Maternal pre-pregnancy weight status and gestational weight gain in association with child behavior: The mediating role of prenatal systemic inflammation

Elnaz Vaghef-Mehrabani, Rhonda C. Bell, Catherine J. Field, Megan Jarman, Jenna L. Evanchuk, Nicole Letourneau, Deborah Dewey, Gerald F. Giesbrecht

Research output: Contribution to journalArticlepeer-review


Background and aims: Maternal pre-pregnancy obesity and excessive gestational weight gain (EGWG) may predispose children to behavioral problems through increased prenatal inflammation. We investigated the association between maternal body mass index (BMI) and gestational weight gain (GWG), and child behavioral problems (primary aim), and the mediating role of prenatal inflammation (secondary aim). Methods: We used self-reported pre-pregnancy BMI and estimated-GWG data (N = 1137) from a longitudinal cohort study. Maternal serum C-reactive protein (CRP) was measured in the 3rd-trimester. Parent-reported Child Behavior Checklist (CBCL) was used to assess child internalizing and externalizing behaviors at 3-years-of-age. We used analysis of covariance (ANCOVA), multiple linear regression, and mediation analyses for data analysis. Results: Maternal obesity (F = 21.98, df 3836), EGWG (F = 6.53, df 2764), and their combination (F = 18.51, df 3764) were associated with the 3rd trimester CRP, but not child behavior in the whole sample. Maternal underweight was associated with withdrawal problems in all children (β = 0.56, 95%CI, 0.11,1.00) and aggressive behaviors in female children (β = 2.59, 95%CI, 0.28,4.91). Obesity had a significant association with externalizing behaviors in female children after controlling for maternal CRP (β = 3.72, 95%CI, 0.12,7.32). Both inadequate and EGWG were associated with somatic complaints in male children (β = 0.50, 95%CI, 0.05,0.95; β = 0.36, 95%CI, 0.01,0.71, respectively). Combined obesity/EGWG was associated with externalizing (β = 6.12, 95%CI, 0.53,11.70) and aggressive (β = 4.23, 95%CI, 0.90,7.56) behaviors in female children. We found no significant effects through CRP. Conclusions: Maternal pre-pregnancy BMI and GWG showed sex-specific associations with child behavioral problems. Prenatal CRP, although increased in obesity and EGWG, did not mediate these associations.

Original languageEnglish
Pages (from-to)249-256
Number of pages8
JournalClinical nutrition ESPEN
Early online date15 Dec 2023
Publication statusPublished - Feb 2024

Bibliographical note

Copyright © 2023 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.


  • Inflammation
  • Gestational Weight Gain
  • Behavioral problems
  • Pre-school children
  • Female
  • Male
  • Pregnancy
  • Alberta Pregnancy Outcomes and Nutrition (APrON) study
  • Gestational weight gain
  • Humans
  • Longitudinal Studies
  • Obesity
  • Child Behavior
  • Weight Gain
  • Child
  • Maternal obesity


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