Associations between Maternal Metabolic Disorders during Pregnancy, Breastfeeding, and Offspring Overweight or Obesity in Childhood

In the United States (US), rates of maternal overweight/obesity are climbing, with about a third of women 20-39 years of age categorized as obese. Paralleling this epidemic is a rise in the prevalence of other metabolic risk factors during pregnancy, including diabetes. This is significant as there is good evidence of adverse birth outcomes associated with high maternal body mass index (BMI) and diabetes during pregnancy. However, less is known about the long-term health effects of these exposures on offspring health. Furthermore, significant disparities exist in the prevalence of metabolic disorders during pregnancy, with non-Hispanic Blacks and Hispanics being more affected. Despite this, few studies have examined race/ethnic disparities in the long-term offspring outcomes of an obesogenic intrauterine environment. The literature is also limited by inadequate control for confounders, and additional epidemiologic evidence is needed to examine potential effect modifiers and mediators along this pathway. This dissertation project proposed to examine two primary research questions related to maternal metabolic wellbeing during pregnancy: 1) what is the association between maternal metabolic disorders (e.g. overweight/obesity and diabetes) during pregnancy and overweight or obesity in childhood, and 2) how do maternal metabolic disorders during pregnancy impact breastfeeding initiation--a well-established risk factor for offspring adiposity. We examined these questions in two retrospective cohorts in South Carolina, and paid particular attention to examining race/ethnic disparities in the associations of interest. Results of this dissertation work suggest that maternal metabolic disorders during pregnancy are associated with reductions in breastfeeding initiation and increased odds of offspring overweight or obesity in childhood. We observed significant differences in the magnitude of these association occurring by race/ethnicity, and significant mediation of this effect by birth anthropometry. The short-term goal of the current research is to inform public health policy and clinical counselling of pregnant mothers to optimize maternal and fetal wellbeing, with the long-term goal of reducing rates of pediatric obesity, potentially reducing cardiometabolic-related healthcare costs, morbidity, and mortality. The overarching goal of the current research is to inform public health policies and clinical counselling of pregnant mothers in South Carolina so as to optimize maternal and child health