Associations between the prenatal environment and cardiovascular risk factors in adolescent girls: Internalizing and externalizing behavior symptoms as mediators

Abstract

This longitudinal study examines links among adolescent internalizing and externalizing symptoms, the prenatal environment (e.g., nicotine exposure) and pre/perinatal maternal health, and cardiovascular risk factors. Girls (N=262) ages 11-17 reported internalizing and externalizing behaviors and mothers reported about the prenatal environment and maternal health during and 3 months post-pregnancy. Adolescent cardiovascular risk included adiposity, smoking, blood pressure, and salivary C-reactive protein. Internalizing symptoms mediated relations between prenatal exposures/maternal health and adiposity; externalizing symptoms mediated relations between prenatal exposures and adolescent smoking. Healthcare providers who attend to internalizing and externalizing symptoms in girls may ultimately influence cardiovascular health, especially among those with pre/perinatal risk factors.

Figure 1

Confirmatory Factor Analyses for five latent variables included in subsequent mediation models. Items for the prenatal environment (figure 1a) and maternal health (figure 1b) come from maternal report at Time 1 (T1). Items for internalizing (figure 1c) and externalizing (figure 1d) behaviors come from adolescent report at Time 2 (T2). Items for adiposity (figure 1e) come from clinician measures to calculate BMI and BMI z-score, and from DXA scans for percent body fat at Time 3 (T3). 262 adolescent girls were included in the study. All models met criteria for good fit (i.e., non-significant χ² test or CFI > .94, RMSEA < .06, SRMR < .08). * p < .05; ** p < .01. Abbreviations include Body Mass Index (BMI).

Figure 2

Externalizing behaviors at Time 2 (T2) mediated the prenatal environment at Time 1 (T1) in predicting age started smoking and amount of smoking, both at time 3 (T3). Standardized beta coefficients provided in figures. Positive coefficients indicate a positive relationship between two variables, negative coefficients indicate negative relationships. Larger absolute values of beta coefficients indicate stronger effects. * p < .05; ** p < .01. Model Fit: χ² (63) = 64.64, P = .42. Circles=latent, squares=observed constructs. The prenatal environment is based on maternal report and externalizing and smoking variables are based on adolescent report from 262 girls.

Figure 3

Internalizing behaviors at Time 2 (T2) mediated the prenatal environment at Time 1 (T1) and maternal health at Time 1 (T1) in predicting adiposity at Time 3 (T3). Standardized beta coefficients provided in figures. Positive coefficients indicate a positive relationship between two variables, negative coefficients indicate negative relationships. Larger absolute values of beta coefficients indicate stronger effects. * p < .05; ** p < .01. Model Fit: χ² (63) = 46.94, p = .94. Circles=latent, squares=observed constructs. The prenatal environment and maternal health are based on maternal report and internalizing variables based on adolescent report from 262 girls. Adiposity based on clinician measures of the 262 adolescent girls.