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.
