Influence of Pregnancy Weight on Maternal and Child Health

WORKSHOP REPORT

Committee on the Impact of Pregnancy Weight on Maternal and Child Health

Board on Children, Youth, and Families

Division of Behavioral and Social Sciences and Education

Institute of Medicine

Food and Nutrition Board

Institute of Medicine

NATIONAL RESEARCH COUNCIL

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
www.nap.edu



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Influence of Pregnancy Weight on Maternal and Child Health: Workshop Report Influence of Pregnancy Weight on Maternal and Child Health WORKSHOP REPORT Committee on the Impact of Pregnancy Weight on Maternal and Child Health Board on Children, Youth, and Families Division of Behavioral and Social Sciences and Education Institute of Medicine Food and Nutrition Board Institute of Medicine NATIONAL RESEARCH COUNCIL INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

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Influence of Pregnancy Weight on Maternal and Child Health: Workshop Report THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Award No. HHSH24055014 between the National Academy of Sciences and the Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project. International Standard Book Number 13: 978-0-309-10406-7 International Standard Book Number 10: 0-309-10406-8 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu Printed in the United States of America Copyright 2007 by the National Academy of Sciences. All rights reserved. Suggested citation: National Research Council and Institute of Medicine. (2007). Influence of Pregnancy Weight on Maternal and Child Health. Workshop Report. Committee on the Impact of Pregnancy Weight on Maternal and Child Health. Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education and Food and Nutrition Board, Institute of Medicine. Washington, DC: The National Academies Press.

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Influence of Pregnancy Weight on Maternal and Child Health: Workshop Report THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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Influence of Pregnancy Weight on Maternal and Child Health: Workshop Report COMMITTEE ON THE IMPACT OF PREGNANCY WEIGHT ON MATERNAL AND CHILD HEALTH MAXINE HAYES (Chair), Department of Health, State of Washington, Olympia BARBARA ABRAMS, School of Public Health, University of California, Berkeley EZRA C. DAVIDSON, JR., Department of Obstetrics and Gynecology, Charles R. Drew University of Medicine and Science, Los Angeles LILLIAN GELBERG, Department of Family Medicine, School of Medicine, University of California, Los Angeles MATTHEW W. GILLMAN, Department of Ambulatory Care and Prevention, Harvard Medical School/Harvard Pilgrim Health Care, Boston JANET C. KING, Children’s Hospital Oakland Research Institute, Oakland, California RONALD E. KLEINMAN, Pediatric Gastroenterology, Massachusetts General Hospital, Boston GREGG A. PANE, District of Columbia Department of Health, Washington, DC KATHLEEN M. RASMUSSEN, Division of Nutritional Sciences, Cornell University LESLIE J. SIM, Study Director JENNIFER APPLETON GOOTMAN, Senior Program Officer WENDY KEENAN, Program Associate HARRIET KITZMAN (liaison to the Board on Children, Youth, and Families), School of Nursing, University of Rochester

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Influence of Pregnancy Weight on Maternal and Child Health: Workshop Report BOARD ON CHILDREN, YOUTH, AND FAMILIES MICHAEL I. COHEN (Chair), Department of Pediatrics, Albert Einstein College of Medicine BARBARA WOLFE (Vice Chair), Department of Economics and Population Health Sciences, University of Wisconsin, Madison WILLIAM BEARDSLEE, Department of Psychiatry, Children’s Hospital, Boston LINDA BURTON, Sociology Department, Duke University P. LINDSAY CHASE-LANSDALE, Institute for Policy Research, Northwestern University BRENDA ESKENAZI, School of Public Health, University of California, Berkeley CHRISTINE C. FERGUSON, School of Public Health and Health Services, George Washington University WILLIAM GREENOUGH, Department of Psychology and Beckman Institute, University of Illinois, Urbana RUBY HEARN, Robert Wood Johnson Foundation, Baltimore BETSY LOZOFF, Center for Human Growth and Development, University of Michigan, Ann Arbor SUSAN MILLSTEIN, Division of Adolescent Medicine, University of California, San Francisco CHARLES NELSON, Laboratory of Cognitive Neuroscience, Children’s Hospital, Boston ELENA NIGHTINGALE, Institute of Medicine, The National Academies, Washington, DC PATRICIA O’CAMPO, Centre for Research on Inner City Health, St. Michael’s Hospital, Toronto LAURENCE STEINBERG, Department of Psychology, Temple University ELLEN WARTELLA, Office of the Executive Vice Chancellor and Provost, University of California, Riverside MICHAEL ZUBKOFF, Development of Community and Family Medicine, Dartmouth Medical School ROSEMARY CHALK, Board Director WENDY KEENAN, Program Associate

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Influence of Pregnancy Weight on Maternal and Child Health: Workshop Report FOOD AND NUTRITION BOARD DENNIS BIER (Chair), Children’s Nutrition Research Center, Baylor College of Medicine MICHAEL P. DOYLE (Vice Chair), Center for Food Safety, University of Georgia DIANE BIRT, Department of Food Science and Human Nutrition, Iowa State University, Ames YVONNE BRONNER, School of Public Health and Policy, Morgan State University SUSAN FERENC, Chemical Producers and Distributors Association, Alexandria, Virginia NANCY F. KREBS, Department of Pediatrics, University of Colorado Health Sciences Center, Denver REYNALDO MARTORELL, Department of Global Health, Rollins School of Public Health, Emory University J. GLENN MORRIS, JR., Department of Epidemiology and Preventive Medicine, School of Medicine, School of Public Health, University of Maryland, Baltimore SUZANNE P. MURPHY, Cancer Research Center of Hawaii, University of Hawaii JOSE M. ORDOVAS, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University JIM RIVIERE, College of Veterinary Medicine, North Carolina State University NICHOLAS J. SCHORK, Department of Psychiatry and Biostatistics, Polymorphism Research Laboratory, University of California, San Diego REBECCA J. STOLTZFUS, Division of Nutritional Sciences, Cornell University JOHN W. SUTTIE, Department of Biochemistry, University of Wisconsin, Madison WALTER C. WILLETT, Department of Nutrition, Harvard School of Public Health, Harvard University BARRY L. ZOUMAS, Department of Agricultural Economics and Rural Sociology, Pennsylvania State University LINDA D. MEYERS, Board Director GERALDINE KENNEDO, Administrative Assistant

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Influence of Pregnancy Weight on Maternal and Child Health: Workshop Report Preface This volume summarizes a one and a half day workshop convened in May 2006 that reviewed U.S. trends in maternal weight (prior to, during, and after pregnancy) among different populations of women; examined the emerging research findings related to the complex relationship of the biological, behavioral, psychological, and social interactions that affect maternal and pregnancy weight on maternal and child health outcomes; and discussed interventions that use this complex relationship to promote appropriate weight during pregnancy and postpartum. Given the unprecedented environment in the United States in which two-thirds of the adult population meet the criteria for being overweight or obese, the implications for women in the reproductive age period are unique in the history of the country. The concerns for maternal and infant health are real. The questions and answers tackled by committee members and workshop participants were not easy. Nevertheless, having an opportunity to explore what is known, examine the gaps in knowledge, and explore what to do now and in the future builds a pathway for further inquiry and action. This report summarizes the workshop proceedings and highlights key themes that deserve further attention. The overarching goal of the workshop was for participants to describe what is known about recent trends in maternal weight gain and the impact of maternal weight during pregnancy on the health of mothers and their children. The workshop provided a valuable opportunity to assess trends that have occurred since the publication of an earlier study by the Institute of Medicine (IOM), which included guidelines for recommended weight

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Influence of Pregnancy Weight on Maternal and Child Health: Workshop Report gain during pregnancy.1 This report seeks to inform the efforts of Title V maternal and child health programs to foster adherence to the IOM recommendations for recommended weight gain during pregnancy as well as contribute to understanding whether there is a substantial need to reexamine these recommendations in light of recent demographic and health trends. The genesis of the workshop began with a proposal that was reviewed and refined by the National Research Council-IOM Board on Children, Youth, and Families and the IOM Food and Nutrition Board. The Maternal and Child Health Bureau of the U.S. Department of Health and Human Services subsequently funded an activity that included the formation of a program committee that met once to help plan and convene the workshop. The efforts of the planning committee members and the workshop participants fostered a collaboration that began the unraveling of a challenging and multifaceted area of study. We are particularly grateful for the contributions of the expert presenters, speakers, and discussants who contributed to the meeting (see the Appendix for the workshop agenda and list of participants). Special appreciation also goes to the members of the planning committee, who volunteered their time and intellectual efforts to shape the workshop program and identify themes and contributors. In addition, we give special thanks to Margaret Feerick, who prepared a comprehensive draft of the workshop report; Leslie Sim, who directed the planning and workshop preparation and the production of the final publication; and Wendy Keenan, who assisted with preparation of the workshop and the final report. Although the workshop report was prepared by the committee, it does not represent findings or recommendations that can be attributed to the committee members. This workshop report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the Report Review Committee of the National Research Council. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We thank the following individuals for their review of this report: Esa M. Davis, Department of Family Medicine-Research Division, Case Western Reserve University/ University Hospital of Cleveland; Calvin J. Hobel, Department of Obstet- 1 Institute of Medicine (1990), Nutrition During Pregnancy. Washington, DC: National Academy Press.

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Influence of Pregnancy Weight on Maternal and Child Health: Workshop Report rics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA; Christine M. Olson, Division of Nutritional Sciences, Cornell University; Magda G. Peck, Department of Pediatrics, University of Nebraska Medical Center; Kathryn Peppe, Program and Policy Office, Association of Maternal and Child Health Programs, Washington, DC; Nicolas Stettler, Department of Pediatrics and Epidemiology, The Children’s Hospital of Philadelphia; and Brian Wrotniak, Department of Pediatrics and Epidemiology, The Children’s Hospital of Philadelphia. Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the report nor did they see the final draft of the report before its release. The review of this report was overseen by Thomas DeWitt, Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center. Appointed by the National Research Council, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authors and the institution. Maxine Hayes, Chair Committee on the Impact of Pregnancy Weight on Maternal and Child Health

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Influence of Pregnancy Weight on Maternal and Child Health: Workshop Report Contents 1   INTRODUCTION   1      References,   5 2   TRENDS IN MATERNAL AND GESTATIONAL WEIGHT   6      Prepregnancy Weight,   9      Gestational Weight Gain,   9      Postpartum Weight Retention,   14      Summary,   16      References,   16 3   DETERMINANTS OF GESTATIONAL WEIGHT GAIN   18      Gestational Weight Gain,   18      Biological and Metabolic Factors of Gestational Weight Gain,   20      Social Predictors of Gestational Weight Gain,   22      Summary,   28      References,   30 4   MATERNAL WEIGHT, GESTATIONAL WEIGHT GAIN, AND MATERNAL HEALTH   33      Short-Term Maternal Health Outcomes,   33      Long-Term Maternal Health Outcomes,   38      Summary,   46      References,   47

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Influence of Pregnancy Weight on Maternal and Child Health: Workshop Report 5   MATERNAL WEIGHT, GESTATIONAL WEIGHT GAIN, AND CHILDREN’S HEALTH   50      Short-Term Infant Health Outcomes,   51      Long-Term Child Health Outcomes,   56      Summary,   61      References,   62 6   PROMOTING APPROPRIATE MATERNAL WEIGHT DURING AND AFTER PREGNANCY   65      Individual Approaches,   65      Psychosocial Approaches,   68      Community Approaches,   71      Health System Approaches,   73      Summary,   76      References,   77 7   EMERGING THEMES   80      Gestational Weight Gain and Birth Weight,   81      Guidance for Maternal Weight and Gestational Weight Gain,   82      Special Populations,   83      Theoretical Approaches,   85      Intervention, Outreach, and Education,   87      Health Care and Health Systems,   88      Scope and Gaps Identified by Individuals During the Workshop,   89      Final Observations,   91      Reference,   92     APPENDIX: WORKSHOP AGENDA AND PARTICIPANTS   93