Elucidating Neighborhood- and Individual-Level Factors Associated with Pregnancy Glycemia Levels and Childhood Obesity

PROJECT SUMMARY/ ABSTRACT
Gestational diabetes mellitus (GDM) is the most common pregnancy complication. The offspring of individuals
with GDM are at significantly higher risk of childhood obesity, a growing epidemic that disproportionately
affects Hispanic and Black children. Because childhood obesity is challenging to reverse, there is an urgent
need to target upstream in utero and early life risk factors to mitigate the obesity epidemic. No studies to date
have examined whether achieving glycemic control during pregnancy can revert the higher risk of childhood
obesity associated with GDM; nor have any studies examined how the prenatal neighborhood environment may
be associated with pregnancy glycemia levels or childhood obesity risk in the offspring. The proposed research
seeks to address these knowledge gaps by elucidating the neighborhood- and individual-level factors
associated with pregnancy glycemia levels and childhood obesity risk in the offspring. In the K99 phase, I will
pursue didactic training complemented by mentorship from renowned experts in the field with a strong record
of mentorship and collaboration. In Aim 1, I will apply training in GDM pathophysiology and management,
neighborhood environment, and health disparities to examine joint associations of prenatal neighborhood built
environment (food environment and walkability) and individual-level behavioral (diet and physical activity) and
biological (insulin resistance) factors with pregnancy glycemia levels (no GDM and GDM with optimal or
suboptimal glycemic control). In Aim 2, I will apply training in childhood body composition to examine
associations of the pregnancy glycemia levels with childhood obesity risk and body composition. I will conduct
these aims using the Pregnancy Environment and Lifestyle Study (PETALS), a multi-racial/ethnic cohort of
3,346 pregnant individuals and their children followed up in the NIH Environmental Influences on Child Health
Outcomes (ECHO) program. In Aim 3 (R00 phase), I will harness longitudinal analysis skills to examine
associations of a more elaborate list of neighborhood-level factors (prenatal neighborhood food environment,
walkability, deprivation, racial residential segregation, and ethnic enclaves) with childhood growth patterns and
obesity risk, potential mediation by nuanced pregnancy glycemia levels (via glycemic control trajectories from
GDM diagnosis to delivery), and effect modification by race/ethnicity and childhood opportunity index. I will
conduct this analysis in the Blood Pressure in Pregnancy, Obesity, Diabetes and Perinatal Outcomes (BIPOD)
study, a population-based, socio-demographically diverse cohort of ~0.4 million pregnant individuals and their
offspring followed for up to 12 years. The proposed training and research will serve as the springboard for
developing competitive R01 applications and launching my career as an independent investigator focused on
the role of multilevel (neighborhood and individual) determinants of cardiometabolic health across the life
course to inform clinical practice and public health policies and interventions, with an ultimate goal to improve
health outcomes and reduce health disparities among pregnant individuals and their offspring.

Grant Number: 5K99HD115836-02
NIH Institute/Center: NIH
Principal Investigator: Rana Chehab