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  • Population Study Article
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Maternal stress and early childhood BMI among US children from the Environmental influences on Child Health Outcomes (ECHO) program

Pediatric Research volume 94, pages 2085–2091 (2023)Cite this article

Abstract

Background

We aimed to understand the association between maternal stress in the first year of life and childhood body mass index (BMI) from 2 to 4 years of age in a large, prospective United States-based consortium of cohorts.

Methods

We used data from the Environmental influences on Child Health Outcomes program. The main exposure was maternal stress in the first year of life measured with the Perceived Stress Scale (PSS). The main outcome was the first childhood BMI percentile after age 2 until age 4 years. We used an adjusted linear mixed effects model to examine associations between BMI and PSS quartile.

Results

The mean BMI percentile in children was 59.8 (SD 30) measured at 3.0 years (SD 1) on average. In both crude models and models adjusted for maternal BMI, age, race, ethnicity, infant birthweight, and health insurance status, no linear associations were observed between maternal stress and child BMI.

Conclusions

Among 1694 maternal–infant dyads, we found no statistically significant relationships between maternal perceived stress in the first year of life and child BMI after 2 through 4 years.

Impact

  • Although existing literature suggests relationships between parental stress and childhood BMI, we found no linear associations between maternal stress in the first year of life and childhood BMI at 2–4 years of age among participants in ECHO cohorts.

  • Higher maternal stress was significantly associated with Hispanic ethnicity, Black race, and public health insurance.

  • Our analysis of a large, nationally representative sample challenges assumptions that maternal stress in the first year of life, as measured by a widely used scale, is associated with offspring BMI.

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Fig. 1: Inclusion of ECHO cohorts, pregnancies, and children for analysis.

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Data availability

De-identified data from the ECHO Program are available through NICHD’s Data and Specimen Hub (DASH) (https://dash.nichd.nih.gov). DASH is a centralized resource that allows researchers to access data from various studies via a controlled-access mechanism. Researchers can now request access to these data by creating a DASH account and submitting a Data Request Form. The NICHD DASH Data Access Committee will review the request and provide a response in approximately 2–3 weeks. Once granted access, researchers will be able to use the data for 3 years. See the DASH Tutorial for more detailed information on the process (https://dash.nichd.nih.gov/resource/tutorial).

References

  1. Finkelstein, E. A., Trogdon, J. G., Cohen, J. W. & Dietz, W. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff. (Millwood) 28, w822–w831 (2009).

    Article  PubMed  Google Scholar 

  2. Cunningham, S. A., Kramer, M. R. & Narayan, K. M. Incidence of childhood obesity in the United States. N. Engl J. Med. 370, 403–411 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Geserick, M. et al. Acceleration of BMI in early childhood and risk of sustained obesity. N. Engl J. Med. 379, 1303–1312 (2018).

    Article  PubMed  Google Scholar 

  4. Woo Baidal, J. A. et al. Risk factors for childhood obesity in the first 1,000 days: a systematic review. Am. J. Prev. Med. 50, 761–779 (2016).

    Article  PubMed  Google Scholar 

  5. Johnson, B. J. et al. Unpacking the behavioural components and delivery features of early childhood obesity prevention interventions in the topchild collaboration: a systematic review and intervention coding protocol. BMJ Open 12, e048165 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  6. Shonkoff, J. P. et al. The lifelong effects of early childhood adversity and toxic stress. Pediatrics 129, e232–e246 (2012).

    Article  PubMed  Google Scholar 

  7. Jang, M., Owen, B. & Lauver, D. R. Different types of parental stress and childhood obesity: a systematic review of observational studies. Obes. Rev. 20, 1740–1758 (2019).

    Article  PubMed  Google Scholar 

  8. Tate, E. B., Wood, W., Liao, Y. & Dunton, G. F. Do stressed mothers have heavier children? A meta-analysis on the relationship between maternal stress and child body mass index. Obes. Rev. 16, 351–361 (2015).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. O’Connor, S. G. et al. Associations of maternal stress with children’s weight-related behaviours: a systematic literature review. Obes. Rev. 18, 514–525 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  10. Doom, J. R. et al. Infant psychosocial environment predicts adolescent cardiometabolic risk: a prospective study. J. Pediatr. 209, 85–91.e81 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  11. Romano, M. E., Buckley, J. P., Elliott, A. J., Johnson, C. C. & Paneth, N. SPR perspectives: scientific opportunities in the environmental influences on child health outcomes program. Pediatr. Res. 92, 1255–1261 (2022).

  12. Blaisdell, C. J. et al. The NIH Echo Program: investigating how early environmental influences affect child health. Pediatr. Res. 92, 1215–1216 (2022).

  13. Cohen, S., Kamarck, T. & Mermelstein, R. A global measure of perceived stress. J. Health Soc. Behav. 24, 385–396 (1983).

    Article  CAS  PubMed  Google Scholar 

  14. Kuczmarski, R. J. CDC Growth Charts: United States (US Department of Health and Human Services, Centers for Disease Control and Prevention, 2000).

  15. Aris, I. M., Kleinman, K. P., Belfort, M. B., Kaimal, A. & Oken, E. A 2017 US reference for singleton birth weight percentiles using obstetric estimates of gestation. Pediatrics 144, e20190076 (2019).

    Article  PubMed  Google Scholar 

  16. Bates, D., Mächler, M., Bolker, B. & Walker, S. Fitting Linear Mixed-Effects Models Using Lme4. J. Stat. Softw. 67, 1–48 (2015).

  17. Van Buuren, S. & Groothuis-Oudshoorn, K. MICE: Multivariate Imputation by Chained Equations in R. J. Stat. Softw. 45, 1–67 (2011).

    Article  Google Scholar 

  18. Taveras, E. M., Gillman, M. W., Kleinman, K. P., Rich-Edwards, J. W. & Rifas-Shiman, S. L. Reducing racial/ethnic disparities in childhood obesity: the role of early life risk factors. JAMA Pediatr. 167, 731–738 (2013).

    Article  PubMed  Google Scholar 

  19. Koch, F. S., Sepa, A. & Ludvigsson, J. Psychological stress and obesity. J. Pediatr. 153, 839–844 (2008).

    Article  PubMed  Google Scholar 

  20. Suglia, S. F., Duarte, C. S., Chambers, E. C. & Boynton-Jarrett, R. Cumulative social risk and obesity in early childhood. Pediatrics 129, e1173–e1179 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  21. Ajslev, T. A., Andersen, C. S., Ingstrup, K. G., Nohr, E. A. & Sørensen, T. I. Maternal postpartum distress and childhood overweight. PLoS One 5, e11136 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  22. Sowan, N. A. & Stember, M. L. Parental risk factors for infant obesity. MCN Am. J. Matern Child Nurs. 25, 234–240 (2000). quiz 241.

    Article  CAS  PubMed  Google Scholar 

  23. Leppert, B. et al. Early maternal perceived stress and children’s BMI: longitudinal impact and influencing factors. BMC Public Health 18, 1211 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  24. Baskind, M. J. et al. Parent-perceived stress and its association with children’s weight and obesity-related behaviors. Prev. Chronic Dis. 16, E39 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  25. Felder, J. N. et al. Prenatal maternal objective and subjective stress exposures and rapid infant weight gain. J. Pediatr. 222, 45–51 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  26. Hurley, K. M., Black, M. M., Merry, B. C. & Caulfield, L. E. Maternal mental health and infant dietary patterns in a statewide sample of Maryland WIC participants. Matern. Child Nutr. 11, 229–239 (2015).

    Article  PubMed  Google Scholar 

  27. Anderson, S. E., Lemeshow, S. & Whitaker, R. C. Maternal-infant relationship quality and risk of obesity at age 5.5 years in a national US cohort. BMC Pediatr. 14, 54 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  28. Fox, K. et al. Maternal stress and excessive weight gain in infancy. Int. J. Environ. Res. Public Health 19, 5743 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  29. Zhu, P., Tao, F., Hao, J., Sun, Y. & Jiang, X. Prenatal life events stress: implications for preterm birth and infant birthweight. Am. J. Obstet. Gynecol. 203, 34.e31–e38 (2010).

    Article  Google Scholar 

  30. Kornfield, S. L., Riis, V. M., McCarthy, C., Elovitz, M. A. & Burris, H. H. Maternal perceived stress and the increased risk of preterm birth in a majority non-Hispanic black pregnancy cohort. J. Perinatol. 42, 708–713 (2022).

    Article  PubMed  Google Scholar 

  31. Khashan, A. S. et al. Second-trimester maternal distress increases the risk of small for gestational age. Psychol. Med. 44, 2799–2810 (2014).

    Article  CAS  PubMed  Google Scholar 

  32. Martín-Calvo, N., Goni, L., Tur, J. A. & Martínez, J. A. Low birth weight and small for gestational age are associated with complications of childhood and adolescence obesity: systematic review and meta-analysis. Obes. Rev. 23(Suppl 1), e13380 (2022).

    Article  PubMed  Google Scholar 

  33. Lyons-Reid, J., Albert, B. B., Kenealy, T. & Cutfield, W. S. Birth size and rapid infant weight gain-where does the obesity risk lie? J. Pediatr. 230, 238–243 (2021).

    Article  PubMed  Google Scholar 

  34. Regnault, N. & Gillman, M. W. Importance of characterizing growth trajectories. Ann. Nutr. Metab. 65, 110–113 (2014).

    Article  CAS  PubMed  Google Scholar 

  35. Ling, J., Xu, D., Robbins, L. B. & Meyer, J. S. Does hair cortisol really reflect perceived stress? findings from low-income mother-preschooler dyads. Psychoneuroendocrinology 111, 104478 (2020).

    Article  CAS  PubMed  Google Scholar 

  36. Dunton, G. F., Chu, D., Naya, C. H., Belcher, B. R. & Mason, T. B. Longitudinal associations of maternal stress and child stress with child body mass index trajectory. Pediatr. Obes. 16, e12724 (2021).

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors wish to thank our ECHO colleagues; the medical, nursing, and program staff; and the children and families participating in the ECHO cohorts. We also acknowledge the contribution of the ECHO program collaborators.

Funding

Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of the Director, National Institutes of Health, under Award Numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), U24OD023319 (PRO Core), UH3OD023251 (A.N.A.), UH3OD023320 (J.A.), UH3OD023313 (S.D.), UH3OD023282 (J.G.), UH3OD023244 (A.E.H.), UH3OD023268 (S.W.), UH3OD023342 (K.L.), UH3OD023349 (T.G.O’C.), UH3OD023272 (S.S.), and UH3OD023337 (R.J.W.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Division of General Pediatrics and Adolescent Health and Duke Center for Childhood Obesity Research, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA

    Charles T. Wood

  2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Marie L. Churchill & Monica McGrath

  3. Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ, USA

    Judy Aschner

  4. Albert Einstein College of Medicine, Bronx, NY, USA

    Judy Aschner

  5. Department of Psychology, Rowan University, Glassboro, NJ, USA

    Steven M. Brunwasser

  6. Vanderbilt University Medical Center, Nashville, TN, USA

    Steven M. Brunwasser

  7. Department of Kinesiology and Community Health, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Champaign, IL, USA

    Sarah Geiger

  8. Division of Neonatology, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA

    Semsa Gogcu

  9. Departments of Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA

    Tina V. Hartert

  10. Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA

    Allison E. Hipwell

  11. Department of Medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Kathleen Lee-Sarwar

  12. AJ Drexel Autism Institute, Drexel University, Philadelphia, PA, USA

    Kristen Lyall

  13. Department of Medical Psychology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

    Nora K. Moog

  14. Department of Psychiatry, Psychology, Neuroscience, and Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA

    Thomas G. O’Connor

  15. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    T. Michael O’Shea

  16. Division of Neonatology, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA

    P. Brian Smith

  17. Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Rosalind J. Wright & Xueying Zhang

  18. Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, USA

    Emily Zimmerman

  19. College of Public Health, George Mason University, Fairfax, VA, USA

    Kathi C. Huddleston

  20. Division of General Pediatrics, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA

    Callie L. Brown

  21. Duke Clinical Research Institute, Durham, NC, USA

    P. B. Smith & K. L. Newby

  22. Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

    L. P. Jacobson

  23. Research Triangle Institute, Durham, NC, USA

    D. J. Catellier

  24. Northwestern University, Evanston, IL, USA

    R. Gershon & D. Cella

  25. Northeastern University, Boston, MA, USA

    A. N. Alshawabkeh

  26. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    S. L. Teitelbaum & A. Stroustrup

  27. Cohen Children’s Medical Center, Northwell Health, New York, NY, USA

    A. Stroustrup

  28. Memorial Hospital of Rhode Island, Providence, RI, USA

    S. Deoni

  29. University of Wisconsin, Madison, WI, USA

    J. Gern

  30. Boston Medical Center, Boston, MA, USA

    L. Bacharier & G. O’Connor

  31. Children’s Hospital of New York, New York, NY, USA

    L. Bacharier & M. Kattan

  32. Johns Hopkins University, School of Medicine, Baltimore, MD, USA

    R. Wood & L. Bacharier

  33. Washington University in St Louis, St Louis, MO, USA

    K. Rivera-Spoljaric

  34. Brigham and Women’s Hospital, Boston, MA, USA

    S. Weiss

  35. Boston University Medical Center, Boston, MA, USA

    G. O’Connor & Kaiser Permanente

  36. Southern California, San Diego, CA, USA

    R. Zeiger

  37. Washington University of St. Louis, St Louis, MO, USA

    L. Bacharier

  38. University of California, UC Davis Medical Center Mind Institute, Davis, CA, USA

    R. Schmidt

  39. University of Pittsburgh Medical Center, Magee Women’s Hospital, Pittsburgh, PA, USA

    H. Simhan

  40. University of Illinois, Beckman Institute, Urbana, IL, USA

    S. Schantz

  41. University of California, San Francisco, San Francisco, CA, USA

    T. Woodruff

  42. Boston Children’s Hospital, Boston, MA, USA

    M. Bosquet-Enlow

Authors
  1. Charles T. Wood
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  2. Marie L. Churchill
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  3. Monica McGrath
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  4. Judy Aschner
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  5. Steven M. Brunwasser
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  6. Sarah Geiger
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  7. Semsa Gogcu
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  8. Tina V. Hartert
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  9. Allison E. Hipwell
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  10. Kathleen Lee-Sarwar
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  11. Kristen Lyall
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  12. Nora K. Moog
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  13. Thomas G. O’Connor
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  14. T. Michael O’Shea
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  15. P. Brian Smith
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  16. Rosalind J. Wright
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  17. Xueying Zhang
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  18. Emily Zimmerman
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  19. Kathi C. Huddleston
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  20. Callie L. Brown
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Consortia

on behalf of program collaborators for Environmental influences on Child Health Outcomes

  • ECHO Components

    • Coordinating Center

      • P. B. Smith
      •  & K. L. Newby

    • Data Analysis Center

      • L. P. Jacobson
      •  & D. J. Catellier

    • Person-Reported Outcomes Core

      • R. Gershon
      •  & D. Cella

  • ECHO Awardees and Cohorts

    • A. N. Alshawabkeh
    • , S. L. Teitelbaum
    • , A. Stroustrup
    • , A. Stroustrup
    • , S. Deoni
    • , J. Gern
    • , L. Bacharier
    • , G. O’Connor
    • , L. Bacharier
    • , M. Kattan
    • , R. Wood
    • , L. Bacharier
    • , K. Rivera-Spoljaric
    • , S. Weiss
    • , G. O’Connor
    • , Kaiser Permanente
    • , R. Zeiger
    • , L. Bacharier
    • , R. Schmidt
    • , H. Simhan
    • , S. Schantz
    • , T. Woodruff
    •  & M. Bosquet-Enlow

Contributions

C.T.W., C.L.B., M.L.C., and M.M. designed, analyzed, and interpreted the data and drafted the article. All authors revised and critically appraised the article for intellectual content and approved the final version.

Corresponding author

Correspondence to Charles T. Wood.

Ethics declarations

Competing interests

The authors declare no competing interests.

Consent to participate

Written informed consent was obtained for ECHO-wide Cohort Data Collection Protocol participation and for participation in specific cohorts.

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Wood, C.T., Churchill, M.L., McGrath, M. et al. Maternal stress and early childhood BMI among US children from the Environmental influences on Child Health Outcomes (ECHO) program. Pediatr Res 94, 2085–2091 (2023). https://doi.org/10.1038/s41390-023-02750-8

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