Association between Breastfeeding and Childhood Obesity: Analysis of a Linked Longitudinal Study of Rural Appalachian Fifth-Grade Children.

INTRODUCTION: Although breastfeeding is associated with improving numerous health outcomes for the child, its role in reducing childhood obesity is contested. Despite this controversy, both the CDC and the US Department of Health and Human Services promote breastfeeding as one of the strategies for reducing childhood obesity. Rural Appalachia has one of the highest rates of childhood obesity and low rates of breastfeeding, compared to rest of the nation. The aim of this study was to examine the association between breastfeeding and childhood obesity at 11 years in the rural Appalachian state of West Virginia (WV). METHODS: The study used linked data from two cross-sectional data sets to examine this relationship longitudinally in fifth-grade WV children. The main outcome variable was BMI adjusted percent (BMI%) and the main exposure was defined as occurrence of breastfeeding. Mean BMI% of children who were not breastfed was significantly higher, compared to children who were breastfed. RESULTS: The result of the multiple regression analysis showed that breastfeeding significantly predicted BMI% of children after controlling for maternal education, health insurance, family history of hypercholesterolemia and diabetes, child's asthma status, and birth weight of the infant. CONCLUSIONS: Our results are consistent with other studies that have shown a significant, but small, inverse association between breastfeeding and childhood obesity. Findings from this study suggest the need to improve breastfeeding rates in the rural Appalachian state of WV as one of the potential strategies to prevent obesity during childhood and adolescence.

Identifying multiple risks of low birth weight using person-centered modeling.

OBJECTIVES: Low birth weight outcomes result from multiple potential risks. The present study used latent class analysis to identify subgroups of women with multiple co-occurring risks and to examine the relationship of these risk classes to low birth weight outcome. METHODS: Data were analyzed on all live singleton births in 2010 and 2011 in West Virginia (N = 28,820). Ten risks were examined including marital status, stress, mother's age, parity status, reported smoking and drug use during pregnancy, delayed prenatal care, Medicaid coverage, uninsurance, and low education. RESULTS: Six latent classes were identified that ranged from a low-risk referent group to higher risk classes characterized by unique constellations of risk factors. Compared with the low-risk referent, all of the remaining five latent classes were significantly associated with increased odds of low birth weight. However, one class was at especially high risk; this class was characterized by unmarried women in the Medicaid program who reported drug use, smoking, stress, and late prenatal care (odds ratio, 4.78; 95% confidence interval, 4.07-5.61). CONCLUSIONS: The person-centered approach identified subgroups of women with unique risk profiles. The results suggest that eliminating a single risk would not resolve the low birth weight problem. Smoking, for example, co-occurs with higher stress and higher levels of drug use among a Medicaid population. It may be beneficial to develop and test tailored interventions to groups with specific co-occurring risks to reduce low birth weight outcomes. Programs targeted to women in the Medicaid program who also engage in substance use and experience stress are especially indicated.

Association between birth characteristics and coronary disease risk factors among fifth graders.

OBJECTIVE: To evaluate the associations between selected birth characteristics-prematurity and poor intrauterine growth-and risk factors for coronary artery disease detected among children enrolled in the fifth grade. STUDY DESIGN: Children (n = 3054) with matched birth and fifth grade health screening data on body mass index (BMI), systolic blood pressure, and fasting lipid profiles were analyzed using MANOVA with the following independent variables of weight gain by the fifth grade: BMI percentile, normal or overweight/obese (BMI ≥ 85 th percentile), prematurity, and intrauterine growth (ie, small for gestational age [SGA], appropriate for gestational age [AGA], or large for gestational age [LGA]). RESULTS: LGA status at birth was associated with overweight/obesity later in life. In fifth grade, overweight/obese children had elevated systolic blood pressure and abnormal levels of most fasting serum lipids compared with normal-weight children regardless of birth characteristics. Beyond the effects of BMI percentile, preterm infants had higher levels of triglycerides (TG) than term infants by the fifth grade (P < .05). SGA infants who become overweight/obese had higher levels of TGs and very low-density lipoproteins compared with AGA and LGA infants, whether overweight or normal weight (P < .05). CONCLUSION: BMI ≥ 85 th percentile in the fifth grade is associated with abnormalities in most coronary artery risk factors regardless of birth characteristics. Beyond the effects of BMI percentile in the fifth grade, preterm infants had higher TG levels than term infants. SGA infants who were overweight/obese in the fifth grade had higher TG and very low-density lipoprotein levels compared with AGA and LGA infants who were overweight/obese or of normal weight in the fifth grade.

WV Birth Score: maternal smoking and drugs of abuse.

The WV Birth Score began in 1984 and was revised in 2007. One part of the form is a score which predicts the top 18% of infants at risk for death in the first year of life. The other components collect information regarding the health of mothers and their infants. Data from the WV Birth Score between 2001 and 2009 reveal that the average smoking rate among mothers was 28.5%. The average maternal tobacco use rate among High Score infants (53.7%) is significantly higher than the average rate among mothers of Low Score infants (23.6%) (p < .0001). Infants born to women who smoked during pregnancy in 2007 weighed 250 grams less than infants of non-smoking women (p < 0.0001). A question on drug exposures during pregnancy reveals that marijuana is the most commonly reported drug on the Birth Score form. Only 5% of the mothers reported using at least one substance during their pregnancy. Smoking rates during pregnancy in WV are among the highest in the nation and lead to higher mortality rates in the infant born to mothers who smoke. Programs to impact smoking and other maternal health issues should be a priority in WV.