Publications
Childhood obesity has become a public health crisis in recent years. Studies suggest that early life influences (both during and after pregnancy) may affect a child's risk of becoming obese. Obesity puts children at higher risk for developing chronic disease later in life such as diabetes, cardiovascular disease, and high blood pressure. The Healthy Start Study aims to investigate how the experiences of women during their pregnancies (e.g. diet, physical activity, smoking) and their environment during pregnancy affect their children's growth throughout early infancy and childhood. This research will help to identify risk factors for childhood obesity and later life chronic disease. This will help us identify protective factors that promote healthy growth of children. 1,410 ethnically diverse pregnant women were recruited from obstetrics clinics at the University of Colorado Hospital to participate in the Healthy Start Study.
Collecting observational data about moms during pregnancy and their children throughout the first 8 years of life has allowed Healthy Start investigators to publish the following papers:
Cord Blood Vitamin D Levels and Early Childhood Blood Pressure: The Healthy Start Study
Katherine A. Sauder, PhD; Alexandra V. Stamatoiu, BS; Elina Leshchinskaya, BS; Brandy M. Ringham, PhD; Deborah H. Glueck, PhD; Dana Dabelea, MD, PhD
May 2019
Research Summary
Vitamin D deficiency is associated with cardiovascular events among adults, but it is unclear whether early-life vitamin D deficiency influences cardiovascular risk factors in children. Sauder and colleagues observed racial/ethnic differences in vitamin D levels in both cord and child blood samples. They observed lower systolic and diastolic blood pressure among children with higher prenatal vitamin D levels. This suggests that early exposure to vitamin D may contribute to early-life programming of child blood pressure.
What does this mean for you and public health?
These findings suggest that an increase in fetal vitamin D may reduce the risk of elevated blood pressure in childhood. In practice these findings point towards a potential strategy for improving child cardiometabolic health via vitamin D supplementation in pregnant women.
Prenatal exposure to traffic and ambient air pollution and infant weight and adiposity: The Healthy Start Study
Anne P. Starling, Brianna F. Moore, Deborah S.K. Thomas , Jennifer L. Peel, Weiming Zhang, John L. Adgate , Sheryl Magzamen, Sheena E. Martenies, William B. Allshouse, Dana Dabelea
March 2020
Research Summary
Starling and colleagues aimed to estimate associations between prenatal ambient air pollution and traffic exposure, and infant weight and adiposity. Previous research found that higher concentrations of air pollution was associated with adverse birth outcomes, and may also lead to an increased risk of obesity. The results were inconsistent, but higher concentrations in third trimester ozone were correlated with greater adiposity at follow-up, and with greater rates of change in fat mass and adiposity from birth to follow-up.
What does this mean for you and public health?
Although limited evidence of an association between prenatal traffic and ambient air pollution exposure and infant body composition was noted, suggestive associations between prenatal ozone exposure and early postnatal changes in body composition merit further investigation.
Prenatal Exposure to Tobacco and Offspring Neurocognitive Development in the Healthy Start Study
Brianna F. Moore, PhD, Allison L. Shapiro, PhD, Greta Wilkening, PsyD PhD, Sheryl Magzamen, PhD, Anne P. Starling, PhD, William B. Allshouse, PhD, John L. Adgate, PhD, Dana Dabelea, MD PhD
November 2019
Research Summary
This study explored the associations between prenatal exposure to tobacco and neurocognitive development using a battery of tests. We found evidence that early-life exposure to tobacco smoke is associated with less optimal fine motor development and reduced inhibitory control in children independent of preterm birth or low birthweight.
What does this mean for you and public health?
Exposure to tobacco smoke during pregnancy can lead to impaired neurocognitive development in early childhood that can later impact academic achievement.
Perfluoroalkyl Substances during Pregnancy and Offspring Weight and Adiposity at Birth: Examining Mediation by Maternal Fasting Glucose in the Healthy Start Study
Anne P. Starling, John L. Adgate, Richard F. Hamman, Katerina Kechris, Antonia M. Calafat, Xiaoyun Ye, and Dana Dabelea
June 2017
Research Summary
Perfluoroalkyl and polyfluoroalkyl substances (PFAS) are widespread, persistent environmental contaminants. Prenatal PFAS exposure has been associated with lower birth weight; however, impacts on body composition and factors responsible for this association are unclear. Starling and colleagues aimed to estimate associations between maternal PFAS concentrations and offspring weight and adiposity at birth, and to estimate associations between PFAS concentrations and maternal glucose and lipids. PFAS were detectable in over half of participants. Results found certain PFAS concentrations were inversely associated with birth weight, adiposity at birth, and maternal glucose. Follow-up of offspring will determine the potential long-term consequences of lower weight and adiposity at birth associated with prenatal PFAS exposure.
What does this mean for you and public health?
Exposure to environmental chemicals during pregnancy may result in reduced infant size. Research has shown that infants born small for gestational age are at an increased risk for adverse cognitive, behavioral, and metabolic health outcomes.
Diet, Physical Activity, and mental health status associated with abnormalities in blood sugar during pregnancy
Katherine A. Sauder, Anne P. Starling, Allison L. Shapiro, Brandy M. Ringham, Dana Dabelea et al.
February 2016
Research Summary
In this analysis, Sauder and colleagues tested the hypothesis that pregnant women who meet certain standards for diet quality, physical activity levels, and mental health status during early and mid-pregnancy are at a decreased risk of abnormal blood glucose levels. It was found that physical activity level was associated with reduced risk of abnormal blood glucose, while diet quality and mental health status were not associated with a decreased risk. When all 3 modifiable factors were examined together, pregnant women who met these standards were at a 73% reduced risk of abnormal blood glucose levels.
What does this mean for you and public health?
These results suggest that pregnant women who maintain moderate physical activity, diet quality, and healthy mental health status in early and mid-pregnancy are at a lower risk of abnormal blood glucose levels, which in turn may reduce the risk of developing gestational diabetes.
Maternal Diet quality in pregnancy and infant fatness
Allison L. Shapiro, Anne P. Starling, Brandy M. Ringham, Dana Dabelea et al.
July 2016
Research Summary
Shapiro and colleagues hypothesized that infants born to women with a poor quality diet (based on the Healthy Eating Index) would have higher fat mass (adiposity) at birth. In this analysis, maternal weight before pregnancy (e.g. obesity) was taken into account, so that the results would be applicable to all pregnant women, despite their weight status. The results of this analysis revealed that a poor quality diet during pregnancy was related to higher infant fatness, regardless of whether or not a woman entered pregnancy with obesity. In other words, a woman with a high quality diet gave birth to a baby with less adiposity, even if she entered pregnancy with obesity.
What does this mean for you and public health?
The results of this analysis highlight the importance of healthy diets during pregnancy for all women of all weights.
Maternal Blood pressure during pregnancy and infant body composition
Anne P. Starling, Allison L. Shapiro, Katherine A. Sauder, Brandy M. Ringham, Dana Dabelea et al.
February 2017
Research Summary
The aim of this analysis was to estimate the relationships between second and third trimester maternal blood pressure changes (in women who do not have chronic high blood pressure) and infant birth weight and body composition. Results of this analysis suggest that greater increases in blood pressure (systolic and diastolic) are associated with increased risk of infants being born small for gestational weight. Furthermore, infant fat mass and fat free mass were lower among infants whose mothers had an increased blood pressure between the second and third trimester of pregnancy.
What does this mean for you and public health?
Research has shown that infants born small for gestational age are at an increased risk for future chronic disease. Increases in maternal blood pressure from the second to the third trimester of pregnancy may put infants at higher risk to be born small for gestational age, although long-term follow-up studies are needed to confirm this.
Maternal High fat diet/niacin intake and infant fatness
Allison L. Shapiro, Brandy M. Ringham, Dana Dabelea et al.
February 2017
Research Summary
Shapiro and colleagues hypothesized that increased intake of niacin (a form of vitamin B3), in addition to a high fat diet during pregnancy, would increase infant fatness (adiposity) at birth. Results of this analysis found no significant relationship between niacin intake during pregnancy and infant adiposity at birth, whether or not intake was addition to a high fat diet. It was found that a high fat diet, in general, during pregnancy was significantly associated with infant adiposity at birth.
What does this mean for you and public health?
The findings of this analysis demonstrate that maternal diet during pregnancy, especially with regards to high fat foods, may impact growth and development of the fetus and result in babies with greater fat mass.
infant exposure to smoking in utero and early-life body composition
Curtis S. Harrod, Dana Dabelea et al.
January 2015
Research Summary
In this analysis, Harrod and colleagues aimed to test the hypothesis that infants who are exposed to smoking in utero will demonstrate "catch-up growth" (compensation for the growth restriction in utero, which is associated with smoking during pregnancy). Specifically, they hypothesized that babies born to mothers who smoked would have higher fat mass and fat free mass at birth and at 5 months of age compared to infants not exposed to smoke in utero. The results of this analysis showed that exposure to smoke in utero was associated with less fat mass and fat free mass at birth, therefore smaller babies.. However, at the 5 month follow-up, babies exposed to smoke in utero had significantly greater fat free mass than babies who were unexposed to smoke, suggesting there is rapid postnatal growth for exposed babies.
What does this mean for you and public health?
Findings in previous studies suggest that "catch-up growth" is associated with an increased risk of early-life developmental changes that predispose infants to obesity later in life. The results of this analysis may indicate that maternal smoking while pregnant may increase the risk of "catch-up growth," and therefore, the risk of obesity later in life.