key: cord-0820229-lanqq1kv
authors: Alves, J.; Yunker, A. G.; DeFendis, A.; Xiang, A. H.; Page, K. A.
title: Children's Anxiety and Physical Activity during COVID-19 in Relation to Prenatal Exposure to Gestational Diabetes
date: 2020-08-07
journal: medRxiv : the preprint server for health sciences
DOI: 10.1101/2020.08.06.20169565
sha: 90a8056abba45e0bb9aae9cb8dc6dd3fdf6ae04f
doc_id: 820229
cord_uid: lanqq1kv

Research goal: Assess the relationships between anxiety levels, physical activity and in utero exposure to Gestational Diabetes mellitus (GDM) in children age 9 to 15, during the COVID-19 pandemic. Methods: During the COVID-19 pandemic, participants completed phone call or video calls with study personnel where they were asked to report on their physical activity and anxiety levels using the 24-hour physical activity recall and the State-Trait Anxiety Inventory for Children. GDM-exposure was assessed using electronic medical records. Results: Children who reported higher levels of moderate to vigorous physical activity or vigorous physical activity, reported lower anxiety symptoms. Children exposed to GDM in utero reported higher anxiety scores and lower engagement in vigorous physical activity compared to unexposed children. Moreover, the pathway through which children exposed to GDM in utero, reported higher anxiety was partially explained by reduced engagement in vigorous physical activity (75%, p=0.05). Conclusions: Engaging in physical activity during the COVID-19 pandemic may be beneficial for reducing anxiety, particularly among children exposed to GDM in utero, who are at increased risk for adverse psychological outcomes.

Methods: During the COVID-19 pandemic, participants completed phone call or video calls with 25 study personnel where they were asked to report on their physical activity and anxiety levels using 26 the 24-hour physical activity recall and the State-Trait Anxiety Inventory for Children. GDM-exposure 27

was assessed using electronic medical records. 28

Results: Children who reported higher levels of moderate to vigorous physical activity or vigorous 29 physical activity, reported lower anxiety symptoms. Children exposed to GDM in utero reported higher 30 anxiety scores and lower engagement in vigorous physical activity compared to unexposed children.

Moreover, the pathway through which children exposed to GDM in utero, reported higher anxiety was 32 partially explained by reduced engagement in vigorous physical activity (75%, p=0.05).

Conclusions: Engaging in physical activity during the COVID-19 pandemic may be beneficial for 34 reducing anxiety, particularly among children exposed to GDM in utero, who are at increased risk for 35 adverse psychological outcomes. 36

The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented stressful time period and 38

is associated with adverse mental health outcomes 1 . Correspondingly, prenatal exposure to 39 gestational diabetes mellitus (GDM) is associated with increased risk for psychiatric disorders 2 , and 40

children exposed prenatally to GDM may be particularly vulnerable to heightened anxiety during the 41 pandemic. Moreover, engaging in physical activity (PA) is associated with mental health benefits 1 , 42 but children are engaging in reduced PA during the pandemic 3 . Our goal was to investigate children's 43 anxiety and PA levels during the COVID-19 pandemic in relation to prenatal GDM-exposure.

Methods 46

Participants were recruited from the existing observational BrainChild study on neuroendocrine 47

programming associated with GDM-exposure. Children were born at a Kaiser Permanente Southern 48

California (KPSC) and had no history of significant medical or psychiatric disorders. Institutional 49

Review Boards (IRB) at the University of Southern California (#HS-15-00540) and KPSC (#10282) 50 approved this study. 51

Each mother's GDM status was determined from electronic medical records. The study 52

included one phone/video call visit with both the participant and a parent present between April 20 th -53

June 26 th , 2020. Questionnaires were read aloud by a trained staff member, and the participant gave 54 answers verbally. 55

Physical activity was assessed using a 24-h physical activity recall (PAR), using metabolic 56 equivalent (MET) values were from the Compendium of Physical Activities 4 . METs ≥3 were classified 57

as moderate-to-vigorous physical activity (MVPA) and MET ≥6 as vigorous physical activity (VPA). 58

State anxiety (S-Anxiety) was assessed via the State-Trait Anxiety Inventory for Children 59

(STAIC) 5 . The S-Anxiety sub-scale was completed to investigate how children were acutely 60 responding to the pandemic. 61

The relationships between GDM-exposure and S-Anxiety and PA were assessed via 62 linear/logistic regression analysis when appropriate. MVPA was not normally distributed, and square-63 root transformation was applied. Many children did not engage in VPA (65%), therefore VPA was 64 treated as a categorical variable (yes/no VPA). Maternal education, defined as high school, some 65 college and college/post, was the only covariate significantly different between GDM-exposed and 66 unexposed children, and therefore was included as covariate. In a post-hoc analysis, we examined 67 PA as a mediator for the association between GDM-exposure and S-Anxiety.

Results

Of the 82 participants from the BrainChild cohort that were eligible to participate, 65 completed the 71 phone call visits. Participant characteristics are described in Table 1 . 72 GDM-exposed children reported greater S-Anxiety (regression coefficient ß=2.0, p=0.02), 73 compared to unexposed children ( Table 1 ). The proportion of children who engaged in any VPA was 74 significantly lower for GDM-exposed children (5%) compared to unexposed children (30%), (p=0.01).

MVPA levels did not differ between GDM-exposed and unexposed children (p=0.10), but GDM-76 exposed children tended to engage in less MVPA (Table 1) . Adjusting for maternal education did not 77 change the results appreciably (p=0.05, 0.03, and 0.07 for S-anxiety, VPA, and MVPA, respectively). 78

Children who reported more time spent in MVPA had lower S-Anxiety (r=-0.34, p<0.01). Children who 79 engaged in VPA also had lower S-Anxiety (mean±SD, 44.8±3.2) compared to children who did not During the pandemic, children exposed to GDM reported higher anxiety symptoms and less 86 engagement in VPA compared to unexposed children. Moreover, we found that the pathway between 87

GDM-exposure and greater anxiety in children was partially explained by lower engagement in VPA. 88 All rights reserved. No reuse allowed without permission.

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted August 7, 2020. . https://doi.org/10.1101/2020.08.06.20169565 doi: medRxiv preprint Our findings suggest that engaging in VPA during stressful periods may be beneficial for reducing 89 anxiety levels, particularly among GDM-exposed children, who may be more vulnerable to adverse 90 psychological outcomes. However, larger sample sizes are needed to replicate our findings. 91 92 

Lifestyle and Mental Health Disruptions During 100 COVID-19. Social Science Research Network

Prenatal exposure to gestational diabetes 103 mellitus as an independent risk factor for long-term neuropsychiatric morbidity of the offspring

Impact of COVID-19 pandemic on children and adolescents' 106 lifestyle behavior larger than expected. Prog Cardiovasc Dis

Compendium of Physical Activities: a 109 second update of codes and MET values

STAIC Preliminary Manual for the State-Trait Anxiety Inventory for 112 Children ("How I Feel Questionnaire")

The authors would like to thank the families who participate in the BrainChild 116Study. The authors would also like to thank Ana Romero for managing the BrainChild study, Mayra 117Martinez and Janet Mora-Marquez for recruiting volunteers and helping collect participant data.