Maternal prepregnancy nutritional status as a key link of intergenerational risk of obesity and chronic disease in childhood and later life among US Pacific Islanders: A life course approach study

The rising prevalence of obesity in women and its adverse effects on the health of their offspring may be a key link to intergenerational risk of obesity and chronic disease in childhood and later life among the US Pacific Islanders in Hawai'i and the US-Affiliated Pacific Islands. In a population with a high burden of chronic disease, there is a huge knowledge gap on modifiable factors associated with obesity and chronic diseases. However, many studies in other populations support the life course model of chronic disease suggesting that poor maternal prepregnancy underweight and obesity are early fetal origins of obesity and chronic disease in childhood and later life.;The purpose of this dissertation is investigate maternal prepregnancy underweight and obesity as key links of intergenerational risks of obesity and chronic disease in childhood among the US Pacific Islanders using the life course model of chronic disease. The first study sought to estimate race-ethnic differences in the prevalence of underweight and obesity in women of reproductive age and their associations with demographic, socioeconomic, lifestyle, and health behaviors among Native Hawaiians and Other Pacific Islanders compared to White women in Hawai'i. The second study sought to estimate race-ethnic differences in the prevalence of maternal prepregnancy underweight and obesity and their associations with low and high birth weight among Samoan and Micronesian women in Hawai'i. The third study sought to estimate the prevalence of maternal prepregnancy underweight and obesity and their associations with low birth weight, high birth weight, and childhood overweight plus obesity adjusting for the mediating effect of early adiposity rebound.;Overall, these studies consistently found high prevalence of prepregnancy obesity among the US Pacific Islander women in Hawai'i and in the US-Associated Pacific Islands. The high prevalence of prepregnancy obesity was positively associated with high birth weight and childhood overweight plus obesity in the offspring. These findings are strongly suggestive that maternal prepregnancy obesity may be a key link of intergenerational risk of obesity and chronic disease in childhood among US Pacific Islanders in Hawai'i and in Palau. Further studies are needed. However, preventive actions should begin during early fetal life.