Infant and child outcomes associated with maternal nutritional status: Examination of maternal prepregnancy body mass index and gestational weight gain Open Access

Abstract

Approximately a third of women of reproductive age in the United States are obese. Obesity
puts substantial burden on individuals and society. Among women of reproductive age, obesity
increases the risk of obstetric complications for mothers and their children. Gestational weight gain
(GWG) is a potential mediator of many of the associations with prepregnancy obesity. The 2009
Institute of Medicine GWG recommendations were limited due to a lack of data by obesity severity
and on the long-term outcomes of GWG. This dissertation address important research gaps related to
infant and child outcomes associated with maternal nutritional status.

The Pregnancy Nutrition Surveillance System was used to examine trends in prepregnancy
obesity among low-income women from 1999-2008 and examine the associations between GWG
and fetal growth by obesity severity. We observed an overall increase in the prevalence of
prepregnancy obesity with substantial variation in trends by maternal race-ethnicity. Associations
between GWG and fetal growth differed by obesity severity. Among class I obese mothers, weight
loss increased the odds of a growth restricted infant; however, among class II and III obese mothers,
limited weight loss, compared to GWG within recommendations, was associated with more
favorable birthweights.

The nationally representative Early Childhood Longitudinal Study-Birth Cohort was used to
examine long-term outcomes of maternal nutritional status. Associations between GWG and child
adiposity at 5 years of age by maternal prepregnancy body mass index (BMI) status were examined.
No harm or benefit of low GWG was observed among all mothers. Among normal weight and
overweight mothers only, GWG above recommendations was associated with an increase in child
BMI z-score. The association between prepregnancy BMI and child neurodevelopment at 2 years of
age was examined. Prepregnancy underweight and severe obesity were associated with poor child
cognitive development. No association was observed between prepregnancy BMI and child motor
development.

The findings of this dissertation address critical data gaps related to infant and child
outcomes of maternal nutrition status. While findings related to fetal growth suggest that GWG
recommendations may be differentially lowered for obese mothers, data related to long-term
outcomes is still limited due to inconsistencies the literature.

Table of Contents

TABLE OF CONTENTS

CHAPTER 1: INTRODUCTION ........................................................................................ 1
References ....................................................................................................................... 6
CHAPTER 2: LITERATURE REVIEW ........................................................................... 10
Maternal Nutritional Status ........................................................................................... 10
Infant and Child Outcomes Associated with Maternal Nutritional Status .................... 16
References ..................................................................................................................... 29
CHAPTER 3: EXPANDED METHODS .......................................................................... 48
Data Sources .................................................................................................................. 48
Statistical Methods ........................................................................................................ 58
References ..................................................................................................................... 62
CHAPTER 4: PREPREGNANCY OBESITY TRENDS AMONG LOW-INCOME
WOMEN, UNITED STATES, 1999-2009 ........................................................................ 66
CHAPTER 5: GESTATIONAL WEIGHT GAIN IN OBESE MOTHERS AND
ASSOCIATIONS WITH FETAL GROWTH ................................................................... 67
CHAPTER 6: RELIABILITY OF GESTATIONAL WEIGHT GAIN REPORTED
POSTPARTUM: A COMPARISON TO THE BIRTH CERTIFICATE .......................... 68
Abstract .......................................................................................................................... 70
Introduction ................................................................................................................... 71
Methods ......................................................................................................................... 72
Results ........................................................................................................................... 76
Discussion ...................................................................................................................... 78
References ..................................................................................................................... 83
CHAPTER 7: GESTATIONAL WEIGHT GAIN AND CHILD ADIPOSITY
MEASURED AT 5 YEARS OF AGE: EXAMINATION OF DIRECT AND
INDIRECT MECHANISMS ............................................................................................. 99
Abstract ........................................................................................................................ 101
Introduction ................................................................................................................. 103
Methods ....................................................................................................................... 105
Results ......................................................................................................................... 112
Discussion .................................................................................................................... 114
References ................................................................................................................... 120
CHAPTER 8: ASSOCIATIONS BETWEEN MATERNAL PREPREGNANCY
BODY MASS INDEX AND CHILD NEURODEVELOPMENT AT 2 YEARS OF
AGE ................................................................................................................................. 139
Abstract ........................................................................................................................ 141
Introduction ................................................................................................................. 143
Methods ....................................................................................................................... 144
Results ......................................................................................................................... 147
Discussion .................................................................................................................... 149
References ................................................................................................................... 155
CHAPTER 9: SUMMARY AND PUBLIC HEALTH IMPLICATIONS ...................... 167
Main findings ............................................................................................................... 167
Strengths and limitations ............................................................................................. 172
Public health implicaitons ........................................................................................... 178
Summary ...................................................................................................................... 180
References ................................................................................................................... 182

About this Dissertation

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School	Laney Graduate School
Department	Biological and Biomedical Sciences
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Health Sciences, Nutrition
Keyword	body mass index pregnancy childhood obesity infancy weight gain
Committee Chair / Thesis Advisor	Sharma, Andrea, Centers for Disease Control and Prevention Ramakrishnan, Usha, Emory University
Committee Members	Schieve, Laura, Centers for Disease Control and Prevention Stein, Aryeh D, Emory University Swan, Deanne, Emory University

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