Public Release: 

Lack of paternal information on birth certificate may increase a child's obesity risk

Study finds higher incidence of obesity-associated risk factors among children with no father listed on birth certificates

Massachusetts General Hospital

A new study by a Massachusetts General Hospital (MGH)-led research team finds an association between the lack of paternal information on infants' birth certificates and increases in several risk factors for childhood obesity. The report being published online in BMC Public Health is among the first to investigate the influence of paternal factors on a child's risk of obesity.

"Most studies of familial influences on childhood obesity outcomes have focused on maternal factors," says Erika R. Cheng, PhD, MPA, of the Indiana University School of Medicine, lead author of the report. "We know that children from single-parent homes are more likely to have obesity, and we also know that women deliver healthier babies when fathers are engaged during the pregnancy. Some research also suggests that fathers play an important role in the feeding of their infants, yet there are very few studies on fathers' feeding practices compared to those examining mothers' practices. All these suggest that fathers can influence their children's obesity risk in ways that are unique."

While there is no way of knowing the significance of missing paternal information on specific birth certificates, Cheng notes that it might indicate a lack of a father's involvement - personal and/or financial - in the child's care. The study took advantage of a new Massachusetts database that links electronic health record information for children seen at 14 local health centers with data from their birth certificates. That data includes factors such as a mother's use of prenatal care, whether she smoked or used alcohol during pregnancy, any complications of pregnancy, and the child's birthweight and Apgar score, a standard measure of newborn health.

Among more than 200,000 children whose health information could be linked to birth-certificate data, almost 16 percent of certificates indicated the mothers were unmarried, and 6 percent of all certificates had no paternal information. Certificates lacking paternal information were more common among children born to women who were young (93 percent) or African American (51 percent). The rate of maternal smoking during pregnancy was five times higher for this group than it was for children with paternal information on their birth certificates, and the initiation of breastfeeding was 71 percent lower. While the birthweights of such children were likely to be lower, the chance of obesity-risk-associated growth measurements during the first two years of life was significantly higher. Obesity-risk-related outcomes - both prenatal and infant - were significantly better for the pregnancies of unmarried mothers with paternal information on certificates and best for pregnancies involving married women.

Elsie Taveras, MD, MPH, chief of General Pediatrics at MassGeneral Hospital for Children and senior author of the report, says, "Our findings - that the mothers of children with absent fathers had higher rates of smoking during pregnancy, lower rates of breastfeeding initiation, and delivered infants with lower birthweights - suggest that the lack of paternal involvement is a potentially modifiable risk factor for childhood obesity. More research is needed to identify the mechanisms by which an absence of paternal birth certificate data increases the risk of poor pregnancy and infant health outcomes. Identifying the biological and social pathways by which fathers can influence their children's obesity rates could help refine prevention and intervention efforts."

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Additional co-authors of the BMC Public Health report are Summer Sherburn Hawkins, PhD, Boston College School of Social Work; and Sheryl Rifas-Shiman, MPH, and Matthew Gilman, MD, SM, Harvard Medical School and Harvard Pilgrim Health Care Institute. Support for the study includes National Research Service Award institutional training grant T32-HD075727.

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $800 million and major research centers in HIV/AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, photomedicine and transplantation biology. The MGH topped the 2015 Nature Index list of health care organizations publishing in leading scientific journals, earned the prestigious 2015 Foster G. McGaw Prize for Excellence in Community Service and returned to the number one spot on the 2015-16 U.S. News & World Report list of "America's Best Hospitals."

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