Patient description: A 16-year-old girl came to the clinic complaining of weight gain and abnormal menstrual cycles. Her BMI was 24, but she has gained 5 kg in the past few weeks. She gets tired more frequently and does not have energy to go dancing with her friends. Her lab results were remarkable for high TSH levels (15 mU/L) and low free T4 levels (0.18 ng/dl). Her anti-TPO levels were extremely high (136 IU/ml). She was diagnosed with Hashimoto disease. She does not smoke and she is not sexually active.

Clinical trial eligibility criteria: eligible ages (years): 0.0-60.0,  Diabetes Obesity Fatty Liver Pregnant women aged 18 years or older [pregnancy confirmed by urine or serum pregnancy test, initial gestational age estimation will be based on date of last menstrual period (LMP) Plan to receive prenatal care at PIMC Agree to continue with research study participation (both mother and their offspring), for at least 3 years after delivery We plan to recruit eligible pregnant women as early as possible, preferably during their first prenatal visit, but will enroll them any time during pregnancy. These mothers are expected to be primarily of AI/AN heritage or have infants that are AI/AN. There are approximately 700 deliveries conducted at PIMC annually. Most pregnant women receive all their prenatal care and deliver at PIMC, but some deliver elsewhere for reasons such as proximity at the time of delivery or availability of hospital beds. We anticipate that most of these pregnant women will meet our recruitment annually; however, there are no pre-determined limits to the number of participants we can recruit for this study. If the mother has participated in the study during a prior pregnancy, she will still be eligible for participation in all successive pregnancies, unless incarcerated or unable to consent or unwilling or is unable to plan for at least 3-years of follow-up of her and her off-spring after delivery. STUDY  Maternal age of less than 18 years Women who are incarcerated or are unable to consent Unwillingness/inability to plan for at least 3 years of follow-up of mother and her offspring post-delivery Women whose fetus is not alive or are not planning to continue the pregnancy. We anticipate that some patients will be lost to follow up for various reasons. However, if any such research participants return to the well childcare clinic for resuming care, they would be eligible to re-enroll in For mothers with repeat pregnancies, her research visit schedule will be based on the delivery of her most recent offspring. Each child will then have his/her own visit schedule independent of the mother. of DYADS FROM LIFE-MOMS STUDY: -Mothers and offspring from the Lifestyle Interventions for Expectant Moms (LIFE-Moms) Phoenix study (Protocol Number 13-DK-N055) will be eligible for participation in the study. There are 39 maternal/child dyads from the Life-Moms study, born between 10/2013 and 11/2014, who will be eligible for participation in The mothers and children will be followed postpartum as per the protocol and data collected during enrollment in the Life-Moms protocol will be used in study data analysis. The mothers in this cohort will be seen for their initial visit at first contact. The data collection for each visit will correspond as detailed in Table 2. After the initial visit, data collection visits will be scheduled as close to the preferred windows as possible and will correspond with the child s visit according to the data collected and the preference of the mother. of STAFF (NIH, and IHS): The study is open to NIH or IHS employees who meet study and except those involved directly with study participants such as data collectors. We will provide the NIH Information Sheet on Staff Research Participation to NIH employees who are considering participation in our protocol prior to obtaining consent. In addition, we will discuss the following applicable safeguards to NIH and IHS staff as a vulnerable class of subjects Unbiased participation for protocol integrity and participant risk assessment Ensure there is no perceived workplace pressure or expectation on either participation or deciding not to participate in the protocol in regard to a benefit or adverse effect on their NIH or HIS employment or staff position Protection of privacy and confidentiality will be maintained, but also with acknowledgement of the limits due to sensitive information that may be in their NIH or IHS file Discussion of time commitments of the study and compensation in accordance with NIH policy 2300-630-3, Leave Policy for NIH Employees Participating in NIH Medical Research Studies