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Document Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Degree Program

Public Health

Year Degree Awarded

2016

Month Degree Awarded

September

First Advisor

Lisa Chasan-Taber

Second Advisor

Penelope Pekow

Third Advisor

Barry Braun

Fourth Advisor

Karen Ertel

Subject Categories

Epidemiology

Abstract

More than 70% of women do not gain within their target range of gestational weight gain (GWG), as recommended by the Institute of Medicine (IOM) in 2009. Risks associated with inadequate GWG include small-for-gestational age, low birthweight, pre-term birth, and difficulty establishing breastfeeding. Risks associated with excessive GWG include large-for-gestational-age, macrosomia, and delivery complications. There are also long-term consequences for maternal and fetal metabolic processes. Higher pre-pregnancy BMI, lower education level, and higher parity are known risk factors for excessive GWG. There are also possible racial / ethnic differences, and Hispanic women, in particular, may be at high risk for excessive GWG. Thus, the research aim was to examine multiple measures of GWG prospectively, including potentially modifiable risk factors for and consequences of GWG outside IOM recommendations among pregnant Hispanic women in Proyecto Buena Salud (PBS), a prospective cohort study.

Chapter 1 examines the association between stress / anxiety in early, mid- and late pregnancy and GWG. Among 1308 Hispanic women, high stress in early pregnancy was associated with lower total GWG; high stress in late pregnancy was associated with lower rate of GWG; and high anxiety in early pregnancy was associated with both lower rate of GWG and lower total GWG.

Chapter 2 examines the association between GWG and cesarean delivery. Among 1215 Hispanic women, each additional pound of GWG was associated with a 2% greater risk of cesarean delivery. Rate of GWG was also positively associated with the risk of cesarean delivery.

Chapter 3 examines the association between GWG and abnormal glucose tolerance (AGT) / gestational diabetes mellitus (GDM). Among 1277 Hispanic women, GWG was inversely associated AGT, but not significantly associated with GDM. Specifically, excessive GWG until the GDM screen was associated with a 35% lower risk of AGT. This association was only significant among women with normal pre-pregnancy BMI.

In conclusion, stress and anxiety were inversely associated with GWG, and GWG was positively associated with cesarean delivery and inversely associated with AGT (among women with normal pre-pregnancy BMI). These projects contribute to an understanding of the correlates and consequences of GWG at various points throughout pregnancy.

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