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Early Prevention of Childhood Obesity: Impact of Maternal Physical Activity on Pregnancy and Child Outcomes Kai Ling Kong Iowa State University

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Early Prevention of Childhood Obesity: Impact of Maternal Physical Activity on Pregnancy and Child Outcomes Kai Ling Kong Iowa State University Iowa State University Capstones, Theses and Graduate Theses and Dissertations Dissertations 2013 Early Prevention of Childhood Obesity: Impact of Maternal Physical Activity on Pregnancy and Child Outcomes Kai Ling Kong Iowa State University Follow this and additional works at: https://lib.dr.iastate.edu/etd Part of the Human and Clinical Nutrition Commons, and the Kinesiology Commons Recommended Citation Kong, Kai Ling, "Early Prevention of Childhood Obesity: Impact of Maternal Physical Activity on Pregnancy and Child Outcomes" (2013). Graduate Theses and Dissertations. 13071. https://lib.dr.iastate.edu/etd/13071 This Dissertation is brought to you for free and open access by the Iowa State University Capstones, Theses and Dissertations at Iowa State University Digital Repository. It has been accepted for inclusion in Graduate Theses and Dissertations by an authorized administrator of Iowa State University Digital Repository. For more information, please contact [email protected]. Early prevention of childhood obesity: Impact of maternal physical activity on pregnancy and child outcomes by Kai Ling Kong A dissertation submitted to the graduate faculty in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Major: Nutritional Sciences Program of Study Committee: Lorraine Lanningham-Foster, Major Professor Christina Campbell Philip Dixon Amy Welch Gregory Welk Iowa State University Ames, Iowa 2013 Copyright © Kai Ling Kong, 2013. All rights reserved. ii DEDICATION Dedicated to my Lord and Savior, Jesus Christ Let all that I am praise the Lord; with my whole heart, I will praise his holy name. Let all that I am praise the Lord; may I never forget the good things he does for me. Psalm 103: 1-2 iii TABLE OF CONTENTS ACKNOWLEDGEMENTS ................................................................................................. vi ABSTRACT ......................................................................................................................... viii CHAPTER 1: GENERAL INTRODUCTION .....................................................................1 Introduction ...........................................................................................................................1 Dissertation Organization......................................................................................................4 CHAPTER 2: LITERATURE REVIEW .............................................................................5 Obesity Overview..................................................................................................................5 Maternal Obesity ...................................................................................................................7 A) Overview of the prevalence .........................................................................................7 B) Adverse health outcomes in obese pregnancies ...........................................................8 Excessive Gestational Weight Gain (GWG) .......................................................................14 A) Overview of weight gain during pregnancy and the recommendations .....................14 B) Adverse health outcomes of excessive GWG ............................................................18 Fetal Origins of Obesity ......................................................................................................21 A) Overview of Developmental Origins of Health and Disease (DOHaD) hypothesis ..21 B) DOHaD hypothesis in obesity ....................................................................................23 Prevention of Pediatric Obesity during Pregnancy .............................................................35 A) Maternal physical activity (PA) .................................................................................36 B) Maternal diet ..............................................................................................................53 C) Pregnancy-specific lifestyle interventions .................................................................55 References ...........................................................................................................................61 CHAPTER 3: A RANDOMIZED-CONTROLLED WALKING INTERVENTION TO IMPROVE PREGNANCY AND BIRTH OUTCOMES BY PROMOTING MODERATE PHYSICAL ACTIVITY AMONG OVERWEIGHT AND OBESE PREGNANT WOMEN: MOMS TO MOVE (M2M) STUDY .........................................84 Abstract ...............................................................................................................................84 Introduction .........................................................................................................................85 Methods ...............................................................................................................................88 Results .................................................................................................................................96 Discussion .........................................................................................................................100 iv References .........................................................................................................................107 Tables ................................................................................................................................113 Figures ...............................................................................................................................116 CHAPTER 4: OBJECTIVELY MEASURED STEP COUNT CAN BE PREDICTED BY SELF-EFFICACY AND PRE-PREGNANCY BMI AMONG OVERWEIGHT AND OBESE PREGNANT WOMEN IN A RANDOMIZED-CONTROLLED TRIAL ..................................................................................................................................120 Abstract .............................................................................................................................120 Background .......................................................................................................................121 Methods .............................................................................................................................125 Results ...............................................................................................................................130 Discussion .........................................................................................................................132 Conclusion ........................................................................................................................137 References .........................................................................................................................137 Tables ................................................................................................................................142 Figures ...............................................................................................................................144 CHAPTER 5: IMPACT OF A WALKING INTERVENTION DURING PREGNANCY ON POST-PARTUM WEIGHT RETENTION AND INFANT OUTCOMES .......................................................................................................................147 Abstract .............................................................................................................................147 Introduction .......................................................................................................................148 Methods and Procedures ...................................................................................................151 Results ...............................................................................................................................156 Discussion .........................................................................................................................159 References .........................................................................................................................165 Tables ................................................................................................................................171 Figure ................................................................................................................................174 CHAPTER 6: GENERAL CONCLUSIONS ...................................................................177 APPENDIX A. RECRUITMENT MATERIALS ............................................................182 APPENDIX B. APPROVED CONSENT FORM ............................................................184 APPENDIX C. M2M STUDY TIMELINE ......................................................................191 APPENDIX D. MEDICAL HISTORY FORM ................................................................192 v APPENDIX E. MEDICAL PROVIDER RELEASE FORM .........................................195 APPENDIX F. THREE-DAY DIET RECORD INSTRUCTIONS ................................196 APPENDIX G. SELF-EFFICACY QUESTIONNAIRES ..............................................198 APPENDIX H. POST-PARTUM QUESTIONNAIRES .................................................200 APPENDIX I. BLOOD PROFILES OF PARTICIPANTS ............................................203 vi ACKNOWLEDGMENTS First and foremost, praise and thanks go to my LORD and Savior, Jesus Christ. I am grateful for all of the strength, endurance and blessings the Lord has provided
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