Date of Award


Document Type

Open Access Thesis


Epidemiology and Biostatistics



First Advisor

Jihong Liu


Data from the 2001 Early Childhood Longitudinal Study Birth- Cohort were used to examine the association between maternal gestational weight gain (GWG) and the risk of obesity in the offspring, and the possible mediating role of birth weight. The Centers for Disease Control growth 2000 reference charts and child's height and weight measured at age 4 or 5 years old were used to determine child body mass index (BMI) Z-scores or obesity status (greater than or equal to the 95th percentile). Multiple linear or logistic regression models were used to adjust for maternal age, race, education, smoking status and prepregnancy BMI. In this population (unweighted n=6400), 43.4% of mothers exceeded the 2009 Institute of Medicine (IOM) weight gain recommendation, while 30.2% gained weight below the recommendation. 17.6% of children were obese. We found that a 1 kg increase in the weekly rate of GWG in the second and third trimesters was associated with 0.37-unit increase in BMI Z-score (95% CI: 0.14-0.61), and 2.31 times higher odds of being obese (95% CI: 1.51-3.54). Gaining weight exceeding IOM recommendations was positively associated with a 0.14 unit increase child BMI Z-scores compared to gaining adequate GWG (95% CI: 0.01-0.26). In a subsample of offspring who were born full term (unweighted n=5400), a 5-kilogram increase in total GWG was also associated with 0.07 unit increase in BMI Z-scores (95% CI: 0.02-0.26) and 1.19 times the odds of being obese (95% CI: 1.08-1.30). Mediation analysis was conducted to decompose the total effects into direct and indirect effects. There were stronger direct effects than indirect effects. Birth weight is a moderate mediator between the association of maternal GWG and offspring and weight status. In conclusion, targeting maternal GWG is a promising approach to prevent childhood obesity.

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