title: Associations of maternal material hardships during childhood and adulthood with prepregnancy weight, gestational weight gain, and postpartum weight retention.
abstract: BACKGROUND
  We examined associations of material hardship with prepregnancy body mass index (BMI), gestational weight gain (GWG), and substantial postpartum weight retention (SPPWR; ≥5 kg at 1 year).
  
  
  METHODS
  We studied 2128 women in Project Viva, a Boston-area cohort with recruitment during1999-2002. At recruitment, women reported whether they experienced material hardship, defined as having ever received public assistance, welfare, or lacked basic necessities (food, rent, or medical care) during childhood, in adulthood before pregnancy, and/or in pregnancy. We used multivariable logistic models adjusted for age, race/ethnicity, and parity (and prepregnancy BMI for GWG and SPPWR) to examine associations of material hardship with the three weight-related outcomes (BMI, GWG, and SPPWR).
  
  
  RESULTS
  Mean age was 31.8 (standard deviation, 5.2) years; 66% of women were white, 16% were obese (prepregnancy BMI ≥30.0 kg/m(2)), 50% experienced excessive GWG, and 17% experienced SPPWR. Material hardship was most common during childhood (n=192, 9%), followed by adulthood (102, 5%), and pregnancy (41, 2%). Hardship in adulthood was associated with prepregnancy obesity (BMI ≥30 kg/m(2) vs. 18.5 to <25.0 kg/m(2)), odds ratio ([OR] 2.35, 95% confidence interval [CI] 1.29, 4.31), but hardship in childhood was not (OR 1.26, 95% CI 0.80, 1.98). Hardship in childhood was associated with excess GWG (OR 1.45, 95% CI 0.99, 2.14), but hardship in adulthood or during pregnancy was not. We saw trends among hardship in each of the periods and associations with SPPWR, but all confidence intervals included the null.
  
  
  CONCLUSIONS
  The timing of hardship exposure may differently influence weight before, during, and after pregnancy.
authors.affiliation: 1 Kraft Fellow in Community Health Leadership, Kraft Family National Center for Leadership and Training in Community Health, Harvard Medical School , Boston, Massachusetts.
authors.forename: Audrey M
authors.initials: AM
authors.lastname: Provenzano
authors.affiliation: 2 Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts.
authors.forename: Sheryl L
authors.initials: SL
authors.lastname: Rifas-Shiman
authors.affiliation: 3 Center for Obesity Research and Education, Department of Medicine, Temple University , Philadelphia, Pennsylvania.
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Herring
authors.affiliation: 4 Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital , Boston, Massachusetts.
authors.forename: Janet W
authors.initials: JW
authors.lastname: Rich-Edwards
authors.affiliation: 2 Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts.
authors.forename: Emily
authors.initials: E
authors.lastname: Oken
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001835:Body Weight; D001900:Boston / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology* / Q000503:physiopathology; D010298:Parity; D049590:Postpartum Period; D011247:Pregnancy / Q000502:physiology*; D011256:Pregnancy Outcome; D012959:Socioeconomic Factors; D015430:Weight Gain