부산대학교 도서관

Summary: Pediatric obesity is a key public health concern in the United States. We studied the association between gestational weight gain (GWG) and offspring growth and obesity risk across three developmental periods thought to be associated with obesity in later life. Mother-child pairs from the Maternal Health Practices and Child Development pregnancy cohort and were followed from <26 weeks gestation to 16 years postpartum. GWG was calculated as a ratio of observed to expected gain based on the 2009 Institute of Medicine GWG guidelines and women were classified as gaining below, within, or above the guidelines as inadequate, adequate, and excessive, respectively. We also studied GWG z-scores which account for prepregnancy BMI and are uncorrelated with gestational length. At birth, 8, 18, and 36 months, offspring weight-for- age z-scores (WAZ) were calculated, as well as body-mass-index-for-age z-scores (BMIZ) at these ages and 10 and 16 years. In accordance with current recommendations, z-scores were calculated based on the 2006 WHO growth standards for children <24 months and the 2000 CDC growth references for children ≥24 months. Child obesity was defined as a BMI ≥95th percentile at 36 months, 10 and 16 years. Compared to adequate, excessive GWG was associated with heavier weight at birth, slower infant growth, and greater risk for obesity at 36 months. At 10 and 16 years, higher GWG was associated with a greater risk of adolescent obesity. Inadequate GWG was associated with lower weight at birth and rapid weight gain from birth to 18 months, but not obesity risk. Children with rapid infant weight gain were more likely to be obese at 10 and 16, but not 3 years. GWG may exert a lasting influence on child growth and may lead to persistent obesity in this low-income sample of black and white mothers and their children. Limiting excessive GWG may impact the intergenerational cycle of obesity, making the findings of this dissertation relevant to public health.