Funded Projects

Developmental Origins of Children's Cardiometabolic Risk

Grantee: Northshore University Healthsystem
Principal Investigator: Madeleine Shalowitz
Project Number: R40MC26808
Project Date: 4/1/2014

Age group(s)

• Women/Maternal
• Early Childhood (3-5 years)
• Middle Childhood (6-11 years)

Abstract

Cardiometabolic risk has reached epidemic levels among the poor and underserved, individually and across generations. For over 3 decades, both childhood and maternal obesity rates have steadily increased. There have been parallel increases in childhood-onset Type 2 diabetes (DM), now detected as early as age 6, along with elevated levels of lipids and blood pressure requiring adult medication to control. A major knowledge gap remains in understanding how social and biological contexts combine to influence intergenerational cardiometabolic risk and disease. Closing this gap may lead to new interventions strongly grounded in scientific evidence about the human life course, starting preconception, and incorporating the entire family unit in a community context. This proposal aligns with MCHB Strategic Research Issue IV to promote healthy development of MCHB populations and Healthy People 2020 objectives to reduce childhood obesity (NWS-10) and prevent inappropriate weight gain (NWS-11). Our overarching theme is biological programming of the next generation's health begins preconception, closely linked to the mother's and father's physical and social well-being. Strongly guided by life course theory and our team's earlier findings, our proposed study is auxiliary to the multisite NIH funded Community Child Health Network (CCHN). CCHN is the first prospective study starting prior to conception to measure maternal allostatic load, parental stress and resilience factors, and the course of prenatal development and early childhood outcomes. The proposed follow-up sample (N=180) resides in Lake County, IL and Washington, DC. Families were followed from the birth of one child until a subsequent pregnancy. We collected additional biological and psychosocial data during that pregnancy, at 2 months postpartum, and then when the child was ages 3 and 4. We are requesting funds to conduct a follow-up set of assessments on the CCHN family sample of subsequently-born children. For this application, we propose a new home visit when the children reach 5-6 years, to 1) update our longitudinal interviews with mothers and fathers and 2) collect new information on their children's growth, including a formal assessment of their neurocognitive development at about the time they will be starting school. Further, we will obtain blood samples to quantify the children's physiological measures of cardiometabolic risk. Finally, we will 1) request and abstract the children's medical records from their primary health provider and other sources of care (only the maternity and newborn hospital record was previously requested by CCHN), and 2) conduct 3 phone calls each year to enhance retention and obtain interim data. The main hypotheses for this project are: Hypothesis 1) Children's cardiometabolic risk at 5 years will be significantly influenced by the mother's stress and her own cardiometabolic health prior to conception. Hypothesis 2) Children's intellectual competence will be significantly affected by maternal stress and cardiometabolic health prior to conception. We will also explore how father stress and cardiometabolic health contribute to their children's lives in a biopsychosocial, intergenerational health model. This exploratory study is particularly valuable given the unique nature of the parent study and the historical exclusion of fathers from much MCH research.