Maternal physical activity linked to improved child neurodevelopment

Child neurodevelopment is influenced by maternal physical activity before and during pregnancy, according to a recent study published in JAMA Network Open.¹

Moderate exercise is recommended during pregnancy to support fetal growth and development.² Additionally, benefits of exercise during pregnancy include improved cardiovascular function, weight control, better sleep, and reduced odds of preterm birth and obesity.¹

“Although the short-term effects of physical activity during pregnancy on the child’s neurodevelopment have been analyzed, large-scale and longitudinal follow-up studies remain scarce,” wrote investigators.

Assessing child neurodevelopment

The cohort study was conducted to evaluate the link between maternal physical activity levels and child neurodevelopment. Maternal-child pairs were recruited between January 24, 2011, and March 31, 2014, without missing data for neurodevelopment or body mass index (BMI) values beyond 5 standard deviations.

Questionnaires were administered at 2 separate points to determine maternal physical activity. Prepregnancy activity was reported in the questionnaire administered during pregnancy, while pregnancy activity was reported in the questionnaire administered from 16- to 27-weeks’ gestation. Typical weekly physical activity was assessed at these times.

The duration of walking, moderate, and vigorous physical activity were compiled to measure physical activity in metabolic equivalent minutes per week. Alongside standard categories of low, moderate, and high, investigators recorded physical activity levels as none, low, and moderate to high. These categories were defined as AL0, AL1, and AL2, respectively.

Assessment tools

Child neurodevelopment was assessed using the Ages and Stages Questionnaire, Third Edition (ASQ-3), a screening tool for developmental delay in children aged 1 to 66 months. ASQ-3 domains include communication, gross motor skills, fine motor skills, problem solving, and personal-social.

Parent responses for ASQ-3 questions included yes, sometimes, and not yet, depending on whether their child could accomplish the activity mentioned. Scores assigned to these responses included 10, 5, and 0 points, respectively, with total domain scores ranging from 0 to 60.

These evaluations were performed at 6 months and 1, 1.5, 2, 2.5, and 3 years of age. Covariates included birth weight, maternal age, gestational age, prepregnancy BMI, predelivery BMI, group childcare use, number of siblings at midpregnancy, family income at midpregnancy, and parental educational background.

Participant characteristics and maternal activity

There were 38,219 mother-child pairs with a mean maternal age of 31.1 years included in the final analysis. Of children, 50.8% were male and 49.1% female. AL2 was the most common category of physical activity, reported in 42.4% of mothers. A median pregnancy BMI of 21.2 and median BMI before delivery of 25.2 were reported.

The odds of threatened preterm and placental abruption were significantly reduced among mothers with midpregnancy physical activity, with rates of 18.8% and 0.3%, respectively, in the AL2 group vs 23.9% and 0.5%, respectively, in the AL0 group.

Placental previa was also less likely in the AL2 group vs the AL0 group, with rates of 0.7% vs 0.5%, respectively, at prepregnancy, and 0.9% vs 0.5%, respectively, at midpregnancy. However, premature rupture of the membranes was more likely in this group, at 8.4% for prepregnancy activity vs 9.5% in the AL0 group. For midpregnancy activity, these rates were 8.6% and 9.4%, respectively.

Child neurodevelopment outcomes

Achieving a score above the ASQ-3 cutoff was only reported for the domain of gross motor skill for children of mothers in the AL1 prepregnancy category, with an odds ratio (OR) of 1.12 vs AL0. For AL2, an association was reported for all ASQ-3 domains, with the greatest ORs of 1.61, 1.37, and 1.32 reported for communication, gross motor, and fine motor, respectively.

Midpregnancy AL1 and AL2 were also linked to improved scores vs AL0. These included gross motor at 1.11 and 1.18, respectively, fine motor at 1.24 and 1.60, respectively, and problem solving at 1.15 and 1.23, respectively.

Only the prepregnancy AL2 category showed improvements in problem solving at 3 years of age, with a OR of 1.16. Odds were significantly increased by group childcare for the communication and personal-social domains.

No substantial differences in overall trends were reported at 6 months and 3 years of age. These results indicated a link between maternal physical activity before and during pregnancy with child neurodevelopment.

“Further investigations are required to find the physiological mechanisms explaining how maternal physical activity affects child neurodevelopment,” wrote investigators.

References

1. Kumasaka I, Suzuki T, Kanamori K, Miura Y, Ota C, Japan Environment and Children’s Study Group. Physical activity before and during pregnancy and neurodevelopment in early childhood. JAMA Netw Open. 2026;9(3):e260345. doi:10.1001/jamanetworkopen.2026.0345
2. Both MI, Overvest MA, Wildhagen MF, Golding J, Wildschut HIJ. The association of daily physical activity and birth outcome: a population-based cohort study.Eur J Epidemiol. 2010;25(6):421-429. doi:10.1007/s10654-010-9458-0