Funded Projects

(SDAS) Maternal Obesity, Excessive Weight Gain, Diabetes Mellitus, and Hypertension During Pregnancy and Risk of Neuro-developmental Disability in Children

Grantee: University of South Carolina
Principal Investigator: Joshua R. Mann
Project Number: R40MC21523
Project Date: 2/1/2011

Final Report

(SDAS) Maternal Obesity, Excessive Weight Gain, Diabetes Mellitus, and Hypertension During Pregnancy and Risk of Neuro-developmental Disability in Children Final Report (PDF)

Age group(s)

• Women/Maternal
• Prenatal
• Perinatal/Infancy (0-12 months)

Abstract

The overall goal of this project is to answer the research question: Do maternal obesity, excessive weight gain, diabetes mellitus, and hypertension in pregnancy increase the risk of cerebral palsy (CP), intellectual disability (ID), and epilepsy in children? In order to answer the research question we will analyze data from a cohort of approximately 200,000 Medicaid maternal-child pairs in a retrospective cohort design. The study will examine maternal obesity, weight gain during pregnancy, pre-pregnancy and gestational diabetes mellitus, and prepregnancy and gestational hypertension using Medicaid billing data and birth certificate information. Previous research by the study team has identified maternal genitourinary infections and pre-eclampsia, both of which have substantial inflammatory components, as significant risk factors for these child outcomes. Since obesity, diabetes, and hypertension also have inflammatory components, it is reasonable to hypothesize that they may also be associated risk of childhood neuro-developmental disability. A major strength of this study is the large sample size available for analysis. Another notable strength is the ability to link mother and child files that incorporate medical diagnoses and prescription information as well as childhood data. We will supplement the billing information on maternal conditions with information from birth certificates, which include indicator variables for diabetes and hypertension, as well as amount of weight gained during pregnancy; since 2004, birth certificates have also included pre-pregnancy body mass index. Child outcomes will be obtained primarily using Medicaid billing data, but we will also obtain information on intellectual disability from the South Carolina Department of Education and the Department of Disabilities and Special Needs files. The proposed study is responsive to Strategic Research Issue #IV: Promoting the healthy development of MCH populations, and to the MCHB Strategic Plan Goal 2: Promote an environment that supports maternal and child health. If maternal obesity-related metabolic conditions are associated with increased risk of NDD in offspring, then increased efforts to promote healthy lifestyles in women of childbearing age have the potential to reduce the risk of lifelong disability in children. The national significance of the research is demonstrated by the burden of the outcomes and the substantial prevalence of the exposures.

Publications

Listed is descending order by year published.

Mann J, McDermott S, Hardin J, et al. Pre-pregnancy body mass index, weight change during pregnancy, and risk of intellectual disability in children. BJOG: An International Journal of Obstetrics and Gynecology. 2013;120(3):309-319.

Mann JR, Deroche CB, Spiryda LB, McDermott S. Editorial: is pre-pregnancy weight a risk factor for intellectual disability? Expert Review of Obstetrics & Gynecology. 2013;8(3):197-199

Mann JR, McDermott S, Pan C, Hardin JW. Maternal hypertension and intrapartum fever are associated with increased risk of ischemic stroke during infancy. Dev Med Child Neurol. 2013 Jan;55(1):58-64.

Mann JR, Pan C, Rao GA, McDermott S, Hardin JW. Children born to diabetic mothers may be more likely to have intellectual disability. Matern Child Health J. 2013 Jul;17(5):928-32. doi: 10.1007/s10995-012-1072-1. PubMed PMID: 22798077

Pan C, Deroche CB, Mann JR, McDermott S, Hardin JW. Is Prepregnancy Obesity Associated With Risk of Cerebral Palsy and Epilepsy in Children? J Child Neurol. 2013 Dec 11. [Epub ahead of print] PubMed PMID: 24334343.

Mann JR, Pan C, Rao GA, McDermott S, Hardin JW. Children born to diabetic mothers may be more likely to have intellectual disability. Matern Child Health J. 2012 Jul 14. [Epub ahead of print] PubMed PMID: 22798077.