The ECHO Minnesota Pre-Conception and Pregnancy Cohort - ABSTRACT Stressful life events in childhood, including physical and sexual abuse, may have detrimental effects on adult health. Physical and sexual abuse is associated with a 40% increase in the risk of adult obesity; childhood abuse is also associated with pre-pregnancy weight though it is unclear whether abuse influences excessive weight gain during pregnancy. Phthalates, a group of environmental toxins commonly found in plastics and ultra-processed foods, have been associated with gestational weight gain. Phthalates are known to have obesogenic effects and could act through consumption of a poor diet (e.g., ultra-processed foods), which may also be associated with early-life abuse. In fact, those who had a history of physical violence in childhood were 44% more likely to have been exposed to ultra-processed foods. In our own previous work, we found that higher ultra-processed food diets were associated with 13.1% higher molar sum concentrations of di(2-ethylhexyl) phthalate metabolites. Despite the evidence that childhood abuse is associated with pre-pregnancy obesity, there have been mixed findings among the few studies that have examined whether childhood abuse is associated with excess gestational weight gain, and no data on whether phthalate levels are a modifying factor in the association. Therefore, our scientific aims are 1) to determine the association between childhood abuse and gestational weight gain and sequelae (i.e. large-for-gestational age newborns, childhood obesity, and cardiometabolic disorders in childhood); and 2) to assess whether high phthalate level measured during pregnancy shows effect modification in these associations. We hypothesize that phthalate exposure modifies the association so that pregnant women with both a history of childhood abuse and high phthalate exposure, possibly through unwholesome dietary patterns, have the highest risk of gaining too much weight during pregnancy thus conferring a harmful intergenerational effect on her child. Our operational aim will use the exceptional performance of our research team to enroll and retain a total of 780 pregnant women and their offspring into the ECHO Cohort, as well as enrolling their partners into the preconception cohort. We will employ a novel recruitment methodology that transcends healthcare systems across the Minneapolis/St. Paul metropolitan area. Upon enrollment into the ECHO Cohort, our study team will coordinate effortless biospecimen collection. This unprecedented collaboration of healthcare systems will leverage our previous success within the ECHO Cohort and provide valuable data to improve the health of American children.
