Title: Maternal obesity and childhood maltreatment in pregnant Latina adolescents
Description: Background: The prevalence of obesity is increasing in the US population, especially among pregnant women extending before, during and after pregnancy. This is a cause for concern, as it poses significant health risks for both mother and infant. Given the urgency of this problem, it is important to examine not only the pathways to obesity in this group but the correlated risks. One significant risk factor for obesity in the general population is childhood maltreatment. This early, varied, and often chronic form of maltreatment, has been associated with long-term adverse physiological and psychological health outcomes across the general population, often conferring heightened risk for health disparities or increasing the burden of already existing disparities. Only two studies have examined childhood maltreatment as a risk factor for maternal obesity and none have examined this relationship in an urban sample of young adult Latina nulliparas. This exploratory study examines relationships between and among a history of early maltreatment, maternal obesity, and key psychosocial risk indices in urban, nulliparous minority adolescents to better understand associations with this risk factor in the context of pregnancy.

The Life Course Health Development Framework as outlined by Halfon and Hochstein is the theoretical framework guiding this study. Methods: This descriptive exploratory study performed a retrospective analysis of a subset of interview-collected data from a larger NIH funded prospective cohort study (1R01MH077144-01A2, Monk, PI). Study participants were pregnant, ranging from 14-19 years of age, and recruited from obstetrical practices affiliated with a large academic medical center in New York City. The sample was primarily Hispanic. An exploratory correlational design employed bivariate as well as multivariate analyses to examine associations among maternal childhood maltreatment (MCM), depression, PTSD, perceived stress, social support and maternal obesity as measured by pre-pregnancy BMI. An association between pre-pregnancy BMI and infant birth weight was also explored. Results: Forty-three percent of this study sample experienced at least one form of childhood maltreatment with more than half experiencing multiple forms.

A similarly high percentage (40 %) of pre-pregnancy overweight and obesity (BMI ≥ 25 and BMI ≥ 30 respectively) was also evidenced. Of these, eighteen percent were obese. Maternal childhood maltreatment was significantly associated with depression, PTSD, elevated stress levels and low levels of social support. Clinically important finding, though not statistically significant, was the finding that mothers with MCM were more than twice as likely to have a pre-pregnancy BMI ≥ 30 than mothers without MCM. Both of these public health concerns confer a heightened risk for additional short and long-term adverse health outcomes for mothers and infants, especially those already compromised by health disparities. Conclusions & Implications: This study provides further evidence that childhood maltreatment and pre-pregnancy obesity are significant health priorities requiring attention. It has characterized, for the first time, the high occurrence of both of these health issues in young adult Latina nulliparas.

The study presents a preliminary risk profile of significant psychosocial indices associated with childhood maltreatment and pre-pregnancy obesity that can serve to inform the development and implementation of systematic prenatal screening programs for populations at psychosocial risk Finally, the study finding that a history of childhood maltreatment more than doubled the risk of pre-pregnancy obesity, while not statistically significant, may be clinically meaningful in that it presents the possibility of early childhood trauma conferring pregnancy-related vulnerability for future adverse health outcomes for both the mothers and their offspring in this group. Next steps in this critical but neglected area of research are to focus on larger population-based studies which will further examine the complex nature of the relationship between MCM and pre-pregnancy obesity as well as correlated risk factors.