Maternal Childhood Adversity, Prepregnancy Obesity, and Gestational Weight Gain

doi:10.1016/j.amepre.2015.08.032

American Journal of Preventive Medicine

Volume 50, Issue 4, April 2016, Pages 463-469

https://doi.org/10.1016/j.amepre.2015.08.032 Get rights and content

Introduction

Growing evidence suggests that exposure to childhood adversity may influence obesity across the life course. High maternal weight complicates pregnancy and increases the risk of child obesity. This study examined the association between maternal childhood adversity and pregnancy-related weight in a large U.S. sample.

Methods

Data on 6,199 pregnancies from 2,873 women followed from 1979 to 2012 by the National Longitudinal Survey of Youth 1979 were analyzed in 2014. Associations between three adversity exposures before age 18 years (history of physical abuse, alcohol problems, or mental illness in the household) and two maternal weight outcomes (prepregnancy obesity and excessive gestational weight gain) were modeled separately using survey-adjusted log-binomial models.

Results

After adjusting for race/ethnicity and early-life socioeconomic factors, childhood physical abuse was associated with a 60% increase in the risk of prepregnancy obesity (adjusted risk ratio=1.6, 95% CI=1.1, 2.2). Household alcohol abuse was associated with a 30% increase in prepregnancy obesity (adjusted risk ratio=1.3, 95% CI=1.0, 1.7), as was household mental illness (adjusted risk ratio=1.3, 95% CI=0.8, 1.9), but the mental illness exposure was not significant. Physical abuse and household alcohol abuse were associated with a significant 20% increase in the risk of excessive gestational weight gain; mental illness was not.

Conclusions

Adversity in early life may affect maternal weight before and during pregnancy. Screening and treating women of reproductive age for childhood adversity and its negative effects could significantly reduce obesity-related health outcomes for women and their children.

Introduction

Maternal prepregnancy obesity and excessive gestational weight gain (GWG) increase pregnancy complications, long-term maternal obesity, and obesity in the next generation.1, 2 One third of U.S. women are obese, 8% are extremely obese, and at least 40% gain excessive weight during pregnancy.3, 4 As the childbearing years may represent a critical window in which to address obesity prevention for women, identifying high-risk women is imperative. However, there is a scant evidence base for preconceptional weight interventions, and lifestyle intervention trials to prevent excessive GWG have yielded inconsistent results.5, 6 Prevention and treatment of obesity is challenging, and new research is needed to identify biological, psychological, and social risk factors for obesity across the life course, including during pregnancy.⁷

There is growing evidence that a history of exposure to physical, emotional, or sexual abuse, or neglect or household dysfunction before age 18 years (adverse childhood experiences [ACEs]) is both common⁸ and a risk factor for obesity and many chronic diseases in adults.⁹ However, only two small studies in select populations have investigated the association between ACEs and pregnancy-related weight.10, 11

This study investigated associations between three specific self-reported ACE exposures (physical abuse, alcohol abuse in the household, and mental illness in the household) and two measures of pregnancy-related weight (prepregnancy obesity and excessive GWG) in a large U.S. sample overall and within subgroups.

Section snippets

Study Sample

The National Longitudinal Survey of Youth 1979 (NLSY79) is a longitudinal study of 12,686 women and men aged 14−22 years enrolled in 1979 with an oversampling of black and Hispanic participants, which has been described in detail previously.¹² Participants were surveyed every year through 1994 and every 2 years from 1996 to 2012. Beginning in 1986, data on women’s pregnancies were collected in the NLSY79 Children and Young Adult Survey.¹² Data were collected retrospectively for pregnancies

Results

After excluding observations with missing data on childhood adversity exposures, prepregnancy BMI, GWG, and relevant covariates, 6,199 pregnancies from 2,873 women were available for analyses. The majority of the analytic sample was white (78%), 15% were black, and 7% were Hispanic (Table 1). Nine percent of the cohort was obese and 38% gained excessive weight during pregnancy.

Comparison of BMI based on reported weight at the closest interview preceding the pregnancy with the recalled

Discussion

In this racially diverse, nationally representative sample, a history of physical abuse or household alcohol abuse in childhood was associated with prepregnancy obesity and excessive GWG. This was independent of race/ethnicity and childhood SES, and did not vary by these factors or by parity. The prevalences of childhood exposure to physical abuse at least twice (13%) and alcohol abuse at home (23%) reported by NLSY79 women are similar to those recalled by women in a 2009 Behavioral Risk Factor

Conclusions

Though the focus of this study was promoting healthy weight, screening and treating women before and during pregnancy for issues related to childhood adversity would likely extend benefits to ensuring an optimal environment for their children’s emotional, social, and physical development. Although the most obvious way to prevent negative effects of childhood adversity is to ensure that no child is harmed or neglected, childhood maltreatment has been shown to be transgenerational,³⁷ with

Acknowledgments

This study was supported by the National Institute of Minority Health and Health Disparities, (R01 MD006104, Dr. Barbara Abrams). All views expressed in this paper are those of the author and do not reflect the views or policies of the U.S. Bureau of Labor Statistics.

The authors would like to thank Jeremy Coyle for his guidance and support with the statistical analyses of this study. Dr. Ranchod contributed to the conception and design of the study, analyzed and interpreted the data, and wrote

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Several studies indicate an increased risk of obesity and chronic diseases in people with adverse childhood experiences (ACEs) (Felitti et al., 1998; Hemmingsson et al., 2014; Stranden et al., 2020; Wissa, 2020). There is also an increased incidence of pre-pregnancy obesity in women reporting negative childhood experiences (Diesel et al., 2016; Nagl et al., 2016; Ranchod et al., 2016). Previous studies have therefore suggested that childhood experiences should be investigated in early pregnancy (Nagl et al., 2016; Ranchod et al., 2016).
To explore knowledge, experiences and attitudes of midwives in maternity care in encounters with pregnant women with obesity, and whether they investigate adverse childhood experiences as a contributing factor to the weight challenges.
Semi-structured interviews were undertaken to explore midwives’ experiences of providing maternity care for women with obesity. For data analysis, Malterud's systematic text condensation was used, a method for thematic cross-case analysis of qualitative data with an inductive approach.
Nine midwives working in maternity care in Central Norway. The interviews were conducted online or at the midwives’ workplace.
The midwives routinely investigated pregnant women's childhood, but few saw a link between adverse childhood experiences and obesity. Pregnant women with obesity were perceived by the midwives as particularly vulnerable, which led to a sensitive, individualised approach focusing on trust and relationship building. This approach, in addition to pointing out complications that can occur with obesity, was described as a balancing act. The midwives described preventative healthcare as a natural task, but hectic days with many competing tasks were seen as an obstacle. The women's motivation for lifestyle change was experienced differently by the midwives; some described strong motivation while others mentioned poor motivation. The midwives found it reassuring to have experience to draw on in broaching difficult topics.
Midwives’ many years of experience enable them to approach obese pregnant women in an individual and careful way. Their mission in public health could be better utilised if they explored negative childhood experiences in relation to pregnant women's weight challenges.
Adverse childhood experiences and lifetime adverse maternal outcomes (gestational diabetes and hypertensive disorders of pregnancy) in the Hispanic Community Health Study/Study of Latinos
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Adverse childhood experiences (ACEs) are highly prevalent, particularly among underserved groups such as Hispanic/Latinos in the United States [4]. Despite the link between childhood adversity and adult disease, there has been little research on how experiencing childhood adversity may impact women's physical health during pregnancy [5–7]. The rates of hypertensive disorders of pregnancy (HDP) and gestational diabetes have increased in the past two decades [6,7].
Childhood adversity is associated with increased risk of adult disease, including type II diabetes and hypertension. However, little is known about potential associations between childhood adversity and adverse pregnancy outcomes. The goal of this study was to examine the relationship between adverse childhood experiences (ACEs) and ever experiencing gestational diabetes mellitus (GDM) or a hypertensive disorder of pregnancy (HDP) in a cohort of Hispanic or Latina women.
We analyzed data from 2319 women from the Hispanic Community Health Study/Study of Latinos who had ever given birth to a liveborn infant. We fit separate logistic regression models accounting for sample weights to examine the association between ACEs and risk of GDM and HDP adjusting for Hispanic/Latino background, age at immigration to the United States, and education.
Women who reported four or more ACEs did not show increased odds of GDM or HDP compared with those who reported three or fewer (GDM adjusted odds ratio: 0.8 [0.5, 1.3]; HDP adjusted OR: 1.0 [0.7, 1.5]).
Unlike previous research with majority non-Hispanic White cohorts, there was no association between ACEs and GDM or HDP. Future research should explore if this relationship varies by race/ethnicity in multiethnic cohorts.
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Evidence is limited on the risk of maternal smoking before and during pregnancy across generations of Hispanic immigrants.
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The Role of Childhood Adversity in the Development of Gestational Diabetes
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Exposure to adverse childhood experiences (ACEs)—including physical, emotional, and sexual abuse, and household dysfunction, such as parental substance abuse—is well recognized to have negative effects on lifestyle behaviors and physical and mental health across life.10,11 The high prevalence of a diverse array of health problems and health-harming behaviors before and during early pregnancy among women exposed to ACEs, such as poor diet quality, physical inactivity, and obesity,11–13 may place these women at a higher risk of GDM.14–21 In addition, experimental and observational studies have indicated that early traumatic experiences may alter the development of nervous, endocrine, and immune systems,22,23 which may link ACEs with GDM through physiologic pathways independent of poor lifestyle.
The influence of women's childhood psychosocial environment and subsequent preconception mental health on risk of developing gestational diabetes mellitus is unclear. This study examines this relationship.
Data from a population-based cohort study, the Australian Longitudinal Study on Women's Health, were used. A total of 6,317 women with no pre-existing diabetes were followed from 1996 (aged 18–23 years) until 2015. Gestational diabetes mellitus diagnosis was self-reported. Exposures to eight subcategories of adverse childhood experiences were recalled. Individual subcategories and total number of adverse childhood experiences were examined. Log-binomial regression models with generalized estimating equations were used to estimate RRs and 95% CIs. Analyses were adjusted for early life, preconception, and antenatal gestational diabetes mellitus risk factors. Effect modification by preconception mental health was tested using cross-product terms. Analyses were conducted in 2018.
Among 11,556 pregnancies, 4.7% were complicated by gestational diabetes mellitus. Compared with women not exposed to adverse childhood experiences, exposure to any three adverse childhood experiences (6% of women, adjusted RR=1.73, 95% CI=1.02, 3.01) or four or more adverse childhood experiences (7%, adjusted RR=1.76, 95% CI=1.04, 2.99) was associated with elevated gestational diabetes mellitus risk in women with preconception depressive symptoms. Among the subcategories of adverse childhood experiences, physical abuse, and household substance abuse were associated with higher gestational diabetes mellitus risk. Adverse childhood experiences were not associated with gestational diabetes mellitus in women without depressive symptoms before pregnancy (p=0.01, for interaction).
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Maternal Prepregnancy Weight and Children's Behavioral and Emotional Outcomes
2017, American Journal of Preventive Medicine
Citation Excerpt :
Pregnancy-related weight data relied on maternal self-report. However, studies have shown that self-reported and clinically assessed prepregnancy weights are highly correlated,7,60 and reliability between self-reported weights within 2 years of the pregnancy and prepregnancy weight has been shown previously in NLSY.61 Child outcomes also relied on maternal report, which may reflect biases that vary by race and gender.
This study investigated associations between maternal prepregnancy BMI and child behaviors at ages 9–11 years and examine interaction by race and gender.
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Boys whose mothers had higher prepregnancy weights exhibited higher total BPI and externalizing scores at ages 9–11 years versus those with normal-weight mothers. Boys with severely obese mothers had higher total BPI (mean difference=7.99, 95% CI=3.53, 12.46) and externalizing (mean difference=5.77, 95% CI=1.50, 10.04) scores. Prepregnancy underweight was associated with boys’ higher total BPI (mean difference=2.34, 95% CI=0.02, 4.66) and externalizing (mean difference=3.30, 95% CI=0.69, 5.91); these associations were not significant in sensitivity analyses. No associations emerged for girls or internalizing problems. Two-way interactions by race and three-way interactions by race and gender were not significant.
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Results suggest the potential long-term impact of early-life cardiometabolic profiles on complications of pregnancy.

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Research ArticleMaternal Childhood Adversity, Prepregnancy Obesity, and Gestational Weight Gain

Introduction

Methods

Results

Conclusions

Introduction

Section snippets

Study Sample

Results

Discussion

Conclusions

Acknowledgments

Am J Prev Med

Am J Prev Med

J Health Econ

Trends Endocrinol Metab

Soc Sci Med

Am J Prev Med

J Obstet Gynecol Neonatal Nurs

Child Abuse Negl

Child Abuse Negl

The impact of maternal obesity on maternal and fetal health

Rev Obstet Gynecol

Risk factors and outcomes of maternal obesity and excessive weight gain during pregnancy

Obesity (Silver Spring)

ACOG Committee opinion no. 549: obesity in pregnancy

Obstet Gynecol

Weight Gain During Pregnancy: Reexamining the Guidelines

Changing diet and physical activity to reduce gestational weight gain: a meta‐analysis

Obes Rev

Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence

BMJ

The association between maltreatment in childhood and pre-pregnancy obesity in women attending an antenatal clinic in Australia

PLoS One

Childhood maltreatment and the risk of pre-pregnancy obesity and excessive gestational weight gain

Matern Child Nutr

Research Article
Maternal Childhood Adversity, Prepregnancy Obesity, and Gestational Weight Gain