Hutchins, Franya
(2020)
Excessive Gestational Weight Gain and Long-Term Maternal Cardiovascular Health.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
Cardiovascular disease (CVD) continues to be the leading cause of death in the United States despite decades of improvement in many risk factors. Public health literature often identifies the high prevalence of obesity as a contributor to the CVD burden. Excessive gestational weight gain (GWG) is emerging as a potential modifiable risk factor for obesity among those who give birth. However, there is no consensus as to whether excessive GWG contributes to CVD. Because obesity is a heterogeneous condition, it is important to evaluate the specific health sequela of a given risk factor. The overall objective of this dissertation is to investigate the role of excessive GWG in long-term maternal cardiovascular health. Using observational data, we estimated associations between excessive GWG and cardiovascular risk factors, and quantified the statistical bias around estimates. In the first aim of this dissertation, we estimated the association between number of births with excessive GWG and midlife BMI in a sample of parous participants in the multi-ethnic cohort Study of Women’s Health Across the Nation. We found that each additional excessive GWG pregnancy was associated with increased maternal BMI at midlife independent of demographic, behavioral, and other reproductive factors. In aim 2, we quantified the potential statistical bias around these estimates to evaluate their susceptibility to common sources of systematic error. Using multiple imputation and misclassification-weighted regressions, we found that our estimates were generally robust to bias. In aim 3, we evaluate whether excessive GWG impacts atherosclerotic CVD risk score or chronic inflammation using 20 years of prospective follow-up across midlife. We found that a history of excessive GWG was associated with a small but statistically significant increase in maternal CVD risk score, and moderate increase in inflammation.
Public health significance: Our findings underscore the importance of prenatal care in supporting long-term maternal health and highlight inflammation as a potential pathway linking reproductive history to CVD. Further, we illustrate that observational data can provide valuable epidemiologic insights even in the presence of likely systematic error.
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Details
| Item Type: |
University of Pittsburgh ETD
|
| Status: |
Unpublished |
| Creators/Authors: |
|
| ETD Committee: |
|
| Date: |
10 September 2020 |
| Date Type: |
Publication |
| Defense Date: |
7 July 2020 |
| Approval Date: |
10 September 2020 |
| Submission Date: |
21 July 2020 |
| Access Restriction: |
2 year -- Restrict access to University of Pittsburgh for a period of 2 years. |
| Number of Pages: |
154 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Public Health > Epidemiology |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
Weight gain during pregnancy, maternal health, statistical error |
| Date Deposited: |
11 Sep 2020 01:16 |
| Last Modified: |
01 Sep 2022 05:15 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/39412 |
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