Exploring Potential Health Disparities in Excessive Gestational Weight Gain

Abstract

Introduction: Although previous public health efforts have focused on redressing health disparities associated with insufficient gestational weight gain, examination of the impact of excessive gestational weight gain is warranted currently given the 2009 revision of the Institute of Medicine (IOM) gestational weight gain guidelines for obese women coupled with rising rates of obesity, particularly among African American women. Materials and Methods: In the years [2004][2005][2006][2007][2008] 4619 African American and Caucasian women gave birth to a single, live, and full-term infant, completed Arkansas Pregnancy Risk Assessment Monitoring System questions about gestational weight gain and prepregnancy weight status, and gained within or in excess of the guidelines. Logistic regression was used to identify sociodemographic and health variables associated with the odds of exceeding the 2009 IOM guidelines overall and by race. Results: Regardless of race, overweight (odds ratio [OR] = 3.21; 95% confidence interval [CI]: 2.64-3.91) and obese (OR = 4.37; 95% CI: 3.50-5.46) women had significantly higher odds of gaining excessively, as compared with normal weight women. In the multivariate model, women who were overweight or obese prepregnancy and who were married had higher odds of exceeding the IOM guidelines, while lower odds of exceeding the guidelines were seen among African American women, those who had Medicaid at any point in their pregnancy, who were multiparous, and those of Hispanic ethnicity. Discussion: These findings can inform efforts to promote appropriate gestational weight gain among those at highest risk (i.e., overweight/obese women) and facilitate targeting to produce greatest improvement in the health of mothers and children.

Gestational weight gain

“…17 Although minority women are more likely to enter a pregnancy as overweight or obese compared to whites, in general, Hispanic and black women are more likely to have inadequate GWG and less likely to have excessive GWG compared to whites. 18–20 For example, in a study of birth records from 2007–2010 in Colorado, Hispanic and black women had an increased odds for inadequate GWG (aOR 1.08, 95% CI 1.04–1.11; aOR 1.12, 95% CI 1.06–1.19, respectively) and decreased odds for excessive GWG (aOR 0.84, 95% CI 0.81–0.86; aOR 0.96, 95% CI 0.90–1.00, respectively) compared to non-Hispanic whites. 21 Deputy et al also examined racial-ethnic associations with GWG, but noted that the odds varied by BMI.…”

Obesity in Pregnancy: A Qualitative Approach to Inform an Intervention for Patients and Providers

“…(10) However, up to 83% of obese pregnant women exceed these recommendations. (11-13) Given that most women are motivated to have “healthy pregnancies,” gestational weight gain (GWG) is potentially modifiable through behavioral interventions that target physical activity, nutrition, etc. Accordingly, the IOM report stated that interventions will be needed to assist obese women to meet the GWG goals.…”

Adequacy of Prenatal Care and Gestational Weight Gain

“…This finding, however, is consistent with an existing study, which found that African Americans and Hispanics were less likely than Caucasian women to exceed the IOM guidelines. 2 Their study did not, however, examine risk factors for insufficient weight gain. There may be a subpopulation of women who have trouble gaining weight during pregnancy due to food insecurity or competing life demands.…”

“…1 To date, a few studies have reported the prevalence of adequate gestational weight gain using the 2009 IOM recommendations. [2][3][4] Similarly, only a few studies have been conducted to assess whether current prenatal care programs effectively promote adequate weight gain during pregnancy. 2 Prenatal care can help prevent potential health problems during the course of pregnancy through screening and the recommendation of healthy lifestyle changes.…”

“…[2][3][4] Similarly, only a few studies have been conducted to assess whether current prenatal care programs effectively promote adequate weight gain during pregnancy. 2 Prenatal care can help prevent potential health problems during the course of pregnancy through screening and the recommendation of healthy lifestyle changes. 5 The American Academy of Pediatrics (AAP) and American Congress of Obstetricians and Gynecologists (ACOG) describe a prenatal care program as ''a coordinated approach to medical care and psychosocial support .…”