All ETDs from UAB

Advisory Committee Chair

Paula Chandler-Laney

Advisory Committee Members

Timothy W Garvey

Gregory Pavela

Brenda Bertrand

Martha Wingate

Document Type

Dissertation

Date of Award

2021

Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions

Abstract

Metabolic syndrome (MetS) is a cluster of symptoms that increase risk for heart disease and type 2 diabetes. Therefore, early detection of MetS is vital for disease prevention. Gestational diabetes (GDM) and/or obesity during pregnancy are associated with a greater risk for MetS in mothers and their children compared to mothers with no GDM. However, little is known about how much a GDM history or in utero exposure to maternal GDM contributes to MetS risk years after that pregnancy in addition to risk attributable to obesity itself. Therefore, the overall objective of this dissertation was explore how a history of GDM, and how current lifestyle factors influence the association between BMI and MetS scores in women and their children 4-10 years after pregnancy. The studies were performed using data from a cross-sectional study of 225 mother-child dyads. Using moderation modeling, we found that the association between current BMI and MetS scores were statistically significant, such that as BMI increased, MetS scores also increased. Among mothers, the association between current BMI and MetS severity scores was significantly modified by GDM after adjusting for age, energy intake and %MVPA, such that as BMI increased, MetS severity increased to a greater degree in the GDM versus non-GDM group. In utero exposure to maternal obesity and GDM significantly modified the relationship between children’s BMIz and MetS risk, such that, for children exposed to GDM in utero, the association between BMIz and MetS risk weakened as BMIz increased. Finally, diet quality (HEI-2015) was not a significant moderator of the association between BMI and MetS in mothers or children, and although there was a trend for physical activity to reduce the strength of this association in children, this was not apparent for mothers. Together, these findings suggest that a history of GDM in mothers, and GDM exposure in children, provide unique information about the risk or severity of MetS in addition to what we already know about the contribution of BMI. More work is needed, however, to identify whether risk for MetS could be mitigated by any modifiable lifestyle factors beyond energy intake and physical activity.

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