To curb the continuing obesity epidemic, `upstream' prevention efforts are desperately needed. To inform such prevention efforts, increased scientific knowledge of the following is required: 1) the mechanisms through which physical activity (PA) in pregnancy, a modifiable lifestyle factor, may impact body size and composition in infancy, and 2) improved methods for evaluating health system based lifestyle interventions to improve maternal gestational weight gain (GWG) and infant birthweight. This K01 will provide Dr. Samantha F. Ehrlich Ph.D., with the expertise needed to achieve her career goals of reducing obesity and diabetes in women and children by promoting and ultimately increasing participation in PA at the population level, particularly through interventions implemented at the health system level. The central hypothesis of this proposal is that increasing PA during pregnancy may mitigate the development of obesity in both the mother (i.e., through appropriate GWG) and child (i.e., through appropriate birthweight and reduced body fat at birth, and developmental programming for appropriate weight/fat mass gains in infancy).
The specific aims are as follows.
Aim 1 : To estimate the effects of PA during pregnancy on infant growth from birth to 1 year of age using novel methods that permit causal inference to be drawn from observational data.
Aim 2 : To estimate the effects of PA regime during pregnancy (i.e., objectively measured PA in early and late pregnancy) on infant body composition (i.e., percent body fat) from birth to 1 year of age using novel methods that permit causal inference to be drawn from observational data with time-dependent confounding (i.e., measures of PA, diet, and fat mass in early and late pregnancy).
Aim 3 : To efficiently evaluate a physician-initiated intervention promoting PA and appropriate weight gain in pregnancy implemented at a single medical center by estimating its effects on maternal GWG and infant birthweight as compared to matched patients from non-intervention medical centers.
Aim 3 uses existing historical data to match at the medical center level and existing electronic health record data to match on individual-level variables. This research will expand knowledge of potential targets for real world interventions of `upstream' obesity prevention, and use novel methods for evaluating one such intervention. Dr. Assiamira Ferrara MD, Ph.D., Senior Research Scientist and Chief of the Women's and Children's Health Section at the KPNC Division of Research, will be my Primary Mentor (obesity prevention). Co-mentors with complementary expertise include Drs. David Bassett, Jr. (objectively measured PA), Hollie A. Raynor (nutrition and behavioral aspects of obesity prevention), and Romain Neugebauer (causal inference-based methods of analysis); Dr. Kelley Pettee Gabriel (PA epidemiology) is a Consultant. The research, new training and professional developmental afforded by this award will ensure Dr. Ehrlich's successful transition to research independence in the area of PA during pregnancy for intergenerational obesity and diabetes prevention.

Public Health Relevance

This proposal investigates the effects of physical activity in pregnancy on offspring body size and composition from birth to 1 year of age, as rapid increases in size during this period strongly predict childhood obesity. It also proposes using existing data sources to efficiently evaluate the effects of a physician initiated intervention promoting physical activity and appropriate weight gain in pregnancy on maternal gestational weight gain and infant birthweight. Such knowledge is greatly needed to inform the development and evaluation of evidence- based `upstream' (i.e. during the gestational period) interventions for intergenerational obesity prevention.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Scientist Development Award - Research & Training (K01)
Project #
Application #
Study Section
Kidney, Urologic and Hematologic Diseases D Subcommittee (DDK)
Program Officer
Osganian, Voula
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Tennessee Knoxville
Public Health & Prev Medicine
Sch Allied Health Professions
United States
Zip Code
Bradley, Marie C; Ferrara, Assiamira; Achacoso, Ninah et al. (2018) A Cohort Study of Metformin and Colorectal Cancer Risk among Patients with Diabetes Mellitus. Cancer Epidemiol Biomarkers Prev 27:525-530
Hedderson, Monique M; Brown, Susan D; Ehrlich, Samantha F et al. (2018) A Tailored Letter Based on Electronic Health Record Data Improves Gestational Weight Gain Among Women With Gestational Diabetes Mellitus: The Gestational Diabetes' Effects on Moms (GEM) Cluster-Randomized Controlled Trial. Diabetes Care 41:1370-1377
Boyer, William R; Churilla, James R; Ehrlich, Samantha F et al. (2018) Protective role of physical activity on type 2 diabetes: Analysis of effect modification by race-ethnicity. J Diabetes 10:166-178
Erwin, Paul C; Meschke, Laurie L; Ehrlich, Samantha F et al. (2017) Neonatal Abstinence Syndrome in East Tennessee: Characteristics and Risk Factors among Mothers and Infants in One Area of Appalachia. J Health Care Poor Underserved 28:1393-1408
Ehrlich, S F; Hedderson, M M; Brown, S D et al. (2017) Moderate intensity sports and exercise is associated with glycaemic control in women with gestational diabetes. Diabetes Metab 43:416-423
Kubo, Ai; Ferrara, Assiamira; Brown, Susan D et al. (2017) Perceived psychosocial stress and gestational weight gain among women with gestational diabetes. PLoS One 12:e0174290
Peng, Tiffany Y; Ehrlich, Samantha F; Crites, Yvonne et al. (2017) Trends and racial and ethnic disparities in the prevalence of pregestational type 1 and type 2 diabetes in Northern California: 1996-2014. Am J Obstet Gynecol 216:177.e1-177.e8
Brown, Susan D; Ehrlich, Samantha F; Kubo, Ai et al. (2016) Lifestyle behaviors and ethnic identity among diverse women at high risk for type 2 diabetes. Soc Sci Med 160:87-93
Ferrara, Assiamira; Hedderson, Monique M; Brown, Susan D et al. (2016) The Comparative Effectiveness of Diabetes Prevention Strategies to Reduce Postpartum Weight Retention in Women With Gestational Diabetes Mellitus: The Gestational Diabetes' Effects on Moms (GEM) Cluster Randomized Controlled Trial. Diabetes Care 39:65-74
Ehrlich, Samantha F; Sternfeld, Barbara; Krefman, Amy E et al. (2016) Moderate and Vigorous Intensity Exercise During Pregnancy and Gestational Weight Gain in Women with Gestational Diabetes. Matern Child Health J 20:1247-57