Research ArticleMaternal Childhood Adversity, Prepregnancy Obesity, and Gestational Weight Gain
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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Maternal Prepregnancy Weight and Children's Behavioral and Emotional Outcomes
2017, American Journal of Preventive MedicineCitation 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.
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2017, Annals of EpidemiologyCitation Excerpt :However, although the life-course perspective of women's risk for adverse pregnancy events extends from her infancy—possibly before, given the importance of in utero exposures—there is less empirical evidence examining relationships between these early-life exposures and a woman's health later in life during pregnancy. Maternal recall of childhood experiences—in particular adverse experiences such as abuse and neglect—have been associated with adverse birth outcomes [18,19], excessive gestational weight gain [20], and development of GDM [21], but biological measurements from that time are rare, due in part to the difficulty and infeasibility of decades-long follow-up studies. Widespread implementation of electronic medical records and improvements in quality of electronic vital records allow for data linkage and the creation of analytic cohorts [22] for use in the evaluation of longitudinal risk factors in association with adverse reproductive health [23,24].