Associations Of Maternal Pregnancy-related Anxiety With Children’s Physical Growth Patterns And Timing Of Adiposity Rebound:A Birth Cohort Study

ObjectivesTo investigate the association of maternal pregnancy-related anxiety with the level of early childhood physical growth patterns and the timing of adiposity rebound(AR)and the possible critical period of effect and dose-response relationship.MethodsThe present study was based on the Ma’anshan birth cohort(MABC),and 3,474 pregnant women with 14 gestational weeks who participated their first antenatal checkup at Ma’anshan Maternal and Child Health Hospital from May 2013 to September 2014 were enrolled as the subjects.Basic demographic characteristics and obstetric information of pregnant women were collected through questionnaires and medical records.The Chinese Pregnancy-related Anxiety scale(C-PRA)was used in the first,second and third trimester of pregnancy,respectively.Body mass index(BMI)and body fat(BF)were measured regularly in childhood.Rapid weight gain(RWG)in infancy was defined as a change in WAZ from birth to 12/24 months ≥0.67.Group-based trajectory models(GBTM)was applied to fit the trajectories of pregnancy-related anxiety score and physical growth,and a fractional polynomial model was used to determine the timing of adiposity rebound(AR)in children.ResultsThe overall prevalence of maternal pregnancy-related anxiety during pregnancy was 35.1%(791/2253).The prevalence of maternal pregnancy-related anxiety in first,second,and third trimesters of pregnancy was 20.6%(463/2253),22.1%(499/2253),and 22.5%(506/2253),respectively.After adjusting for confounders(maternal age at pregnancy,race,residence,pre-pregnancy BMI,maternal educational levels,monthly household income,smoking during pregnancy,alcohol consumption during pregnancy,pregnancy complications,parity),children born of maternal pregnancy-related anxiety in the second trimester(OR= 0.72,95% CI: 0.58 ～ 0.89)and third trimester(OR= 0.73.95% CI: 0.59 ～ 0.91)and new-onset pregnancy-related anxiety in the second trimester(OR= 0.69,95% CI: 0.51 ～ 0.94)of pregnancy were associated with lower levels of RWG in the first year of life;Children whose mothers had pregnancy-related anxiety in the second trimester had lower overall RWG levels from 0 to 12 months of age(β =-0.13,95% CI:-0.24 ～-0.02);Generalized estimating equation models(GEEs)showed that children in the group with pregnancy-related anxiety in the third trimester of pregnancy had lower overall levels of BMI from 0 to 72 months of age(β =-0.11,95% CI:-0.20 ～-0.01);Children with the group with maternal pregnancy-related anxiety during pregnancy(OR = 0.69,95% CI: 0.48 ～ 0.93),maternal pregnancy-related anxiety in the second trimester of pregnancy(OR= 0.56,95% CI:0.37 ～ 0.83),maternal pregnancy-related anxiety in third trimester of pregnancy(OR= 0.63,95% CI: 0.42 ～ 0.93)and maternal new onset of pregnancy-related anxiety in the second trimester of pregnancy(OR = 0.48,95% CI: 0.26 ～ 0.87)were less likely to develop a high BMI trajectory from 0 to 72 months of age;GEEs analysis showed that children in the group with maternal pregnancy-related anxiety in the third trimester of pregnancy had lower BF levels from 48 to 72 months of age(β =-0.18,95% CI:-0.35 ～-0.01);Children in the group with maternal pregnancy-related anxiety in the third trimester of pregnancy were less likely to develop a high BF trajectory from 48 to 72 months of age(OR = 0.70,95% CI: 0.52 ～ 0.95);we did not find any association between maternal pregnancy-related anxiety and the timing of AR in children.ConclusionsChildren born to mothers with pregnancy-related anxiety during pregnancy had lower levels of physical development(RWG,BMI,BF)in childhood,with separate analyses by trimester showing that this association occurred mainly in the second and third trimester of pregnancy.