Prepregnancy Body Mass Index, Gestational Weight Gain, and Child's Asthma Development

The prevalence of childhood asthma, maternal prepregnancy obesity, and excessive gestational weight gain (GWG) have been on the rise in recent decades. This has brought attention to these topics and whether maternal weight related metrics affect the risk of asthma. Methodological challenges and data quality have led to mixed results presented in the literature. This dissertation aims to further investigate the association between prepregnancy body mass index (BMI) and childhood asthma development (aim 1), evaluate potential mediating pathways between prepregnancy BMI and childhood asthma risk (aim 2), and explore the role of GWG on risk of childhood asthma (aim 3). We investigated these questions using electronic medical records from a large cohort of over 100,000 mother-child pairs enrolled in Kaiser Permanente Northern California (KPNC) who gave birth between 2005-2014.First, we estimated the risk of childhood asthma for increasing prepregnancy BMI among those followed up to ages 4, 6, and 8 years, defining asthma using a combination of diagnostic codes and controller medication dispensings, and including prepregnancy BMI obese subclasses. Second, we assessed potential intermediate factors between prepregnancy BMI and childhood asthma, namely GWG (delivery weight minus prepregnancy weight), gestational age, and the child's own BMI. Third, we evaluated the association between GWG and childhood asthma while operationalizing GWG several different ways including total GWG (continuous and categories), observed GWG compared to Institutes of Medicine (IOM) recommended ranges of GWG, and trimester-specific GWG (total and rates); we also implemented the parametric g-formula to account for the time-varying nature of GWG and to control for time-varying confounding. In our first study, we found that higher prepregnancy BMI was modestly associated with increased childhood asthma risk, even after controlling for important confounding variables. Our second study showed that childhood obesity did have a modest mediating effect on the association between prepregnancy BMI and childhood asthma, but there was no evidence for gestational age or GWG as intermediate factors. In our third study, we observed a null association between GWG metrics and childhood asthma development, even when controlling for time-varying confounding. Collectively, these findings suggest evidence for a causal link between prepregnancy obesity and childhood asthma development, potentially partially mediated through the child's own obesity. These findings did not show evidence for an effect of GWG on childhood asthma. Even though the studies presented in this dissertation are valuable additions to the existing literature, further investigation of potential mechanisms and preventative interventions is needed. Understanding of biological mechanisms and interventions would not only benefit pregnant women but would also have positive impacts on reducing childhood asthma risk.

Level thesis:degree_level

Doctorate Degree

Year dc:date.issued

2022

Author dc:creator

• Rosenquist, Natalie

Advisor dc:contributor.advisor

• Darrow, Lyndsey

Committee members dc:contributor.committeemember

• Strickland, Matthew
• Ryu, So Young
• Weber, Ann
• Burkin, Heather

• childhood asthma
• gestational weight gain
• prepregnancy obesity

Handle dc:identifier.uri

http://hdl.handle.net/11714/8422

OAI identifier oai:identifier

oai:scholarwolf.unr.edu:11714/8422