Mental Health
The association between pre-pregnancy weight changes and offspring risks of attention-deficit/hyperactivity disorder Jimin Clara Park* Jimin Park Park Park Park Park Park Park Rhodes College
Background: Pre-pregnancy obesity has been linked to increased risk of attention-deficit/hyperactivity disorder (ADHD) in offspring, but evidence is limited on the association of pre-pregnancy weight and obesity status change with offspring ADHD risk.
Methods: Using nationally representative linked data from South Korea’s National Health Insurance Service and the National Disability Registration System(2011-2018), 443,294 offspring of 394,429 mothers aged ≥20 years were followed from birth to first ADHD diagnosis until 2022(mean=6.9 years). Pre-pregnancy weight and obesity status were from two standardized biennial health examinations(within 2 years before pregnancy and about 2 years earlier), and weight change was the percentage difference between them. Obesity status was defined by Asia-Pacific body mass index cutoffs(non-obese, <25 kg/m²; obese, ≥25 kg/m²). ADHD diagnosis required specialist-documented diagnoses consistent with the Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases criteria with standardized behavioral assessments. Cox proportional hazards models were adjusted for sociodemographic, reproductive, lifestyle, and maternal clinical factors.
Results: Cumulative offspring ADHD incidence was 2.68% among mothers with persistent obesity and 2.64% among mothers who maintained non-obese status. Compared with mothers who maintained non-obese status, persistent maternal obesity was associated with higher offspring ADHD risk(hazard ratio[HR]1.17; 95% confidence interval[CI]1.08-1.26). Compared with weight change within ±5%, ≥10% weight gain was associated with increased risk(HR 1.12; 95% CI 1.05-1.20). In subgroup analyses, the association of persistent maternal obesity with offspring ADHD risk was stronger among mothers with mental disorders(HR 1.75; 95% CI 1.37-2.25;P for interaction=0.011).
Conclusions: Persistent maternal pre-pregnancy obesity and ≥10% weight gain were associated with higher offspring ADHD risk.