Association of maternal weight gain during pregnancy, pre-pregnancy body mass index, and their combined effect with emotional and behavioral problems in preschool children

Abstract

Objective To investigate emotional and behavioral problems in preschool children in Nantong City, and to analyze the relationship between maternal gestational weight gain (GWG), pre-pregnancy body mass index (BMI), and their combined effects on children′s emotional and behavioral problems, so as to provide evidence for health management during and before pregnancy. Methods A cross-sectional survey was conducted in eight kindergartens in Nantong City from September to December 2023, involving 2 176 preschool children. Maternal GWG and pre-pregnancy BMI were obtained through questionnaires, and children′s emotional and behavioral problems were assessed using the Strengths and Difficulties Questionnaire (SDQ). Multivariate Logistic regression models were used for data analysis. Results The abnormal detection rates of preschool children in peer relationship problems, hyperactivity, prosocial behavior, conduct problems, and emotional symptoms were 30.33％(660/2 176)、29.60％(644/2 176)、26.01％(566/2 176)、22.62％(492/2 176), and 18.00％(392/2 176), respectively, with an overall abnormal detection rate of 23.90%(521/2 176). Boys had a higher abnormal detection rate than girls(χ²=94.732, P＜0.01). Maternal pre-pregnancy overweight/obesity and excessive GWG were identified as risk factors for emotional and behavioral problems in preschool children (OR＝1.19, 95%CI: 1.01 - 1.31,P<0.05; OR＝1.12, 95%CI: 1.03 - 1.22,P<0.05). Stratified by pre-pregnancy BMI, excessive GWG was an independent risk factor for emotional and behavioral problems in children across normal-weight, underweight, and overweight/obese groups (OR＝1.09, 95%CI: 1.03 - 1.43,P<0.05; OR＝1.37, 95%CI: 1.02 - 1.89,P<0.05; OR＝1.35, 95%CI: 1.07 - 1.71,P<0.05). The combined effects of insufficient GWG with pre-pregnancy overweight/obesity, excessive GWG with pre-pregnancy underweight, and normal pre-pregnancy BMI significantly increased the risk of emotional and behavioral problems in offspring (OR=1.30,95%CI: 1.15 - 1.56,P<0.05; OR= 1.20, 95%CI: 1.02 - 1.46,P<0.05; OR＝1.10, 95%CI: 1.02 - 1.23,P<0.05). Gender-stratified analysis revealed that insufficient GWG combined with pre-pregnancy overweight/obesity was a risk factor for emotional and behavioral problems in boys. Conclusions Maternal insufficient or excessive GWG and abnormal pre-pregnancy BMI are significantly associated with emotional and behavioral problems in preschool children, especially in boys. The combined effects of insufficient GWG and pre-pregnancy overweight/obesity have a pronounced impact on emotional and behavioral problems.

Keywords

gestational weight gain / body mass index / emotional-behavioral problems / preschool children