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Understanding the Relationship of Pregnancy Weight and Weight Change with Infant and Child Health


Weight and weight change during pregnancy influence fetal growth and development and may have long-lasting effects on offspring health. Additionally, nearly half of women now begin pregnancy overweight or obese and a wide range of weight is gained and lost during and after pregnancy. In response to these concerns, the Institute of Medicine (IOM) revised its gestational weight gain recommendations in 2009 to include a specific, relatively narrow range of recommended gain for women with prepregnancy obesity. Unfortunately, limited scientific evidence and quantitative methods guided these recommendations. The IOM made several research recommendations, including that studies on the impact of gestational weight gain on a range of child outcomes be conducted in large, diverse populations, and that such studies address the extent to which optimal weight gain differs by maternal prepregnancy body mass index (BMI) and other maternal factors, including maternal race/ethnicity.

This dissertation aims to address gaps in our understanding of how pregnancy weight and weight change are associated with child health. The first paper demonstrates two recently developed, quantitative approaches to studying gestational weight gain and determining optimal ranges of weight gain for minimal risk of preterm birth. It also informs whether weight gain recommendations should be tailored to maternal race/ethnicity, which has previously been suggested by the IOM. The second paper identifies longitudinal trajectories of maternal weight from prepregnancy through the postpartum period and assesses the relationship between maternal weight trajectories and offspring obesity in childhood. The third paper determines if maternal history of physical abuse in childhood is related to the risk of offspring overweight in childhood, and whether prepregnancy BMI and gestational weight gain play mediating roles in such an association.

These dissertation papers together provide valuable information to help determine ranges of weight gain during pregnancy that minimize risk of adverse infant and child health outcomes. They also intend to stimulate further research to establish a scientific evidence base for creating effective interventions and clinical gestational weight gain guidelines. Promoting healthy weight and weight gain in pregnancy presents a potentially feasible and effective opportunity to improve infant and child health.

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