Date of Award

Summer 8-4-2026

Embargo Period

8-4-2031

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Public Health Sciences

College

College of Graduate Studies

First Advisor

Kelly J. Hunt

Second Advisor

Brian Neelon

Third Advisor

Roger B. Newman

Fourth Advisor

Stefanie N. Hinkle

Fifth Advisor

Hermes Florez

Abstract

Childhood obesity in the US has been increasing in prevalence for decades. Children with obesity are more likely to suffer from obesity in adolescence and adulthood and are at a much higher risk of developing chronic cardiometabolic conditions later in life. There is no single leading cause of childhood obesity. The Developmental Origins of Health and Disease (DOHaD) theory presents the idea that exposures in the prenatal, perinatal, and postnatal periods, such as pre-pregnancy BMI, birthweight, and diet and exercise, can have lifelong implications. Several international prospective cohorts have found associations with fetal growth in pregnancy and future childhood BMI, yet results are differing and have yet to be replicated in a US cohort. While a recent publication has found that birthweight partially mediates the association between pre-pregnancy BMI and childhood obesity, fetal parameters more accurately represent in-utero development, and no one to our knowledge has assessed if fetal growth acts as a modifier of this relationship. Furthermore, it is widely established that childhood physical activity levels have an impact on childhood BMI, but it is also known that a child’s built environment can either hinder or promote their physical activity levels. Instead of using ecologic metrics like walkability to assess a child’s built environment, assessing a self-reported measure could provide better insight into one’s individual experiences within their own neighborhood. Therefore, this dissertation will examine three aims: (1) to examine how ultrasound-measured fetal parameters and their growth over time are associated with childhood BMI percentile; (2) to examine if fetal growth parameters and their growth over time mediate the association between maternal pre-pregnancy BMI and childhood BMI percentile; and (3) to examine how self-reported and ecologic built environment characteristics are associated with childhood BMI overweight or obese. These aims will provide further insight into the upstream modifiable risk factors contributing to childhood obesity in the US.

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Copyright is held by the author. All rights reserved.

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