Neonatal and neurodevelopmental outcomes in preterm infants according to maternal body mass index: A prospective cohort study

Autoři: Marie Moreau aff001;  Mathilde Remy aff001;  Simon Nusinovici aff002;  Valérie Rouger aff003;  Lisa Molines aff001;  Cyril Flamant aff003;  Guillaume Legendre aff005;  Jean-Christophe Rozé aff003;  Agnès Salle aff006;  Patrick Van Bogaert aff003;  Régis Coutant aff008;  Géraldine Gascoin aff001
Působiště autorů: Department of Neonatal Medicine, Angers University Hospital, Angers, France aff001;  CIC 1413, Nantes University Hospital, Nantes, France aff002;  Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France aff003;  Department of Neonatal Medicine, Nantes University Hospital, Nantes, France aff004;  Department of Obstetrics and Gynaecology, Angers University Hospital, Angers, France aff005;  Department of Endocrinology, Diabetology and Nutrition, Angers University Hospital, Angers, France aff006;  Department of Paediatric Neurology, Angers University Hospital, Angers, France aff007;  Department of Paediatric Endocrinology, Angers University Hospital, Angers, France aff008
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article



Maternal obesity is associated with an increase in maternal, foetal and neonatal morbidity and mortality. The aim of our study was to evaluate the relationships between maternal pre-pregnancy body mass index and (1) neonatal outcome in preterm infants, and (2) neurodevelopmental outcome at 2 years of corrected age.


We conducted a single-centre cohort study. Infants born between 24+0 and 33+6 weeks of gestation between January 2009 and December 2013, hospitalised in the neonatal intensive care unit of Angers University Hospital, and with available data regarding maternal pre-pregnancy body mass index were eligible. Three groups were defined according to maternal body mass index: normal (n = 418), overweight (n = 136) and obese (n = 89). The primary outcome was neurodevelopment at 2 years of corrected age. Children with a non-optimal neuromotor and/or psychomotor assessment and/or a sensory disability were regarded as having a “non-optimal neurodevelopmental outcome”. Neuromotor function was regarded as non-optimal when cerebral palsy was present or when the clinical examination revealed neurological signs of abnormal muscular tone. Psychomotor assessment was regarded as non-optimal if the revised Brunet-Lézine test was < 85 or when the overall score in the parental Ages and Stages Questionnaire (ASQ) was < 185. Finally, sensory disabilities such as blindness and children who required a hearing aid were taken into account. The secondary outcome was the composite criteria of neonatal complications. Multivariable analysis included the following variables: mother’s age, gestational age, smoking during pregnancy, magnesium sulphate and steroid treatment during pregnancy, twin status, gender, socioeconomic status and social security benefits for those with low incomes.


The study population was composed of 643 preterm infants. Among them, 520 were assessed at 2 years. There was no difference in the proportion of infants with non-optimal neurodevelopmental outcomes between the three groups (16.6% for obese, 13.5% for overweight, 16.9% for normal body mass index mothers; p = 0.73). According to multivariable analysis, being born from an overweight or obese mother was not associated with an increased risk of non-optimal neuro-development at 2 years (adjusted OR = 0.84 [0.40–1.76] for obese, adjusted OR = 0.83 [0.43–1.59] for overweight mothers). There was no difference in the proportion of preterm infants with a non-optimal composite criterion of neonatal complications between the three groups. In the multivariable analysis, being born from an overweight or obese mother was not associated with an increased risk of non-optimal neonatal outcomes (adjusted OR = 0.95 [0.49–1.83] for obese, adjusted OR = 1.18 [0.69–2.01] for overweight mothers).


In this large prospective cohort of preterm infants born before 34 weeks of gestation, we found no relationship between maternal body mass index and neurodevelopmental outcomes at 2 years of corrected age and no relationship between maternal body mass index and neonatal outcomes. Other prematurity-related factors may be more relevant for neurodevelopmental outcome than the mother’s pre-pregnancy BMI.

Klíčová slova:

Birth weight – Body Mass Index – Cerebral palsy – Infants – Neonates – Neurodevelopment – Obesity – Pregnancy


1. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet Lond Engl. 2013 Aug 3;382(9890):427–51.

2. Stevens GA, Singh GM, Lu Y, Danaei G, Lin JK, Finucane MM, et al. National, regional, and global trends in adult overweight and obesity prevalences. Popul Health Metr. 2012 Nov 20;10(1):22. doi: 10.1186/1478-7954-10-22 23167948

3. Harper A. Reducing morbidity and mortality among pregnant obese. Best Pract Res Clin Obstet Gynaecol. 2015 Apr;29(3):427–37. doi: 10.1016/j.bpobgyn.2014.08.010 25457861

4. Declercq E, MacDorman M, Cabral H, Stotland N. Prepregnancy Body Mass Index and Infant Mortality in 38 U.S. States, 2012–2013. Obstet Gynecol. 2016 Feb;127(2):279–87. doi: 10.1097/AOG.0000000000001241 26942355

5. Marchi J, Berg M, Dencker A, Olander EK, Begley C. Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews. Obes Rev Off J Int Assoc Study Obes. 2015 Aug;16(8):621–38.

6. Villamor E, Cnattingius S. Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study. Lancet Lond Engl. 2006 Sep 30;368(9542):1164–70.

7. Tabet M, Flick LH, Tuuli MG, Macones GA, Chang JJ. Prepregnancy body mass index in a first uncomplicated pregnancy and outcomes of a second pregnancy. Am J Obstet Gynecol. 2015 Oct;213(4):548.e1–7.

8. Catalano PM, Shankar K. Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. BMJ. 2017 Feb 8;356:j1. doi: 10.1136/bmj.j1 28179267

9. Cnattingius S, Villamor E, Johansson S, Edstedt Bonamy A-K, Persson M, Wikström A-K, et al. Maternal obesity and risk of preterm delivery. JAMA. 2013 Jun 12;309(22):2362–70. doi: 10.1001/jama.2013.6295 23757084

10. Persson M, Johansson S, Villamor E, Cnattingius S. Maternal overweight and obesity and risks of severe birth-asphyxia-related complications in term infants: a population-based cohort study in Sweden. PLoS Med. 2014 May;11(5):e1001648. doi: 10.1371/journal.pmed.1001648 24845218

11. Aune D, Saugstad OD, Henriksen T, Tonstad S. Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis. JAMA. 2014 Apr 16;311(15):1536–46. doi: 10.1001/jama.2014.2269 24737366

12. Kim SS, Zhu Y, Grantz KL, Hinkle SN, Chen Z, Wallace ME, et al. Obstetric and Neonatal Risks Among Obese Women Without Chronic Disease. Obstet Gynecol. 2016;128(1):104–12. doi: 10.1097/AOG.0000000000001465 27275800

13. van der Burg JW, Sen S, Chomitz VR, Seidell JC, Leviton A, Dammann O. The role of systemic inflammation linking maternal BMI to neurodevelopment in children. Pediatr Res. 2016 Jan;79(1–1):3–12. doi: 10.1038/pr.2015.179 26375474

14. Villamor E, Tedroff K, Peterson M, Johansson S, Neovius M, Petersson G, et al. Association Between Maternal Body Mass Index in Early Pregnancy and Incidence of Cerebral Palsy. JAMA. 2017 07;317(9):925–36. doi: 10.1001/jama.2017.0945 28267854

15. Reynolds LC, Inder TE, Neil JJ, Pineda RG, Rogers CE. Maternal obesity and increased risk for autism and developmental delay among very preterm infants. J Perinatol Off J Calif Perinat Assoc. 2014 Sep;34(9):688–92.

16. Li M, Fallin MD, Riley A, Landa R, Walker SO, Silverstein M, et al. The Association of Maternal Obesity and Diabetes With Autism and Other Developmental Disabilities. Pediatrics. 2016 Feb;137(2):e20152206. doi: 10.1542/peds.2015-2206 26826214

17. Hanf M, Nusinovici S, Rouger V, Olivier M, Berlie I, Flamant C, et al. Cohort Profile: Longitudinal study of preterm infants in the Pays de la Loire region of France (LIFT cohort). Int J Epidemiol. 2017 Oct 1;46(5):1396–1397h. doi: 10.1093/ije/dyx110 29106567

18. Olsen IE, Groveman SA, Lawson ML, Clark RH, Zemel BS. New intrauterine growth curves based on United States data. Pediatrics. 2010 Feb;125(2):e214–224. doi: 10.1542/peds.2009-0913 20100760

19. Gosselin J, Amiel-Tison C, Infante-Rivard C, Fouron C, Fouron J-C. Minor neurological signs and developmental performance in high risk children at preschool age. Dev Med Child Neurol. 2002 May;44(5):323–8. doi: 10.1017/s0012162201002158 12033718

20. Leroux BG, N’guyen The Tich S, Branger B, Gascoin G, Rouger V, Berlie I, et al. Neurological assessment of preterm infants for predicting neuromotor status at 2 years: results from the LIFT cohort. BMJ Open. 2013;3(2).

21. Brunet O, Lézine I, Josse D. Brunet-Lézine révisé: échelle de développement psychomoteur de la première enfance: manuel BLR-C. Issy-Les-Moulineaux (France): Etablissements d’Applications Psychotechniques; 1997.

22. Squires J, Bricker D, Potter L. Revision of a parent-completed development screening tool: Ages and Stages Questionnaires. J Pediatr Psychol. 1997 Jun;22(3):313–28. doi: 10.1093/jpepsy/22.3.313 9212550

23. Skellern CY, Rogers Y, O’Callaghan MJ. A parent-completed developmental questionnaire: follow up of ex-premature infants. J Paediatr Child Health. 2001 Apr;37(2):125– doi: 10.1046/j.1440-1754.2001.00604.x 11328465

24. Flamant C, Branger B, Nguyen The Tich S, de la Rochebrochard E, Savagner C, Berlie I, et al. Parent-completed developmental screening in premature children: a valid tool for follow-up programs. PloS One. 2011;6(5):e20004. doi: 10.1371/journal.pone.0020004 21637833

25. Saben J, Lindsey F, Zhong Y, Thakali K, Badger TM, Andres A, et al. Maternal obesity is associated with a lipotoxic placental environment. Placenta. 2014 Mar;35(3):171–7. doi: 10.1016/j.placenta.2014.01.003 24484739

26. Liang T, Jinglong X, Shusheng D, Aiyou W. Maternal obesity stimulates lipotoxicity and up-regulates inflammatory signaling pathways in the full-term swine placenta. Anim Sci J Nihon Chikusan Gakkaiho. 2018 Sep;89(9):1310–22. doi: 10.1111/asj.13064 29947166

27. Hinkle SN, Schieve LA, Stein AD, Swan DW, Ramakrishnan U, Sharma AJ. Associations between maternal prepregnancy body mass index and child neurodevelopment at 2 years of age. Int J Obes 2005. 2012 Oct;36(10):1312–9.

28. Brion M-J, Zeegers M, Jaddoe V, Verhulst F, Tiemeier H, Lawlor DA, et al. Intrauterine effects of maternal prepregnancy overweight on child cognition and behavior in 2 cohorts. Pediatrics. 2011 Jan;127(1):e202–211. doi: 10.1542/peds.2010-0651 21187310

29. Mina TH, Lahti M, Drake AJ, Denison FC, Räikkönen K, Norman JE, et al. Prenatal exposure to maternal very severe obesity is associated with impaired neurodevelopment and executive functioning in children. Pediatr Res. 2017 Jul;82(1):47–54. doi: 10.1038/pr.2017.43 28288149

30. Basatemur E, Gardiner J, Williams C, Melhuish E, Barnes J, Sutcliffe A. Maternal prepregnancy BMI and child cognition: a longitudinal cohort study. Pediatrics. 2013 Jan;131(1):56–63. doi: 10.1542/peds.2012-0788 23230067

31. Álvarez-Bueno C, Cavero-Redondo I, Lucas-de la Cruz L, Notario-Pacheco B, Martínez-Vizcaíno V. Association between pre-pregnancy overweight and obesity and children’s neurocognitive development: a systematic review and meta-analysis of observational studies. Int J Epidemiol. 2017 Oct 1;46(5):1653–66. doi: 10.1093/ije/dyx122 29040611

32. Shepherd E, Gomersall JC, Tieu J, Han S, Crowther CA, Middleton P. Combined diet and exercise interventions for preventing gestational diabetes mellitus. Cochrane Database Syst Rev. 2017 13;11:CD010443. doi: 10.1002/14651858.CD010443.pub3 29129039

33. Pierrat V, Marchand-Martin L, Arnaud C, Kaminski M, Resche-Rigon M, Lebeaux C, et al. Neurodevelopmental outcome at 2 years for preterm children born at 22 to 34 weeks’ gestation in France in 2011: EPIPAGE-2 cohort study. BMJ. 2017 16;358:j3448. doi: 10.1136/bmj.j3448 28814566

34. Beaino G, Khoshnood B, Kaminski M, Pierrat V, Marret S, Matis J, et al. Predictors of cerebral palsy in very preterm infants: the EPIPAGE prospective population-based cohort study. Dev Med Child Neurol. 2010 Jun;52(6):e119–125. doi: 10.1111/j.1469-8749.2010.03612.x 20163431

35. Danieli-Gruber S, Maayan-Metzger A, Schushan-Eisen I, Strauss T, Leibovitch L. Outcome of preterm infants born to overweight and obese mothers†. J Matern-Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2017 Feb;30(4):402–5.

36. Faucett AM, Metz TD, DeWitt PE, Gibbs RS. Effect of obesity on neonatal outcomes in pregnancies with preterm premature rupture of membranes. Am J Obstet Gynecol. 2016 Feb;214(2):287.e1–287.e5.

37. Khalak R, Rijhsinghani A, McCallum SE. Impact of maternal obesity on very preterm infants. Obes Silver Spring Md. 2017 May;25(5):945–9.

38. Aly H, Hammad T, Nada A, Mohamed M, Bathgate S, El-Mohandes A. Maternal obesity, associated complications and risk of prematurity. J Perinatol Off J Calif Perinat Assoc. 2010 Jul;30(7):447–51.

39. Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2017 21;3:CD004454. doi: 10.1002/14651858.CD004454.pub3 28321847

40. Ancel P-Y, Goffinet F, EPIPAGE-2 Writing Group, Kuhn P, Langer B, Matis J, et al. Survival and morbidity of preterm children born at 22 through 34 weeks’ gestation in France in 2011: results of the EPIPAGE-2 cohort study. JAMA Pediatr. 2015 Mar;169(3):230–8. doi: 10.1001/jamapediatrics.2014.3351 25621457

Článek vyšel v časopise


2019 Číslo 12
Nejčtenější tento týden