Intergenerational Obesity: Do Early Adversity and Pregnancy Explain Disparities?

描述(申请人提供)：虽然遗传倾向肯定会导致肥胖，但肥胖方面现有的种族/民族差异在很大程度上仍然无法解释。女性在生育期间患肥胖症的风险特别高；然而，黑人、西班牙裔和非西班牙裔白人女性在怀孕前、怀孕期间和怀孕后体重增加之间的关系可能不同。母亲怀孕时肥胖和/或怀孕期间体重增加过多也可能对后代代谢过程的发展和规划产生重大影响--这种影响也可能因种族/族裔而异。因此，生育是一个重要的发展窗口，可以在这个窗口内探索肥胖的种族/民族差异的根源--对母亲和她们的孩子来说都是如此。本项目的目的是调查以下几个因素之间的影响和相互作用的种族/民族差异：早期产妇的社会环境(例如，社会经济状况和家庭结构)、与怀孕有关的体重(例如，妊娠体重过度增加和产后体重滞留)以及不良的产妇童年经历(例如，在家中的身体虐待、药物滥用或精神疾病)。1979年美国全国青年纵向调查(NLSY)及其对NLSY女性所生子女的配套研究为进行队列研究提供了宝贵的数据集。这些备受推崇的、具有全国代表性的研究对大约4000名美国妇女及其子女进行了研究，为评估同一代母亲及其子女的产次体重、社会经济和心理因素以及BMI提供了一个独特的机会。这项提案的一个创新特点是收集了关于2012年NLSY浪潮中产妇不良童年经历历史的新数据。我们将利用以前在其他研究项目上合作过的机构的合作者的专业知识，他们的专业知识涵盖围产期流行病学、营养和肥胖症、神经生物学、健康差距、心理学、社会流行病学和生物统计学等领域。我们假设：1)在调整了孕前BMI和当前的社会环境后，过多的孕期体重增加和产后体重保留将在早期社会劣势和中年BMI之间的联系中起中介作用，并且对于黑人女性来说，这种中介作用将更大；2)在根据当前的社会环境进行调整后，母亲的早期社会环境和怀孕前、怀孕期间和怀孕后的高体重代表着后代肥胖的种族差异增加的途径；以及3)母亲的儿童期不良经历史将在很大程度上解释早期社会环境和怀孕体重增加与母婴BMI之间的关联，并根据当前的社会环境进行调整。 与公共卫生的相关性：儿童早期的逆境和怀孕期间体重的过度增加共同表明了一条潜在的未知途径，这可能会导致妇女及其子女肥胖方面的种族/民族差异。了解孕妇的早期生活经历和怀孕前、怀孕期间和怀孕后的体重如何单独和共同促进按种族/族裔划分的母婴肥胖症的发展，将为制定预防肥胖症的新方法打开大门。

DESCRIPTION (provided by applicant): While genetic predisposition certainly contributes to obesity, the existing racial/ethnic disparities in obesity remain largely unexplained. Women are at special risk for developing obesity during childbearing; however, the relationship between weight gain before, during and after pregnancy may differ between black, Hispanic, and non-Hispanic white women. Maternal obesity at conception and/or excessive weight gain during pregnancy may also significantly influence the development and programming of metabolic processes in offspring - impacts which may also vary by race/ethnicity. Therefore childbearing represents an important developmental window within which to explore the origins of racial/ethnic disparities in obesity - for both mothers and their children. The purpose of this project is to investigate racial/ethnic differences in the impact and interactions between several factors that may increase maternal BMI at mid-life as well as obesity in offspring: early maternal social environment (e.g., socioeconomic status and family structure), pregnancy- related weight (e.g., excessive gestational weight gain and postpartum weight retention), and adverse maternal childhood experiences (e.g., physical abuse, substance abuse or mental illness in the home). The U.S. 1979 National Longitudinal Survey of Youth (NLSY) and its companion study of children born to NLSY females provide a valuable data set to conduct a cohort study. These highly respected, nationally representative studies of approximately 4000 U.S. women and their children provide a unique opportunity to assess parity- related weight, socioeconomic and psychological factors, and BMI across one generation of mothers and their children. An innovative feature of this proposal is the collection of new data on history of maternal adverse childhood experiences in the 2012 wave of the NLSY. We will capitalize on expertise of collaborators from institutions that have worked together previously on other research projects and whose expertise spans the fields of perinatal epidemiology, nutrition and obesity, neurobiology, health disparities, psychology, social epidemiology and biostatistics. We hypothesize that: 1) after adjusting for pre-pregnancy BMI and current social environment, excessive gestational weight gain and postpartum weight retention will mediate the association between early social disadvantage and mid-life BMI and that this mediation will be larger for black women; 2) after adjusting for current social environment, a mother's early social environment and high weight before, during and after pregnancy represent pathways through which racial disparities in offspring obesity are increased; and 3) maternal history of childhood adverse experiences will explain a substantial portion of the association between early social environment and pregnancy weight gain with maternal and child BMI, adjusting for current social environment. PUBLIC HEALTH RELEVANCE: The combination of early childhood adversity and excessive gestational weight gain during pregnancy together suggest a potential unexplored pathway which may contribute to racial/ethnic disparities in obesity in women and their children. Understanding how maternal early life experiences and maternal weight before, during and after pregnancy, contribute, individually and jointly, to the development of maternal and child obesity by race/ethnicity stands to open the door for the development of novel approaches to obesity prevention.