The proposed research continues a prospective study of maternal growth during adolescent pregnancy and its potential sequelae. It has already been shown that growth during pregnancy, estimated using the Knee Height Measuring Device (KHMD) since serial measurements of stature are insensitive, is associated with larger gestational weight gains, continued accrual of subcutaneous fat, and retained weight postpartum. However, despite the large weight gains, infant size is reduced (-150-200 g) in the presence of maternal growth, and maternal growth is associated with evidence of diminished placental blood flow and reduced levels of micronutrients (e.g., ferritin, folate) in cord blood. The purpose of this study is to determine whether or not the milieu which underlies adolescent growth, i.e., higher levels of fasting insulin and insulin-like growth factor-I (IGF-1), is also present during adolescent pregnancy and underlies maternal growth by KHMD and the observed changes in body composition and mediates the association between maternal growth and reduced infant birth weight through its effect on the substrate supply of pregnancy (e.g., glucose and branch-chain amino acids). Further, since the transient increase in insulin at adolescence may be more likely to become permanent with the weight retention associated with maternal growth, it is hypothesized that adolescent multiparas and mature women with a history of adolescent childbearing will have increased levels of fasting insulin, be characterized by an increased risk of overweight and obesity, a centripetal fat distribution, and continued reductions in birth weight. A prospective cohort study is proposed to address these aims, comparing 600 adolescent primiparas and multiparas (<18 y) and 600 mature women (19-29 y). Of the mature gravidas, half of the multiparas (n=150) will have had a history of adolescent childbearing. Subjects will be followed through pregnancy with measures of fasting insulin, IGF-I, body composition, and the substrate supply of pregnancy, and into the postpartum at 4-6 weeks and 6 months to determine the effects of hyperinsulinemia on weight gain, weight retention, and pregnancy outcome and long-term effects on the persistence of overweight and higher insulin levels in the postpartum period. The investigators state that if the proposed hypotheses are verified, then the results would help to explain some of the ethnic differences in birthweight because of the increased rate of teenage childbearing among minority women and underscore what may be the long- term consequences of adolescent pregnancy, to wit, overweight, obesity, and increased risk for cardiovascular disease and non-insulin dependent diabetes mellitus.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
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Epidemiology and Disease Control Subcommittee 2 (EDC)
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University of Medicine & Dentistry of NJ
Obstetrics & Gynecology
Schools of Osteopathy
United States
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Chen, Xinhua; Scholl, Theresa O (2014) Maternal biomarkers of endothelial dysfunction and preterm delivery. PLoS One 9:e85716
Scholl, Theresa O; Chen, Xinhua; Goldberg, Gary S et al. (2011) Maternal diet, C-reactive protein, and the outcome of pregnancy. J Am Coll Nutr 30:233-40
Chen, Xinhua; Scholl, Theresa O; Leskiw, Maria et al. (2010) Differences in maternal circulating fatty acid composition and dietary fat intake in women with gestational diabetes mellitus or mild gestational hyperglycemia. Diabetes Care 33:2049-54
Chen, Xinhua; Scholl, Theresa O (2008) Association of elevated free fatty acids during late pregnancy with preterm delivery. Obstet Gynecol 112:297-303
Chen, Xinhua; Scholl, Theresa O; Stein, T Peter (2006) Association of elevated serum ferritin levels and the risk of gestational diabetes mellitus in pregnant women: The Camden study. Diabetes Care 29:1077-82
Scholl, Theresa O (2005) Iron status during pregnancy: setting the stage for mother and infant. Am J Clin Nutr 81:1218S-1222S
Stagnaro-Green, Alex; Chen, Xinhua; Bogden, John D et al. (2005) The thyroid and pregnancy: a novel risk factor for very preterm delivery. Thyroid 15:351-7
Johnson, William G; Scholl, Theresa O; Spychala, John R et al. (2005) Common dihydrofolate reductase 19-base pair deletion allele: a novel risk factor for preterm delivery. Am J Clin Nutr 81:664-8
Chen, Xinhua; Scholl, Theresa O (2005) Oxidative stress: changes in pregnancy and with gestational diabetes mellitus. Curr Diab Rep 5:282-8
Scholl, Theresa O; Chen, Xinhua; Khoo, Chor San et al. (2004) The dietary glycemic index during pregnancy: influence on infant birth weight, fetal growth, and biomarkers of carbohydrate metabolism. Am J Epidemiol 159:467-74

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