Preconception and Prenatal Health Impacting Factors and Child Health

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Abstract Childhood obesity and neurodevelopmental impairments have increased in recent decades and are the most prevalent conditions threatening child’s health and well-being. The consequences of these conditions signify the need to identify modifiable factors to target for upstream prevention. Emerging evidence suggests that prenatal exposures to psychological distress, substance use, and lifestyle factors during critical windows of fetal development may operate to developmentally program childhood obesity and neurodevelopment (ND). However, few studies have taken a multiple exposure approach to understand the individual and joint effects of these exposures. In Aim 1 we will examine the role of in utero exposure to psychological distress and substance use on child growth, adiposity, obesity, and ND and the extent to which prenatal lifestyle factors and neighborhood factors may mitigate these associations. Further, while maternal diet and physical activity impact infant growth and adiposity, few studies in diverse populations have assessed mechanistic pathways and little is known about their impact on ND. We propose the 24-hour movement profile and metabolomics as our specialized measures of lifestyle, and obesity and ND as our specialized outcomes. The 24-hour movement profile incorporates the interdependent relationships between device-based measures of physical activity and sleep during pregnancy to better inform interventions. Metabolomics can elucidate mechanistic pathways and will be measured repeatedly on the samples collected according to the ECHO protocol (prenatal blood, cord blood, postnatal child’s blood, and breastmilk). In Aim 2 we will clarify the joint effects of maternal prenatal dietary patterns and the 24-hour movement and child growth, obesity, and ND and whether metabolomic signatures prenatally, at birth, and postnatally mediate these associations. For Aims 1 and 2 we will also examine how associations vary by neighborhood characteristics and infant sex assigned at birth. In Aim 3 we will maximize recruitment and retention by implementing evidence-based strategies focused on engaging diverse groups in clinical research and implementing the ECHO Cohort Protocol applying systematic quality control approaches and best practices. We propose to contribute to the ECHO Program by recruiting a diverse cohort of 1,800 pregnant individuals from two medical centers at Kaiser Permanente Northern California serving a diverse population (~70% racial/ethnic minority groups with 50% having a low income), the conceiving partner, their resulting child, and to follow all of them at multiple visits after the child is born. In Aim 4 we will explore the role of preconception maternal and paternal lifestyle factors on infant birth size to identify critical time periods to intervene on to prevent upstream risk factors for childhood obesity and ND. All members of our diverse research team will have equal opportunity to contribute to all aspects of our project and to be involved in the new ECHO phase. Findings from this study will have important implications for informing interventions, prevention strategies and policies to ensure optimal health and well-being for all children.