BACKGROUND:Children born to mothers with obesity or gestational diabetes mellitus (GDM) face elevated risks of central adiposity and adverse cardiometabolic outcomes, including metabolic syndrome (MetS) and systemic inflammation. However, it remains unclear whether these risks are primarily driven by current adiposity or by in utero exposure. This study investigated associations between waist circumference (WC), waist-to-height ratio (WHtR), and continuous MetS (cMetS) scores in children, and evaluated whether in utero exposure to maternal obesity or GDM moderated these relationships. Associations between cMetS and cardiometabolic biomarkers were also examined. METHODS:Children were grouped by maternal early-pregnancy weight status and GDM diagnosis: (1) normal weight without GDM, (2) overweight/obesity without GDM, and (3) overweight/obesity with GDM. WC was classified as < 85th or ≥ 85th percentile; WHtR as < 0.5 or ≥ 0.5. cMetS scores were computed with and without the WC component. Group differences and associations were assessed using ANCOVA and correlation analyses. RESULTS:WC and WHtR were strong predictors of cMetS, independent of in utero exposure group. Children with WC ≥ 85th percentile or WHtR ≥ 0.5 had significantly higher cMetS scores (p < 0.0001), even when WC was excluded from the cMetS calculation. cMetS was inversely correlated with adiponectin and positively correlated with leptin, the leptin-to-adiponectin ratio, HOMA-IR, CRP, and IL-6 (all p < 0.01). CONCLUSIONS:Central adiposity-indexed by WC or WHtR-rather than in utero exposure, is the primary driver of cardiometabolic risk. Associations between cMetS and cardiometabolic biomarkers underscore insulin resistance and adipose tissue dysfunction as key mechanisms underlying MetS in children.

Disclosure: M.M. Barr: None. P. Li: None. P.C. Chandler-Laney: None. Background: Children born to women with obesity or gestational diabetes mellitus (GDM) are at risk for obesity and cardiometabolic disease, but because most women with GDM also have obesity, it is difficult to disentangle the effects of each. The primary objective of this study is to describe the growth trend of children born to women with normal weight (NW) without GDM, overweight/obesity (OW/OB) without GDM, or OW/OB with GDM, during the 5 years following a baseline assessment in the Health After Pregnancy (HAPi) study (2017-2019, child age 4-10 years). Methods: A retrospective chart review of electronic health records (EHR) was conducted of child participants from the HAPi study. Body weight, height, and BMI Z-scores were retrieved from clinic or emergency room visits that occurred in the Children’s of Alabama or University of Alabama at Birmingham EHR between 1/1/2020 and 10/31/2024. Data was stratified by age range (4-6, 6-9, 9-11, 11-13, and 13-17 years). Using SAS software, a curvilinear mixed effects regression model was used to evaluate group differences in children’s BMI Z-scores over time, accounting for non-linear trend of BMI Z-scores over time. Results: Of the original 219 children enrolled in the HAPi Study, 132 had clinical visits in the EHR with weights at least 28 days apart during the 5 years following the HAPi study (child age 4.5 to 17 years). There was no significant difference in the proportion of participants from each group with EHR data: NW without GDM (Group 1, N=48), OW/OB without GDM (Group 2, N=45), and OW/OB with GDM (Group 3, N=39). Each child had between one and eighteen weight measurements. Children Groups 2 and 3 had significantly higher BMI Z-scores compared to group 1 (control group) from ages 9 to 13 years. Of interest, Group 2 children mean BMI Z-scores decreased as they aged and were not significantly different from Group 1 by ages 13 to 17 years. This was distinctly different from steady upward BMI Z-scores with increasing age in Group 3. These trends held when controlled for maternal BMI (both during pregnancy and at time of HAPi study), child BMI Z-score during the HAPi study, household income, household number of children, maternal education attainment, childhood insulin resistance (measured during the HAPi Study), and length of breastfeeding during infancy. Conclusion: Greater adiposity in the 9 to 13-year-old children born to women with OW/OB or GDM (Groups 2 and 3), compared to those born to women with NW (Group 1), is consistent with data from the parent study. Although not statistically significant until older ages, the trend showing divergence of the growth trajectory for children in Group 2 versus Group 3 suggests that pediatric obesity is less likely to persist through adolescence for those born to glucose tolerant women with OW/OB, and more likely to persist for those born to women with GDM. Presentation: Monday, July 14, 2025

Introduction: For preterm infants, the first 2 weeks after birth are a time when nutrition and protein intake is variable and often falls below recommended intakes. Our objective was to investigate the relationship between protein intake, including source of protein, during the first 2 weeks after birth and fat-free mass (FFM) accretion in a group of very preterm infants. Methods: In this observational cohort study, body composition was assessed using air displacement plethysmography in eligible infants <32 weeks gestational age at 2 weeks after birth and prior to discharge. FFM accretion was calculated as difference between the two measurements. We collected daily nutrition data for the first 2 weeks. Multivariable linear regression was used to assess the relationship between protein intake and body composition and weight gain. Results: Seventy-eight infants were included (mean birthweight: 1,408 +/- 278 g). Mean cumulative protein intake of this cohort in the first 2 weeks was 2.4 +/- 0.8 g/kg/day of which 74 +/- 19% was enteral (1.7 +/- 0.6 g/kg/day). Enteral protein intake was associated with higher FFM while parenteral protein was associated with lower FFM. Total protein intake from both sources during the first 2 weeks after birth was positively associated with greater weight gain. Conclusion: Enteral protein intake during the first 2 weeks after birth is associated with higher FFM and weight in preterm infants. Future interventional studies should investigate the effects of higher enteral protein intake during the first 2 weeks after birth on growth and body composition.

BACKGROUND:Stress is associated with physiological and behavioral adaptations that increase the risk for obesity and related diseases in adults and children. Mechanisms linking stress to chronic disease are diverse and not fully elucidated, but research suggests stress may impact eating behaviors and increase food intake and thereby, risk for obesity. OBJECTIVE:The purpose of this study was to test the hypotheses that women's perceived stress and household disorder are associated with more uncontrolled and emotional eating among women, more food responsiveness and emotional overeating among their children, and greater adiposity in both women and their children. METHODS:Women (n = 86) completed the Perceived Stress Scale, Confusion, Hubbub and Order Scale, Three Factor Eating Questionnaire, and Child Eating Behavior Questionnaire. Total body fat (%) was measured via dual-energy X-ray absorptiometry. Linear regression models evaluated associations of perceived stress and household disorder with eating behaviors and adiposity of women and their children (4-10 years old). RESULTS:In a sample of predominantly non-Hispanic Black women (84.9%, n = 73), more perceived stress and household disorder were associated with more uncontrolled and emotional eating (p < 0.05). Women's perceived stress was not associated with their children's eating behaviors; however, household disorder was positively associated with children's food responsiveness and emotional overeating (p < 0.05). Perceived stress and household disorder were not associated with adiposity of women or their children. CONCLUSIONS:These findings suggest household disorder may be a factor for home-based interventions to consider when addressing eating behaviors among families with children.

As the worldwide prevalence of overweight and obesity continues to rise, so too does the urgency to fully understand mediating mechanisms, to discover new targets for safe and effective therapeutic intervention, and to identify biomarkers to track obesity and the success of weight loss interventions. In 2016, the American Heart Association sought applications for a Strategically Focused Research Network (SFRN) on Obesity. In 2017, 4 centers were named, including Johns Hopkins University School of Medicine, New York University Grossman School of Medicine, University of Alabama at Birmingham, and Vanderbilt University Medical Center. These 4 centers were convened to study mechanisms and therapeutic targets in obesity, to train a talented cadre of American Heart Association SFRN-designated fellows, and to initiate and sustain effective and enduring collaborations within the individual centers and throughout the SFRN networks. This review summarizes the central themes, major findings, successful training of highly motivated and productive fellows, and the innovative collaborations and studies forged through this SFRN on Obesity. Leveraging expertise in in vitro and cellular model assays, animal models, and humans, the work of these 4 centers has made a significant impact in the field of obesity, opening doors to important discoveries, and the identification of a future generation of obesity-focused investigators and next-step clinical trials. The creation of the SFRN on Obesity for these 4 centers is but the beginning of innovative science and, importantly, the birth of new collaborations and research partnerships to propel the field forward.

Objective: The goal of this study was to evaluate whether differences in gestational weight gain (GWG) and adverse perinatal outcomes exist for Black and White women who are overweight or have obesity (OW/OB) at entry to prenatal care. Methods: We enrolled 183 pregnant women with BMI 25-45 kg/m2 (71

Abstract Introduction Elevated blood pressure (BP) is an important modifiable risk factor for cardiovascular disease (CVD), the leading cause of death in the world. Elevated BP in adolescence increases the risk for CVD in adulthood. Unfortunately, 1.3 million adolescents (ages 12 to 19) have extremely elevated blood pressure or hypertension (HTN). Evidence suggests that sleep duration is associated with HTN in adults, but less is known about these relationships during adolescence. Furthermore, there is limited research focused on specific developmental stages, particularly late adolescence, which is the last age group before adulthood. Also, there is a paucity of research on BP including other sleep variables like sleep efficiency. Therefore, the purpose of this secondary data analysis was to determine if sleep duration and sleep efficiency were associated with BP during late adolescence. Methods This secondary data analysis included older adolescents (16-18 years) who participated in the Cleveland Children’s Sleep and Health Study, a cohort study examining sleep disturbances and health outcomes. Height, weight, and BP (systolic (SBP) and diastolic (DBP)) were measured using standard clinical procedures. Objective sleep duration and sleep efficiency were measured by at least five days of actigraphy. Subjective sleep duration was averaged from daily self-report. The association was evaluated using Pearson correlations and multiple linear regressions. Results This sample included 259 adolescents (age 17.7±0.4, 63.3% White, 55.6% female). Pearson correlation analysis indicated a negative relationship between sleep efficiency and SBP (r = -0.210, p < 0.001) with a small-medium effect size (95% CI [-0.316, 0.098]). However, the negative correlation between sleep efficiency and SBP was no longer significant after controlling for assigned sex, race, and body mass index percentiles in a multiple linear regression model. Conclusion This secondary data analysis did not provide sufficient evidence on the associations between sleep duration and sleep efficiency with BP in older adolescents, possibly due to the homogenous sample with small variations in BP, sleep duration, and sleep efficiency. Therefore, there is a need for future studies including more heterogenous samples to evaluate the relationships between sleep and BP in this age group. Support (if any) 1st author - NHLBI T32HL105349 & NICHD 5T32HD101397-03

SummaryBackgroundLeptin resistance occurs with obesity, but it is unknown if individuals at risk for obesity develop leptin resistance prior to obesity.ObjectiveInvestigate whether leptin resistance is independent of weight status in children at risk for obesity due to intrauterine exposure to maternal obesity or gestational diabetes mellitus (GDM).MethodsMother–child dyads (N = 179) were grouped by maternal pregnancy weight and GDM status: (1) normal weight, no GDM; (2) overweight/obesity, no GDM; (3) overweight/obesity with GDM. Children (4–10 years) were further stratified by current body mass index (BMI) <85th or ≥85th percentile. Leptin resistance of children and mothers was calculated as fasting leptin/fat mass index. Two‐way ANOVA was used to assess whether leptin concentrations and leptin resistance differed by current weight status or in utero exposure group, after adjusting for race, sex and Tanner stage.ResultsChildren with a BMI ≥85th percentile had more leptin resistance than those with a BMI <85th percentile (p < 0.001), but leptin resistance did not differ by in utero exposure. Similarly, leptin resistance in women was associated with weight status and not prior GDM.ConclusionsResults suggest that leptin concentrations are associated with obesity but not risk for obesity based on in utero exposure to maternal obesity or GDM.

PURPOSE:Investigate whether obesity risk and current weight status are independently associated with physical activity (PA) and whether PA is associated with adiposity and insulin resistance (homeostatic model assessment of insulin resistance) among children with high versus low obesity risk based on in utero exposure to maternal overweight/obesity with gestational diabetes mellitus (GDM; high risk) or without GDM (overweight/obesity; high risk) or maternal normal weight without GDM (low risk). METHOD:Secondary analysis of data from children born to women with overweight/obesity and GDM, overweight/obesity without GDM, or normal weight without GDM. PA was assessed with accelerometry, percentage of body fat derived from anthropometrics, and homeostatic model assessment of insulin resistance calculated from glucose and insulin. RESULTS:Among 4- to 10-year-old children (N = 163), analyses of covariance showed that children with a current BMI ≥85th percentile had less vigorous PA than those with BMI <85th percentile, but in utero exposure was not an independent predictor of PA. In linear regression modeling, moderate to vigorous PA was inversely associated with percentage of body fat and homeostatic model assessment of insulin resistance independent of age, Tanner stage, and accelerometer wear time, with stronger associations in high-risk groups. CONCLUSIONS:Children's PA is related to current weight status but not underlying risk for obesity but may be especially important to reduce obesity and insulin resistance in high-risk children.

High blood pressure (BP) is the leading risk factor for cardiovascular disease (CVD). Although factors outside the home, such as crime and noise, have been associated with high BP in women and children, it is unknown if disorder within the home (household disorder) influences BP. We tested the hypothesis that women and children with more household disorder would have higher BP, independent of age, race, sodium intake, and body mass index (BMI). This study was a secondary analysis of data from mother-child dyads (n = 216). Mothers were 87% African American, 34 ± 5 years old, with BMI 33.59 ± 9.43 kg/m². Children were 7 ± 2 (range: 4-10) years of age with BMI z score 0.60 ± 2.07. Household disorder was measured by the Confusion Hubbub and Order Scale. Mother-child dyads were assessed for weight, height, BP (adults), BP percentile (children), energy intake, and sodium intake. The relationship between household disorder and BP was evaluated using Pearson's partial correlation coefficients. In fully adjusted models, household disorder was positively associated with systolic BP for mothers (r = 0.15, p < .05) and tended to be positively associated with diastolic BP (r = 0.11, p = .10). For the children, household disorder was not associated with systolic or diastolic BP percentile. This study's results suggest that household disorder is positively associated with higher BP in adult women, but not their children. Nevertheless, these data suggest that interventions to address household disorder could benefit maternal BP and potentially improve long-term CVD outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Central adiposity is a known risk factor for cardiovascular disease in the non-pregnant patient. As such, we sought to evaluate the relationship between 3rd trimester anthropometric measures of central adiposity and the development of hypertensive disorders of pregnancy (HDP) at term and compare these to the predictive value of BMI alone. Secondary analysis of a prospective cohort study from 2017-2020 of patients with viable singletons at a single center. Patients underwent a study visit at 36 weeks at which 19 measurements of central adiposity and BMI were obtained by trained personnel: 1) ultrasound (min/max subcutaneous and pre-peritoneal fat depth above umbilicus, below umbilicus, subxiphoid) 2) anthropometric skinfold thicknesses (tricep, flank, abdomen, thigh) and 3) waist, hip, arm circumferences. The primary outcome was diagnosis of a HDP (gestational hypertension, preeclampsia, eclampsia) at term. Measurement exposures were evaluated at alpha=0.05 using backward elimination multivariable logistic regression to generate a best-fit model. Receiver operator characteristic (ROC) curves with area under the curve (AUC) assessed the models' predictive ability. AUCs, the best-fit model and its component predictors were compared to BMI. Of 201 women analyzed, 42 (21%) developed HDP at term. Patients with HDP had slightly higher BMIs (42.6 vs. 38.5), were more likely to be AMA, have public insurance, and a lower education level (all p< 0.05). Arm, waist, and hip circumference as well as waist-hip ratio were associated with the development of HDP (p< 0.05). The best fit model was a poor predictor of HDP at term (AUC 0.69 [0.59-0.78]), and was no more predictive than BMI alone, also a poor predictor (AUC 0.62 [0.53-0.71], p=0.24) (Table). Our study demonstrated that measures of central obesity are no more predictive of HDP at term than BMI, itself a poor predictor. Future study is warranted to see if markers of central obesity improve prediction of hypertensive disorders if measured at earlier gestational ages.

Objective This study aimed to compare attendance of nutritional counseling, dietary composition, exercise patterns, and socioeconomic factors among obese women with inappropriate gestational weight gain (iGWG) versus appropriate GWG (aGWG). Study Design Medicaid-eligible women receiving prenatal care at a tertiary care center from January 2013 to December 2015 were offered individualized nutritional counseling by a registered dietitian encouraging well-balanced meals and 150 min/wk of exercise. We conducted a prospective case–control study of obese women (body mass index or BMI ≥30) with a singleton gestation with iGWG (<11 or >20 pounds) versus aGWG (11–20 pounds). Dietary intake, activity level, and socioeconomic factors were compared with Chi-square, Fisher's exact, Student's t-test, and Wilcoxon Rank Sum tests as indicated, and odds ratios with 95% confidence intervals were calculated. Multivariate regression analysis for significant variables was performed. A subgroup analysis of women with BMI ≥40 was planned. Results A total of 401 women were analyzed: 78% (n = 313) with iGWG and 22% (n = 88) with aGWG. Demographics were similar between groups. Women with iGWG less frequently reported physician reinforcement of counseling and reported more physical inactivity and unemployment; there were no differences in caloric intake or macronutrient profile between groups. Multivariate regression identified physician reinforcement and employment as independent predictors of aGWG. Among women with BMI ≥40 (n = 133), those with iGWG (78%) were less likely to attend counseling, report physician reinforcement of counseling, and have adequate caloric and protein intake when compared with those with aGWG (22%). Activity level and socioeconomic factors were not different between groups. Conclusion Physician reinforcement of nutritional counseling, greater activity level, and employment are associated with aGWG in women with BMI ≥30, while individualized professional nutritional counseling and dietary modifications were further associated with aGWG in women with BMI ≥40. Thus, greater focus should be placed on enhancing exposure to counseling and altering nutritional and exercise choices to optimize aGWG. Key Points

Patients with BMI≥40 kg/m2 are more likely than those of normal BMI (< 25 kg/m2) to have a cesarean delivery (CD), but BMI is at best, a moderate predictor. We evaluated the relationship between late-3rd trimester ultrasonographic (US)/anthropometric measures of central adiposity and CD in patients with BMI≥40 and compared their predictive value to BMI alone. Prospective cohort study of patients with BMI≥40 at >36 weeks' GA and viable singletons with prenatal care and birth at a single center. Exclusions were contraindications to vaginal delivery or prior CD. Patients underwent a study visit at >36 weeks' at which 19 central adiposity measures (predictive exposures) and BMI were obtained by trained personnel: US (min/max subcutaneous and pre-peritoneal fat depth above umbilicus, below umbilicus, subxiphoid) and anthropometric (skinfold thicknesses [tricep, flank, abdomen, thigh] and circumferences [waist, hip, arm]). Several indices (e.g. abdominal fat index [AFI]) were also calculated from these measures. The primary outcome was CD; secondary outcome was spontaneous labor. Measurement exposures were evaluated at alpha=0.05 using forward selection multivariable logistic regression to generate a best-fit model. Receiver operator characteristics (ROC) curves with area under the curve (AUC) assessed the model's predictive ability; AUCs for BMI and the best-fit model were compared. From 2017-2020, 149 women (mean BMI 45.4±5.2) were enrolled and analyzed. The CD rate was 21%. Patients undergoing CD were more likely to be nulliparous (p< 0.001). In our best-fit model, maximum pre-peritoneal fat depth above the umbilicus, below umbilicus AFI, and subxiphoid AFI were associated with CD (all p< 0.05). This 3-variable model was significantly more predictive of CD (AUC 0.76 95%CI 0.67-0.86) than BMI alone (AUC 0.60 [0.49-0.71] p=0.002) (Figure). No central adiposity measure, even BMI (AUC=0.56), was associated with spontaneous labor. Select maternal US fat depth measurements near delivery have significantly more predictive ability than BMI alone for CD in patients with BMI≥40.

A known association exists between exposure to gestational diabetes mellitus (GDM) and epigenetic age acceleration (EAA) in GDM-exposed offspring compared to those without GDM exposure. This association has not been assessed previously in mothers with pregnancies complicated by GDM. A total of 137 mother-child dyads with an index pregnancy 4–10 years before study enrollment were included. Clinical data and whole blood samples were collected and quantified to obtain DNA methylation (DNAm) estimates using the Illumina MethylEPIC 850K array in mothers and offspring. DNAm age and age acceleration were evaluated using the Horvath and Hannum clocks. Multivariable linear regression models were performed to determine the association between EAA and leptin, high-density lipoprotein cholesterol (HDL-C), fasting glucose, fasting insulin, and HOMA-IR. Mothers with a GDM and non-GDM pregnancy had strong correlations between chronological age and DNAm age (r > 0.70). Offspring of GDM mothers had moderate to strong correlations, whereas offspring of non-GDM mothers had moderate correlations between chronological age and DNAm age. Association analyses revealed a significant association between EAA and fasting insulin in offspring (FDR < 0.05), while HDL-C was the only metabolic marker significantly associated with EAA in mothers (FDR < 0.05). Mothers in the GDM group had a higher predicted epigenetic age and age acceleration than mothers in the non-GDM group. The association between EAA with elevated fasting insulin in offspring and elevated HDL-C in mothers suggests possible biomarkers that can better elucidate the effects of exposure to a GDM pregnancy and future cardiometabolic outcomes.

AbstractObjectiveObesity in pregnancy and gestational diabetes (GDM) increase cardiometabolic disease risk but are difficult to disentangle. This study aimed to test the hypothesis that 4–10 years after a pregnancy complicated by overweight/obesity and GDM (OB‐GDM), women and children would have greater adiposity and poorer cardiometabolic health than those with overweight/obesity (OB) or normal weight (NW) and no GDM during the index pregnancy.MethodsIn this cross‐sectional study, mother‐child dyads were stratified into three groups based on maternal health status during pregnancy (OB‐GDM = 67; OB = 76; NW = 76). Weight, height, waist and hip circumferences, and blood pressure were measured, along with fasting glucose, insulin, HbA1c, lipids, adipokines, and cytokines.ResultsWomen in the OB and OB‐GDM groups had greater current adiposity and poorer cardiometabolic health outcomes than those in the NW group (p < 0.05). After adjusting for current adiposity, women in the OB‐GDM group had higher HbA1c, glucose, HOMA‐IR and triglycerides than NW and OB groups (p < 0.05). Among children, adiposity was greater in the OB‐GDM versus NW group (p < 0.05), but other indices of cardiometabolic health did not differ.ConclusionsPoor cardiometabolic health in women with prior GDM is independent of current adiposity. Although greater adiposity among children exposed to GDM is evident at 4–10 years, differences in cardiometabolic health may not emerge until later.

We observed that a 3-variable model of late 3rd trimester ultrasonographic (US) measures of central adiposity is superior to BMI alone in predicting cesarean delivery (CD) in patients with BMI≥40 kg/m2. As these patients are more likely to experience maternal and neonatal morbidity, we evaluated the predictive ability of these measurements as well as a new primary model for adverse perinatal outcomes and compared these to BMI alone. Planned secondary analysis of a single center prospective cohort study of patients with BMI≥40 at >36 weeks' GA and viable singletons. Patients underwent a single study visit >36 weeks' (blinded to clinicians) at which BMI and 19 US/anthropometric central adiposity measures were obtained by trained personnel. Exclusions were contraindications to vaginal birth or prior CD. For this analysis, the primary outcome was composite perinatal morbidity (maternal puerperal infection, umbilical cord arterial pH< 7.1, NICU admission and other neonatal morbidities, Table). Receiver operator characteristics (ROC) curves with area under the curve (AUC) assessed the original 3-variable model's predictive ability for the composite; AUCs for BMI, the 3-variable model from the primary analysis, and a new best-fit forward selection (α =0.05) model for the composite were compared. From 2017-2020, 149 women (mean BMI 45.4±5.2) were enrolled. The rate of perinatal morbidity was 18%. Multivariable logistic regression retained only one measurement, minimum pre-peritoneal subxiphoid fat depth, that was significantly associated with the perinatal composite (Model 1), but was poorly predictive (AUC 0.64 95%CI 0.52-0.76). BMI had no predictive ability (AUC 0.49 [0.37-0.61]), while our original 3-variable model (Model 2) had poor prediction, similar to Model 1 (Table). In patients with BMI≥40, maternal US fat depth measurements are no more predictive of adverse perinatal outcome than BMI alone, itself a poor predictor. As perinatal outcome may reflect other maternal and labor characteristics, incorporating these into models may improve prediction.

One study has revealed an association between GDM exposure and offspring age acceleration compared to non-GDM exposed offspring. This association has not been evaluated expansively. Our study seeks to expand this area of research to evaluate the association between exposure to a GDM pregnancy and accelerated epigenetic aging. This cohort included 137 mother-child dyads (GDM-OB = 66 mothers, 61 offspring; Normal Weight/NW = 71 mothers, 55 offspring) who gave birth 4–10 years before enrollment. Demographic characteristics and whole blood samples from mothers and offspring were collected. A MethylEPIC 850K array was performed. Epigenetic age and the residuals from age acceleration were calculated using the Horvath epigenetic clock. The mean epigenetic age of mothers in the GDM group was higher than the NW group (M = 48.4 ± 8.5; M = 43.4 ± 9.7; X2 = 15.8, P < .0001, respectively). Offspring of NW mothers had a higher epigenetic age than offspring of GDM mothers (M = 20.2 ± 7.7; M = 17.3 ± 8.4; X2 = 13.9, P = .0002, respectively). Mothers with a NW and GDM pregnancy had a strong positive correlation between chronological age and epigenetic age (r = 0.76, P = 1.8E-12; r = 0.72, P = <2.2E-16, respectively). NW and GDM offspring had moderate correlations between chronological age and epigenetic age (r = 0.43, P = .0011; r = 0.65, P = 1.3E-08, respectively). Mothers in the GDM group had a higher mean epigenetic age than mothers in the NW group. Offspring of NW Mothers had a higher average epigenetic age than offspring of GDM Mothers. Accelerated aging in pediatric populations remains an understudied area, enhancing the impact of quantification of methylation age vs. chronological age in mother-child dyads from our study.

Objective: Maternal prenatal stress and mood symptoms are associated with risk for child psychopathology. Within the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies (ECHO-FGS), a racially and ethnically diverse cohort, we studied associations between prenatal stress and depressive symptoms with child neurobehavior, and potential mediation by fetal growth velocity (FGV) in low-risk pregnancies. Method: For 730 mother-child pairs, we had serial ultrasound measurements, self-reports of prenatal stress and depression, observations of child executive functions and motor skills from 4 to 8 years, and maternal reports of child psychiatric problems. We tested associations between prenatal stress and depressive symptoms with child neurobehavior in regression analyses, and associations with FGV in mixed effect models. Post hoc we tested severity of prenatal symptoms; FGV at 25(th), 50(th), and 75(th) percentiles; and moderation by biological sex and by race and ethnicity. Results: Prenatal stress and depressive symptoms were associated with child psychiatric problems, and prenatal depressive symptoms with decrements in executive functions and motor skills, especially in biological male children. Neither prenatal stress nor depressive symptoms were associated with FGV. Conclusion: In one of the largest cohorts with observed child outcomes, and the first with broad representation of race and ethnicity in the United States, we found that prenatal stress and depressive symptoms were associated with greater reports of child psychiatric symptoms. Only prenatal depressive symptoms were associated with observed decrements in cognitive abilities, most significantly in biological male children. Stress during lowrisk pregnancies may be less detrimental than theorized. There was no mediation by FGV. These findings support the need to attend to even small changes in prenatal distress, as these may have long-lasting implications.

Postpartum fat mass (FM) and fat-free mass (FFM) may be informative predictors of future disease risk among women; hence, there is growing use of bioelectrical impedance analysis (BIA) to quantify FFM and FM among postpartum women due to the quick, non-invasive, and inexpensive nature of BIA. Despite this, very few studies have examined BIA’s performance, and it remains unclear as to whether specific BIA equations are needed for postpartum women. To explore these questions, we measured total body FFM and FM with a multi-frequency, segmental BIA, and dual-X-ray absorptiometry (DXA) in (1) women at one and four months postpartum (n = 21); and (2) height- and weight-matched non-postpartum women (controls, n = 21). BIA was compared to DXA using Deming regression models, paired t-tests, and Bland–Altman plots. Between-group comparisons were performed using an analysis of variance models. The mean difference between DXA and BIA was 1.2 ± 1.7 kg FFM (p < 0.01) and −1.0 ± 1.7 kg FM (p < 0.05) in postpartum women at both time points. The measurements of longitudinal changes in FFM and FM were not significantly different between BIA and DXA. Furthermore, there was no significant difference in BIA’s performance in postpartum vs. non-postpartum women (p = 0.29), which suggests that population-specific equations are not needed for postpartum women. The results of this study suggest that BIA is a suitable method to assess postpartum body composition among women at one and four months postpartum, using existing age-, race-, and sex-adjusted equations.

We previously observed that late 3rd trimester measures of central adiposity are superior to BMI alone in predicting cesarean delivery (CD) in women with BMI≥40 kg/m2. We evaluated the relationship between these central adiposity measures and CD in patients with normal BMI (18.5-24.9 kg/m2) and compared the predictive value of these models between patients with normal BMI and BMI≥40. Planned secondary analysis of a prospective study (2017-2020) of patients with viable singletons at a single center. Exclusions were contraindications to vaginal birth and prior CD. Our primary study identified a 3-variable logistic regression (LR) model of ultrasonographic (US) predictors (Model 1 - Table) superior to BMI alone in prediction of CD in women with BMI≥40 at >36 weeks'. In this secondary analysis, primary outcome was also CD. BMI and 19 US/anthropometric measures were evaluated >36 weeks GA as predictive exposures at alpha = 0.05 using backward elimination LR to generate a best-fit model from the normal BMI cohort (Model 2). Receiver operator characteristic (ROC) curves with area under the curve (AUC) assessed the models' predictive accuracy; AUCs for BMI alone, Model 1 and Model 2 were compared in the 2 BMI cohorts. 149 women with BMI ≥40 (mean 45.4±5.2 kg/m2; CD rate 21%) and 52 with normal BMI (CD rate 15%) were analyzed. In our normal BMI best-fit model, 6 measurements (Table) were significantly associated with CD; this 6-variable model had outstanding CD prediction (AUC 0.97 [0.93-1.00]) (Figure). While Model 2's predictive ability exceeded BMI alone in those with normal BMI, it had poor prediction in the BMI≥40 cohort (Table, AUC=0.62). Similarly, the best-fit model in the BMI ≥40 cohort, had poor prediction in normal BMI women (Table, AUC=0.66). US/anthropometric measures of central adiposity near delivery have outstanding predictive ability for CD compared to BMI alone in patients with normal BMI. While these measures are poorly predictive in BMI≥40, this predictive value in normal BMI patients merits validation in larger, more diverse cohorts.View Large Image Figure ViewerDownload Hi-res image Download (PPT)