Overweight In Early Childhood Among Term and Preterm WIC Participants

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Overweight In Early Childhood Among Term and
Pre-term WIC Participants

• Cassandre Larrieux, MPH
• Violanda Grigorescu, MD, MSPH
• Kobra Eghtedary, PhD
• Alethia Carr, RD, MBA
• MCH Epidemiology Section, Genomics,
  Perinatal Health, and
• Chronic Disease Epidemiology Division, Bureau of
  Epidemiology,
• Michigan Department of Community Health
• WIC Division, Bureau of Family, Maternal, and
  Child Health,
• Michigan Department of Community Health

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Learning Objectives

• Describe the prevalence of overweight in a group
  of WIC/Medicaid participants.
• Describe the general health consequence of
  childhood overweight.
• Identify factors correlated with early childhood
  overweight.

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Background

• In general, overweight is a condition in which a
  person has an excess amount of body fat.
• This occurs when there is an imbalance of
  calories consumed and calories expended in the
  body
• In adults, overweight is a BMI of 25 kg/m2 or
  more.
• Overweight and obesity are associated with an
  increased risk of a variety of adverse health
  conditions
• diabetes,
• hypertension,
• heart disease,
• cerebrovascular disease,
• several forms of arthritis, and
• premature death

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(No Transcript)
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Background

• In the twenty years between NHANES I and NHANES
  II, the prevalence of obesity had doubled in
  children over the age of six years old.
• The latest data for NHANES (1999-2002) shows that
  16 (over 9 million) of children 6-19 are
  overweight.
• Also childhood and adolescent overweight is
• a strong predictor of adult overweight
• can further exacerbate adverse outcomes in
  adulthood.

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Background

• Several studies have identified critical periods
  in the development of overweight in children
• Gestation
• Infancy
• 3-6 years old, and
• Puberty
• Catch-up growth, experienced by pre-term and low
  birthweight infants, is believed to contribute to
  obesity
• In addition, pre-term birth is also associated
  with an increased risk of adult morbidity (e.g.
  cardiovascular and metabolic disorders) and
  mortality.

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Study Question

• Does gestational age at birth have any impact on
  child overweight?

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Methods Data Source

• 2000 birth records, Pregnancy Nutritional
  Surveillance System (PNSS), and the Pregnancy
  Nutritional Surveillance System (PedNSS) data
  were linked and mother/child pairs were identify.
  The childs information in subsequent PedNSS were
  then linked to the corresponding mother/child
  dyad.
• The resulting dataset had information for 7,624
  children and their mothers from 2000-2003

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Methods Study Population

• The study population was Medicaid participants
  born in 2000 who were continuously enrolled in
  Michigan WIC until they were three years old
  (2003) and whose mother participated in WIC
  prenatally.
• Participants were grouped based on the BMI
  percentile
• BMI95th percentile for age and sex
• BMIlt95th percentile for age and sex

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Demographics Childrens Characteristics

• 85.5 pf participants were either White or Black
• 47.3 were ever breastfed as infants
• 12.8 were born preterm
• 13.4 were overweight at 4 years old

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Demographics Mothers Characteristics

• 55.0 of the mothers of the study participants
  were between 20-29 years old
• 83.9 has a HS education or less
• 30.7 had a pre-pregnancy BMI greater then 29
  kg/m2
• 39.9 gained more weight then recommended for
  their BMI

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Methods Logistic Regression

• A logistic regression model was developed to
  determine the adjusted odds ratio of overweight
  at three years old for the gestational age.
• Dependent Variable
• Overweight (at 3 yrs old)
• Independent variable of interest
• Gestational Age at Birth (term or pre-term)
• Potential confounders
• Childs Race/ethnicity
• Childs birthweight
• Childs ever breastfed status
• Mothers pre-pregnancy BMI
• Mothers weight gain during pregnancy
• Mothers Education
• Maternal Smoking

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Methods Logistic Regression (continue)

• Software SAS v9.13
• Our reference groups were
• Non-Hispanic White child
• Born at term
• Born with a normal birthweight
• Mother had
• a HS diploma/GED
• normal BMI pre-pregnancy (19.8BMI26.0)
• Gained the recommended amount of weight for their
  BMI

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Regression Results Childs Characteristics
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Regression Results Maternal Characteristics
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Summary

• The odds of a child being overweight at three
  years old was
• 43 higher if the child was Hispanic
• 73 higher if the child was born with a high
  birthweight
• 32 lower of the child was Black
• 35 higher if the mother had less than a high
  school education
• 2x higher if the mother has a very high
  pre-pregnancy BMI

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Conclusions Discussion

• In this study, gestational age at birth was not
  statistically significantly associated with
  overweight at three years old, the results were
  encouraging.
• Modifiable maternal and infant factors were found
  to be statistically significant predictors early
  childhood overweight.

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Limitations

• Length of study period
• No information about
• Paternal health and obesity
• Exclusive breastfeeding
• Feeding practices in later infancy and
  toddler-hood
• Maternal morbidity that may contribute to
  childhood overweight (e.g. gestational diabetes)
• Finding may not be generalizable to all children
• Cases were taken from a socioeconomically
  vulnerable population

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Thank You!

• Any questions?

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PROC corr for birthweight and prematurity