Date of Award


Document Type

Open Access Dissertation


Epidemiology and Biostatistics


The Norman J. Arnold School of Public Health

First Advisor

Jihong Liu


This dissertation focused on early life exposures and their impact on children and mothers’ health. It consists of three distinct studies with an overarching goal of understanding how early life factors influence health outcomes among children and mothers. The broad aims are: 1) to examine the association between maternal gestational weight gain and offspring weight at 1 year, while assessing the mediating role of birth weight; 2) to determine the association between breastfeeding practices and development of allergic conditions (eczema/skin allergy, hay fever/respiratory allergy, and asthma); and 3) to examine the association between breastfeeding and postpartum weight retention at 12 months.

The first study used recent data collected from a prospective cohort of Chinese pregnant women living in Daxin County, in southern China. Using multivariable linear regression models, we found that maternal gestational weight gain is positively related to offspring weight-for-age Z scores in early infancy and this relationship was significantly mediated by birth weight.

The last two studies utilized data from the Infant Feeding Practice Survey (IFPS) II, a longitudinal prospective cohort study of mothers and their newborn infants conducted by the CDC in 2005–2007. The second study combined data from IFPS II and its Year 6 Follow Up (Y6FU) collected in 2012. Using multivariable logistic regression models, we found that the odd of eczema/ skin allergy was higher among non-exclusively breastfed infants when compared with exclusively breastfed infants. However, no association was found between breastfeeding practices and hay fever/ respiratory allergy and asthma.

The last study, which used multivariable linear regression models and generalized estimating equations found a significant association between breastfeeding (intensity and duration) and postpartum weight retention over time and at 12 months among a cohort of US mothers. When stratified by prepregnancy body mass index (BMI), this association remained significant only among normal weight women (BMI <25 kg/m2).

In conclusion, early life exposures such as maternal gestational weight gain and breastfeeding practices were significantly related to health outcomes in children and mothers both in China and in the US. Targeted efforts should be made to encourage mothers to gain healthy weight in pregnancy and to adhere to the American Academy of Pediatrics recommendations for breastfeeding. Such efforts may be an effective strategy to improve health outcomes in the maternal and child health (MCH) population.

Included in

Epidemiology Commons