Protocol for iGrow (Infant Growth and Development Study): biopsychosocial predictors of childhood obesity risk at 2 years

Childhood Adversity Predicts Maternal Pre-Pregnancy BMI but not Gestational Weight Gain

INTRODUCTION

Obesity and excessive weight gain during pregnancy have lasting implications for both women and infant health. Adverse childhood experiences and stressful life events have been associated with pre-pregnancy obesity and excessive gestational weight gain. However, the effect of each has been examined independently and scant work has investigated the effects of both in the same analysis. The current study examined the unique and conjoint effects of adverse childhood experiences and recent stressful life events on women's pre-pregnancy BMI and gestational weight gain.

METHODS

A racially and socioeconomically diverse sample of 176 pregnant women completed questionnaires and anthropometric measurements during the third trimester and two months postpartum.

RESULTS

Maternal adverse childhood experiences were uniquely associated with pre-pregnancy BMI (β = 0.21, p = .02), but not gestational weight gain. Recent stressful life events did not uniquely predict pre-pregnancy BMI or gestational weight gain, nor did it explain the association between adverse childhood experiences and pre-pregnancy BMI. Adverse childhood experiences and recent stressful life events did not interact to predict either of the women's weight outcomes.

DISCUSSION

Adverse childhood experiences have lasting unique effects on women's pre-pregnancy BMI. Obesity is related to several perinatal health issues for the mother and child, thus understanding the effects of childhood adversity on women's weight outcomes is critical. Routine screening for ACEs among women of childbearing age and pregnant women, paired with referrals and educational resources, can mitigate the deleterious effects of childhood adversity on women and infant health.

Longitudinal Associations Among Food Insecurity During Pregnancy, Parental Mental Health Symptoms, Controlling Feeding Styles, and Infant Food Responsiveness

BACKGROUND

Research is needed to identify pathways by which household food insecurity (FI) contributes to parental controlling feeding styles and infant food responsiveness, 2 factors that play a role in shaping obesity risk across infancy and early childhood.

OBJECTIVES

This longitudinal study tested the hypothesis that prenatal FI would be positively associated with higher infant food responsiveness via greater parental mental health symptomatology and controlling feeding styles (pressuring, restrictive).

METHODS

Participants included a community sample of 170 birth parents and their infants participating in an ongoing longitudinal study. Parents self-reported household FI and mental health symptoms (depression and anxiety) during pregnancy. Postnatally, parents reported their mental health symptoms, their use of controlling feeding styles, and infant food responsiveness. Path analyses with bias-corrected 95% bootstrapped CIs tested direct and indirect associations between prenatal FI and infant food responsiveness.

RESULTS

Prenatal FI was indirectly associated with higher infant food responsiveness via greater parental mental health symptomatology and pressuring to finish (b = 0.01; 95% CI: 0.001, 0.025). Prenatal FI was associated with greater parental mental health symptomatology across the peripartum period (β = 0.54; P < 0.001), which in turn was associated with more pressuring to finish at 2 months pospartum (β = 0.29; P = 0.01) and higher infant food responsiveness at 6 months (β = 0.17; P = 0.04). There were no direct effects of prenatal FI on controlling feedings styles or infant food responsiveness.

CONCLUSIONS

Our findings point to parental mental health as a potential pathway by which FI may be associated with obesity-promoting parental feeding styles and infant appetitive behaviors. In addition to ensuring reliable access to enough quality food during pregnancy, multipronged assistance that promotes emotional well-being during the peripartum period and clinical guidance on noncontrolling feeding styles could benefit parent and infant health and well-being.

Racial Disparities in Neighborhood and Household Socioeconomic Disadvantage Predict Postpartum Weight Retention

Introduction

Structural racism leads to neighborhood-level socioeconomic disadvantage, which determines adverse birth outcomes. Individual socioeconomic disadvantage is associated with compromised healthy pregnancy outcomes. This study aimed to investigate the pathways by which race, neighborhood socioeconomic disadvantage, and household socioeconomic disadvantage predict subsequent maternal postpartum weight retention.

Method

A total of 176 (N=176) racially diverse women were studied from the third trimester to 6 months after delivery. Neighborhood socioeconomic disadvantage was defined by information from the American Community Survey based on women's census tract and self-reports of neighborhood healthy food availability, safety, violence, and walking environment. Household socioeconomic disadvantage included food insecurity, income-to-needs ratio, and maternal education. Pregnancy health risk was operationalized using a summative index that included prepregnancy overweight/obesity, excessive gestational weight gain, and diagnosed hypertensive disorders during pregnancy. Postpartum weight retention was operationalized as a 6-month postpartum weight minus prepregnancy weight. Data were analyzed using structural equation modeling with bootstrapped CIs to estimate indirect effects.

Results

One third of participants retained more than 22 lbs. of pregnancy weight gain 6 months after delivery. Increased household socioeconomic disadvantage (β=0.64, p=0.039) and pregnancy health risk (β=0.34, p=0.002) were directly associated with higher postpartum weight retention. Maternal race/ethnicity had an indirect impact on postpartum weight retention through neighborhood socioeconomic disadvantage and household socioeconomic disadvantage. Non-Hispanic Black women had greater neighborhood socioeconomic disadvantage than non-Hispanic White women (White vs Black β= -0.62; p<0.001) and all other women (other vs Black β= -0.22; p=0.013). In addition, Black women had greater household socioeconomic disadvantage than White women (White vs Black β= -0.35; p=0.004), both of which in turn predicted higher postpartum weight retention.

Conclusions

To prevent postpartum weight retention, education on behavior change to lose weight is essential, but it must be offered in the context of basic resources, at both the neighborhood and household levels.

Infant appetite and weight gain in early infancy: Moderating effects of controlling feeding styles

Excessive infant weight gain is a strong predictor of later obesity. While controlling feeding has been linked to negative weight outcomes, research has not considered associations between infant appetite and maternal feeding simultaneously in relation to infant weight. This longitudinal study examined infant food responsiveness and slowness in eating as predictors of infant weight outcomes and tested controlling feeding styles (restrictive and pressuring) as moderators. Data came from a diverse sample of mothers and their infants participating in an ongoing longitudinal study. Mothers (n = 159) reported infant appetite and feeding styles at 2 postnatal timepoints (2-month visits and 6-month visits). The infant weight outcomes included change in weight-for-age z-scores (WAZ-change) and rapid weight gain (RIWG; WAZ-change ≥ 0.67 SD) from birth to the second postnatal visit. Data were analyzed using hierarchical multiple and logistic regressions, controlling for birthweight, gestational age, maternal race/ethnicity, feeding mode, and residing with an intimate partner. Over 25% of infants exhibited RIWG. Greater infant food responsiveness predicted both greater infant weight gain and RIWG status. Infant food responsiveness and slowness in eating interacted with controlling feeding styles in a unique way. Infants with higher food responsiveness whose mothers were less restrictive had greater weight gain (b = 0.61, p < 0.001) and increased probability of RIWG (b = 2.71, p < 0.01) than infants with more restrictive mothers. Higher slowness in eating was associated with a lower RIWG probability among infants of mothers with lower pressuring feeding (b = -1.86, p < 0.05). For infants with a large appetite, some level of restrictive feeding may be beneficial for preventing excessive weight gain while pressuring may exacerbate the positive association between faster eating and RIWG.

Women's Social Well-Being During Pregnancy: Adverse Childhood Experiences and Recent Life Events

BACKGROUND

Adverse experiences during childhood and recent stressful life events are each associated with women's reduced well-being and poorer health during pregnancy. Few studies, however, have focused upon pregnant women's social well-being, and inclusion of both independent variables in the same analysis is rare. This study focuses upon adverse experiences during childhood as well as recent life events in relationship to four aspects of social well-being: social support, couple aggression for partnered women, neighborhood safety, and food insecurity.

MATERIALS AND METHODS

A diverse community sample of 176 pregnant women completed questionnaires during their third trimester. A cross-sectional design was used that included retrospective reports of childhood experiences, as well as reports of recent life events and current well-being.

RESULTS

Adverse experiences during childhood were uniquely associated with couple aggression (β = 0.206, p = 0.026) and lower neighborhood safety (β = -0.185, p = 0.021). Recent stressful life events were uniquely associated with lower social support (β = -0.247, p = 0.001) and greater food insecurity (β = 0.494, p = 0.000). For social support and food insecurity, there was a significant indirect pathway from adverse childhood experiences through recent stressful life events. Adverse child experiences and recent stressful life events did not interact.

CONCLUSIONS

A life-course perspective that considers women's experiences across their life span is critical for use by both researchers and health practitioners. Adverse childhood experiences and recent stressful life events are important for understanding social features of pregnant women's daily lives.