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Shriyan P, Sudhir P, van Schayck OC, Babu GR. Association of high cortisol levels in pregnancy and altered fetal growth. Results from the MAASTHI, a prospective cohort study, Bengaluru. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 14:100196. [PMID: 37461746 PMCID: PMC7614758 DOI: 10.1016/j.lansea.2023.100196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/09/2023] [Accepted: 03/28/2023] [Indexed: 07/20/2023]
Abstract
Background The role of maternal stress levels on mothers' mental health and fetal growth has been previously studied. However, the evidence linking cortisol exposure during pregnancy to growth outcomes in infants is sparsely available from lower and middle-income countries. We aim to investigate the association of serum cortisol levels in pregnancy with infant birth outcomes and postpartum depressive symptoms in a public health facility in India. Methods The current study is a part of the maternal antecedents of adiposity and studying the transgenerational role of hyperglycemia and insulin (MAASTHI) prospective cohort. We assessed the relationship between maternal exposure to serum cortisol and adverse neonatal outcomes and postpartum depressive symptoms. Serum cortisol levels in stored blood samples were measured in 230 pregnant women as a biomarker for stress during pregnancy. Pregnant women between 18 and 45 years of age were recruited for the study, presenting at ≥14 weeks of gestation and providing voluntary written informed consent. The Edinburgh Postnatal Depression Scale assessed postpartum depressive symptoms, and detailed infant anthropometric measurements were carried out at birth. Findings We found that higher levels (>17.66 μg/L) are significantly associated with low birth weight (OR = 2.28; 95% CI 1.21-4.32) and lower weight for length (OR = 2.16; 95% CI 1.07-4.35). The odds of developing postpartum depressive symptoms in pregnant women with higher mean cortisol cut-off levels is 2.3-fold [OR: 2.33, 95% CI (1.17, 4.64)] compared than women with lower cortisol levels. No significant association was found between serum cortisol and infants' birth weight for gestational age, head circumference, the sum of skinfold thickness, and crown-rump length. Interpretation Our results support the hypothesis that higher maternal cortisol levels may adversely impact birth weight, weight for length in newborns, and postpartum depressive symptoms in mothers. Funding This study was supported by the India Alliance Senior Fellowship [Grant No. IA/CPHS/20/1/505278] awarded to Giridhara R. Babu.
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Affiliation(s)
- Prafulla Shriyan
- Indian Institute of Public Health, Public Health Foundation of India, Bengaluru, Karnataka, 560023, India
| | - Paulomi Sudhir
- Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Onno C.P. van Schayck
- Care and Public Health Research Institute, Maastricht University, Maastricht, Limburg, the Netherlands
| | - Giridhara R. Babu
- Indian Institute of Public Health, Public Health Foundation of India, Bengaluru, Karnataka, 560023, India
- Clinical and Public Health Research Fellowship, The Wellcome Trust/DBT India Alliance, New Delhi, 110025, India
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Odendaal HJ, Human M, van der Merwe C, Brink LT, Nel DG, Goldstein RD. The Association between Maternal Depression, Infant Characteristics and Need for Assistance in A Low-Income-Country. JOURNAL OF SUBSTANCE ABUSE AND ALCOHOLISM 2021; 8:1090. [PMID: 36466546 PMCID: PMC9718379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Depression in the peripartum period is prevalent in low-income-countries. The identification of women needing referral is often lacking and on the other hand, women in need of support and treatment do not make use of existing support. OBJECTIVES To identify risk factors for fetal and postnatal consequences of depression in pregnancy and to investigate further management once women at risk have been identified. METHODS The Safe Passage Study was a large prospective multicenter international study. Extensive information, including the Edinburgh postnatal depression scale (EPDS), was collected during the study. At risk women were referred to the study's social worker (SW). Women were categorized according to risk on their EPDS results. Risk categories were characterized and investigated for infant outcomes. RESULTS Data from 5,489 women were available for analysis and revealed a 51% prevalence of prenatal depression. Fourteen percent of at-risk women attended SW appointments, while 36% accepted the SW referral but persistently failed to attend. At risk women were significantly younger, had less formal education, had lower monthly income, and lived in more crowded conditions. They used significantly more alcohol and cigarettes. Their infants had shorter gestational ages, lower birth weights and were more growth restricted. Infants of depressed women who missed appointments weighed less and were more growth restricted. CONCLUSION Women with high EPDSs had less favorable socioeconomic conditions, used more alcohol or tobacco during pregnancy, and their infants weighed less with more growth restriction. Women who repeatedly missed their appointments came from the poorest socioeconomic conditions and their infants had worse birth outcomes.
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Affiliation(s)
- HJ Odendaal
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Science, South Africa
| | - M Human
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Science, South Africa
| | - C van der Merwe
- Department of Psychiatry, Faculty of Medicine and Health Science, South Africa
| | - LT Brink
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Science, South Africa
| | - DG Nel
- Department of Statistics and Actuarial Science, Faculty of Economic and Management Science, South Africa
| | - RD Goldstein
- Robert’s Program on Sudden Unexpected Death in Pediatrics, Boston Children’s Hospital and Harvard Medical School, USA
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Koya S, Babu GR, R D, Iyer V, Yamuna A, Lobo E, S P, Kinra S, Murthy GVS. Determinants of Breastfeeding Practices and Its Association With Infant Anthropometry: Results From a Prospective Cohort Study in South India. Front Public Health 2020; 8:492596. [PMID: 33102418 PMCID: PMC7116249 DOI: 10.3389/fpubh.2020.492596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 09/04/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction Despite national efforts for promoting exclusive breastfeeding (EBF) during the first 6 months of the infants' life, breastfeeding rates are low in India. Evidence on the interference of supplementary food on optimal nourishment and growth of the infant has also been well-established. Our study was undertaken to assess the effect of breastfeeding practices on infant anthropometry and determine the various factors affecting breastfeeding practices. Methods A prospective cohort study - Maternal antecedents of adiposity and studying the transgenerational role of hyperglycemia and insulin (MAASTHI) was conducted at a tertiary care public hospital in Bengaluru, South India. From the consenting women, data such as obstetric history, infant feeding practices, anthropometry of mother and child, the psychosocial status of the women using the Edinburgh Postnatal Depression Scale (EPDS), was collected at baseline and subsequent follow-up: post-delivery and 14 weeks after birth. In this study, we analyzed data collected from April 2016 to April 2018, with descriptive statistics presented in mean and standard deviation, and logistic regression adjusting for confounders. Results Among the 240 women enrolled in the study, 33% (n= 80) were using supplementary food for their infants at 14 weeks of infants age. Infants who received supplementary feeding at age 14 weeks had nearly 2.5 times higher odds of being wasted (OR: 2.449, p-value: 0.002) as compared to exclusively breastfed infants. Conclusion Infants between 14 to 16 weeks of age who received supplementary feeding were at risk of wasting as compared to exclusively breastfed infants. Despite strong evidence in support of the benefits of exclusive breastfeeding, awareness in urban women in India is low. Increased focus on promoting exclusive breastfeeding is necessary to ensure proper nutritional intake and healthy growth of infants.
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Affiliation(s)
- Srinidhi Koya
- DTA3 MSCA Research Fellow, School of Social Sciences, Humanities & Law, Teesside University, Middlesbrough, United Kingdom
| | - Giridhara R. Babu
- Public Health Foundation of India and Wellcome Trust-DBT India Alliance Research Fellow in Public Health, New Delhi, India
| | - Deepa R
- Research Fellows, Indian Institute of Public Health Bangalore, Public Health Foundation of India, New Delhi, India
| | - Veena Iyer
- Indian Institute of Public Health Gandhinagar, Public Health Foundation of India, New Delhi, India
| | - A. Yamuna
- Indian Institute of Public Health Bangalore, Public Health Foundation of India, New Delhi, India
| | - Eunice Lobo
- Indian Institute of Public Health Bangalore, Public Health Foundation of India, New Delhi, India
| | - Prafulla S
- Research Fellows, Indian Institute of Public Health Bangalore, Public Health Foundation of India, New Delhi, India
| | - Sanjay Kinra
- London School of Hygiene & Tropical Medicine & University College London Hospital, London, United Kingdom
| | - G. V. S. Murthy
- Public Health Foundation of India, and International Center for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Babu GR, Murthy GVS, Reddy Y, Deepa R, Yamuna A, Prafulla S, Krishnan A, Lobo E, Rathnaiah M, Kinra S. Small for gestational age babies and depressive symptoms of mothers during pregnancy: Results from a birth cohort in India. Wellcome Open Res 2020. [PMID: 31828224 DOI: 10.12688/wellcomeopenres.14618.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Annually, more than a million low birthweight (LBW) is born in India, often afflicting disadvantaged families. Several studies have undertaken the association of poverty, nutritional status, and obstetric factors with LBW. Through our study, we aimed to examine the possibility of any relation between the Edinburgh Postnatal Depression Scale (EPDS) score measured during pregnancy with the incidence of babies born Small for Gestational Age (SGA). Methods: Pregnant women attending the antenatal clinic at a public hospital between 14 to 32 weeks were recruited from April 2016 to Oct 2017. The EPDS was administered to assess depression through face-to-face interviews. Newborn anthropometry was performed post-delivery. For analysis, birth weight <10 percentile was classified as SGA. Results: Prevalence of depressive symptoms (EPDS score >11) was 16.5% (n=108/654) in antenatal mothers. These women delivered a higher proportion of SGA babies (21.3 v/s 15.8) compared to women with no symptoms. The odds of women giving birth to a child with SGA were twice as high for women with EPDS scores >11 (adjusted OR = 2.03; 95% CI = 1.12 - 3.70) compared to the women with EPDS scores of ≤11, The EPDS 12 (Adjusted OR = 1.96; 95% CI = 1.04 - 3.69) and EPDS 13 (Adjusted OR = 2.42; 95% CI = 1.24 - 4.70) cut-off categories also proved to be a risk factor for SGA with significant p-value (0.0006 and 0.0003) and the individuals with more than 13 EPDS score is found to have the highest odds of SGA. Conclusions: We found a strong association of antenatal depressive symptoms during pregnancy with SGA measured by EPDS. Thus, we recommend the implementation of timely and effective screening, diagnostic services, and evidence-based antenatal mental health services to combat SGA and further associated-metabolic syndromes.
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Affiliation(s)
- Giridhara R Babu
- Indian Institute of Public Health - Bangalore, Bengaluru, Karnataka , 560023, India.,The Wellcome Trust/DBT India Alliance, New Delhi, 110025, India
| | - G V S Murthy
- Indian Institute of Public Health, Public Health Foundation of India, Madhapur, Hyderabad, 500033, India.,International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Yogesh Reddy
- Indian Institute of Public Health - Bangalore, Bengaluru, Karnataka , 560023, India
| | - R Deepa
- Indian Institute of Public Health - Bangalore, Bengaluru, Karnataka , 560023, India
| | - A Yamuna
- Indian Institute of Public Health - Bangalore, Bengaluru, Karnataka , 560023, India
| | - S Prafulla
- Indian Institute of Public Health - Bangalore, Bengaluru, Karnataka , 560023, India
| | - Anjaly Krishnan
- Indian Institute of Public Health - Bangalore, Bengaluru, Karnataka , 560023, India
| | - Eunice Lobo
- Indian Institute of Public Health - Bangalore, Bengaluru, Karnataka , 560023, India
| | - Mohanbabu Rathnaiah
- Department of Psychiatry, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TU, UK
| | - Sanjay Kinra
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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Babu GR, Murthy GVS, Reddy Y, Deepa R, Yamuna A, Prafulla S, Krishnan A, Lobo E, Rathnaiah M, Kinra S. Small for gestational age babies and depressive symptoms of mothers during pregnancy: Results from a birth cohort in India. Wellcome Open Res 2020; 3:76. [PMID: 31828224 DOI: 10.12688/wellcomeopenres.14618.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Annually, more than a million low birthweight (LBW) is born in India, often afflicting disadvantaged families. Several studies have undertaken the association of poverty, nutritional status, and obstetric factors with LBW. Through our study, we aimed to examine the possibility of any relation between the Edinburgh Postnatal Depression Scale (EPDS) score measured during pregnancy with the incidence of babies born Small for Gestational Age (SGA). Methods: Pregnant women attending the antenatal clinic at a public hospital between 14 to 32 weeks were recruited from April 2016 to Oct 2017. The EPDS was administered to assess depression through face-to-face interviews. Newborn anthropometry was performed post-delivery. For analysis, birth weight <10 percentile was classified as SGA. Results: Prevalence of depressive symptoms (EPDS score >11) was 16.5% (n=108/654) in antenatal mothers. These women delivered a higher proportion of SGA babies (21.3 v/s 15.8) compared to women with no symptoms. The odds of women giving birth to a child with SGA were twice as high for women with EPDS scores >11 (adjusted OR = 2.03; 95% CI = 1.12 - 3.70) compared to the women with EPDS scores of ≤11, The EPDS 12 (Adjusted OR = 1.96; 95% CI = 1.04 - 3.69) and EPDS 13 (Adjusted OR = 2.42; 95% CI = 1.24 - 4.70) cut-off categories also proved to be a risk factor for SGA with significant p-value (0.0006 and 0.0003) and the individuals with more than 13 EPDS score is found to have the highest odds of SGA. Conclusions: We found a strong association of antenatal depressive symptoms during pregnancy with SGA measured by EPDS. Thus, we recommend the implementation of timely and effective screening, diagnostic services, and evidence-based antenatal mental health services to combat SGA and further associated-metabolic syndromes.
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Affiliation(s)
- Giridhara R Babu
- Indian Institute of Public Health - Bangalore, Bengaluru, Karnataka , 560023, India.,The Wellcome Trust/DBT India Alliance, New Delhi, 110025, India
| | - G V S Murthy
- Indian Institute of Public Health, Public Health Foundation of India, Madhapur, Hyderabad, 500033, India.,International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Yogesh Reddy
- Indian Institute of Public Health - Bangalore, Bengaluru, Karnataka , 560023, India
| | - R Deepa
- Indian Institute of Public Health - Bangalore, Bengaluru, Karnataka , 560023, India
| | - A Yamuna
- Indian Institute of Public Health - Bangalore, Bengaluru, Karnataka , 560023, India
| | - S Prafulla
- Indian Institute of Public Health - Bangalore, Bengaluru, Karnataka , 560023, India
| | - Anjaly Krishnan
- Indian Institute of Public Health - Bangalore, Bengaluru, Karnataka , 560023, India
| | - Eunice Lobo
- Indian Institute of Public Health - Bangalore, Bengaluru, Karnataka , 560023, India
| | - Mohanbabu Rathnaiah
- Department of Psychiatry, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TU, UK
| | - Sanjay Kinra
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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Babu GR, Murthy GVS, Reddy Y, Deepa R, Yamuna A, Prafulla S, Krishnan A, Lobo E, Rathnaiah M, Kinra S. Small for gestational age babies and depressive symptoms of mothers during pregnancy: Results from a birth cohort in India. Wellcome Open Res 2020; 3:76. [PMID: 31828224 PMCID: PMC6892423 DOI: 10.12688/wellcomeopenres.14618.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2020] [Indexed: 01/20/2023] Open
Abstract
Background: Annually, more than a million low birthweight (LBW) is born in India, often afflicting disadvantaged families. Several studies have undertaken the association of poverty, nutritional status, and obstetric factors with LBW. Through our study, we aimed to examine the possibility of any relation between the Edinburgh Postnatal Depression Scale (EPDS) score measured during pregnancy with the incidence of babies born Small for Gestational Age (SGA). Methods: Pregnant women attending the antenatal clinic at a public hospital between 14 to 32 weeks were recruited from April 2016 to Oct 2017. The EPDS was administered to assess depression through face-to-face interviews. Newborn anthropometry was performed post-delivery. For analysis, birth weight <10 percentile was classified as SGA. Results: Prevalence of depressive symptoms (EPDS score >11) was 16.5% (n=108/654) in antenatal mothers. These women delivered a higher proportion of SGA babies (21.3 v/s 15.8) compared to women with no symptoms. The odds of women giving birth to a child with SGA were twice as high for women with EPDS scores >11 (adjusted OR = 2.03; 95% CI = 1.12 – 3.70) compared to the women with EPDS scores of ≤11, The EPDS 12 (Adjusted OR = 1.96; 95% CI = 1.04 – 3.69) and EPDS 13 (Adjusted OR = 2.42; 95% CI = 1.24 – 4.70) cut-off categories also proved to be a risk factor for SGA with significant p-value (0.0006 and 0.0003) and the individuals with more than 13 EPDS score is found to have the highest odds of SGA. Conclusions: We found a strong association of antenatal depressive symptoms during pregnancy with SGA measured by EPDS. Thus, we recommend the implementation of timely and effective screening, diagnostic services, and evidence-based antenatal mental health services to combat SGA and further associated-metabolic syndromes.
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Affiliation(s)
- Giridhara R Babu
- Indian Institute of Public Health - Bangalore, Bengaluru, Karnataka , 560023, India.,The Wellcome Trust/DBT India Alliance, New Delhi, 110025, India
| | - G V S Murthy
- Indian Institute of Public Health, Public Health Foundation of India, Madhapur, Hyderabad, 500033, India.,International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Yogesh Reddy
- Indian Institute of Public Health - Bangalore, Bengaluru, Karnataka , 560023, India
| | - R Deepa
- Indian Institute of Public Health - Bangalore, Bengaluru, Karnataka , 560023, India
| | - A Yamuna
- Indian Institute of Public Health - Bangalore, Bengaluru, Karnataka , 560023, India
| | - S Prafulla
- Indian Institute of Public Health - Bangalore, Bengaluru, Karnataka , 560023, India
| | - Anjaly Krishnan
- Indian Institute of Public Health - Bangalore, Bengaluru, Karnataka , 560023, India
| | - Eunice Lobo
- Indian Institute of Public Health - Bangalore, Bengaluru, Karnataka , 560023, India
| | - Mohanbabu Rathnaiah
- Department of Psychiatry, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TU, UK
| | - Sanjay Kinra
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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Babu GR, Deepa R, Lewis MG, Lobo E, Krishnan A, Ana Y, Katon JG, Enquobahrie DA, Arah OA, Kinra S, Murthy G. Do Gestational Obesity and Gestational Diabetes Have an Independent Effect on Neonatal Adiposity? Results of Mediation Analysis from a Cohort Study in South India. Clin Epidemiol 2019; 11:1067-1080. [PMID: 31920399 PMCID: PMC6938184 DOI: 10.2147/clep.s222726] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 12/12/2019] [Indexed: 12/20/2022] Open
Abstract
Purpose Neonates born to mothers with obesity or gestational diabetes mellitus (GDM) have an increased chance of various metabolic disorders later in life. In India, it is unclear whether maternal obesity or GDM is related to offspring adiposity. We aimed to understand the independent effect of maternal obesity and GDM with neonatal adiposity and whether GDM has a mediating effect between maternal obesity and neonatal adiposity. Methods We recruited a cohort of 1120 women (between April 2016 and February 2019) from the public hospitals in Bangalore, India, who voluntarily agreed to participate and provided written informed consent. The primary outcome was neonatal adiposity, defined as the sum of skinfold thickness >85th percentile. Exposure included maternal obesity, defined as >90th percentile of skinfold thickness. GDM, the potential mediator, was classified using the World Health Organization criteria by oral glucose tolerance test. Binary logistic regression was applied to test the effect of maternal obesity and GDM on neonatal adiposity, adjusting for potential confounders. We used Paramed command in STATA version 14 for analyzing mediating effects. Results We found that maternal obesity (odds ratio (OR)=2.16, 95% CI 1.46, 3.18) and GDM (OR=2.21, 95% CI1.38, 3.52) have an independent effect on neonatal adiposity. GDM significantly mediates 25.2% of the total effect between maternal obesity and neonatal adiposity, (natural direct effect OR = 1.16 95% CI 1.04, 1.30) with significant direct effect of maternal obesity (natural direct effect OR = 1.90 95% CI 1.16, 3.10) and significant total effect (OR=2.20 95% CI 1.35, 3.58). Conclusion We showed that maternal obesity and GDM are independently associated with offspring adiposity. Also, GDM mediates the association of maternal obesity on adiposity in children. Interventions focused on obesity prevention in women, and effective screening and management of GDM may contribute to reducing childhood obesity in India.
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Affiliation(s)
- Giridhara R Babu
- Indian Institute of Public Health-Bangalore, Public Health Foundation of India (PHFI), Bangalore, India
| | - R Deepa
- Indian Institute of Public Health-Bangalore, Public Health Foundation of India (PHFI), Bangalore, India
| | - Melissa Glenda Lewis
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India (PHFI), Hyderabad, India
| | - Eunice Lobo
- Indian Institute of Public Health-Bangalore, Public Health Foundation of India (PHFI), Bangalore, India
| | - Anjaly Krishnan
- Indian Institute of Public Health-Bangalore, Public Health Foundation of India (PHFI), Bangalore, India
| | - Yamuna Ana
- Indian Institute of Public Health-Bangalore, Public Health Foundation of India (PHFI), Bangalore, India
| | - Jodie G Katon
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Daniel A Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.,California Center for Population Research, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.,UCLA Center for Health Policy Research, Los Angeles, CA, USA
| | - Sanjay Kinra
- Non-communicable Disease Epidemiology , London School of Hygiene & Tropical Medicine and, University College London Hospital, London, UK
| | - Gvs Murthy
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India (PHFI), Hyderabad, India.,International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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