Lifestyle, Weight Gain, and Pregnancy Complications from a Life-Course Perspective

Abstract

Across a woman’s life, critical events occurred during each life-stage, where underlying physiological transitions take place between different stages, accompanied with weight fluctuations. Weight status is a key marker for the overall status of health. It is also a risk factor or a sub-clinical marker for many chronic disease outcomes. Starting from in-utero development followed by puberty, a woman would experience a growth spurt and steady weight gain in several areas of the body to approach to full physical maturity. As women enter early adulthood, most of them may experience pregnancy with marked maternal weight gain, which is commonly known as GWG, to support the growth of the fetus. As women enter mid-life, the metabolism status generally slows down accompanied with lifestyle changes. As a result, most women are likely to experience gradual yet often unnoticeable weight gain. Finally, as women enter old age after menopause, the body composition will undergo changes with a loss of lean mass and an accumulation of fat mass. This dissertation thesis focused on women’s weight change during two phases, which are weight change during pregnancy and weight change in mid-life, and the implications of the weight changes on the overall health of the women and clinical disease outcomes occurred during the corresponding stage. This thesis follows a global health perspective by investigating maternal weight change in the setting of Sub-Saharan Africa and mid-life weight change in the setting of the United States, using longitudinal epidemiological studies conducted in the respective settings. Through investigation of these research questions with important public health implications, this thesis demonstrates the importance of maternal weight gain on pregnancy outcomes related to birth and identify upstream factors associated with optimal maternal weight gain. Further, it also confirms the importance of healthy lifestyle on mid-life weight gain prevention, particularly for a high-risk group for obesity-related diseases defined by history of pregnancy complication.