body mass index z-scores (0.47 [95% CI, 0.37, 0.57] and 0.52 [95% CI, 0.44, 0.61], respectively) and risk of overweight (odds ratios, 3.77 [95% CI: 1.38, 10.27] and 4.35 [95% CI: 1.69, 11.24]). New recommendations for gestational weight gain may be required in this era of epidemic obesity.
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                Author and article information

                Journal
                Obes Rev
                Obesity reviews : an official journal of the International Association for the Study of Obesity
                Wiley
                1467-789X
                1467-7881
                April 2018
                : 19
                : 4
                Affiliations
                [1 ] Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
                [2 ] Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA.
                Article
                NIHMS915615
                10.1111/obr.12643
                6059608
                29164765
                ccc90960-0789-4bcf-9657-3902d516b099
                History

                meta-analysis,prenatal obesity,Child neurodevelopment,maternal weight

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