Effects of gestational weight gain on emotional and behavioral problems in children: Results from the CLaB study

Abstract

BACKGROUND: Gestational weight gain (GWG) may influence child neurodevelopment, with potential effects on emotional and behavioral outcomes. This study investigates the relationship between GWG and behavioral problems in children aged 7-8 years. METHODS: This cohort study used data from the Botucatu Infant Cohort. The first wave (2015-2016) included 656 newborns and their mothers, with maternal GWG classified as insufficient, adequate, or excessive according to National Academy of Medicine guidelines. The second wave (2023-2024) assessed 394 children aged 7-8 years using the Strengths and Difficulties Questionnaire (SDQ) to identify emotional and behavioral problems (scores ≥17). We used Poisson regression adjusted for confounders to test whether GWG adequacy (insufficient, adequate, or excessive) was associated with total, internalizing (≥8), and externalizing (≥11) behavioral problems. RESULTS: Among 309 children with complete data, 36.2% presented scores indicative of behavioral problems on the SDQ; 37.5% showed internalizing problems, and 27.5% exhibited externalizing problems. When adequate GWG was the reference category, prevalence ratios varied but did not reach statistical significance. However, when excessive GWG was the reference, children of mothers with insufficient weight gain had a higher prevalence of behavioral problems (PR = 1.48; 95% CI: 1.02-2.13). In contrast, compared to children whose mothers had adequate weight gain, those whose mothers gained excessive weight had fewer internalizing problems (PR = 0.66; 95% CI: 0.47-0.94). CONCLUSION: The prevalence of behavioral problems assessed by the SDQ was very high, highlighting a significant issue in the study context. However, our hypothesis that GWG outside recommended ranges could influence behavioral problems in children aged 7-8 years was only partially confirmed. Insufficient GWG was associated with overall behavioral problems (SDQ > 17), while excessive GWG appeared protective against internalizing problems. No association was found between GWG and externalizing problems.