APPENDIX A
Acronyms and Abbreviations, Glossary, and Supplemental Information

ACRONYMS AND ABBREVIATIONS

ACTH adrenocorticotrophic hormone

ADHD attention deficit hyperactivity disorder

ADRB3 beta 3 adrenergic receptor gene

AHRQ Agency for Healthcare Research and Quality

ALL acute lymphoblastic leukemia

AML acute myeloid leukemia

BEE basal daily energy expenditure

BIA bioimpedance analysis (also bioelectrical impedance analysis)

BMI body mass index

BMR basal metabolic rate

BRFSS Behavioral Risk Factor Surveillance System

CBG corticosteroid-binding globulin

CDC Centers for Disease Control and Prevention

CI confidence interval

CVD cardiovascular disease

DEXA dual energy X-ray absorptiometry

DHEAS dehydroepiandrosterone sulfate

DNA deoxyribonucleic acid



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appendix A Acronyms and Abbreviations, Glossary, and Supplemental Information ACRONYMS AND ABBREVIATIONS ACTH adrenocorticotrophic hormone ADHD attention deficit hyperactivity disorder ADRB3 beta 3 adrenergic receptor gene AHRQ Agency for Healthcare Research and Quality ALL acute lymphoblastic leukemia AML acute myeloid leukemia BEE basal daily energy expenditure BIA bioimpedance analysis (also bioelectrical impedance analysis) BMI body mass index BMR basal metabolic rate BRFSS Behavioral Risk Factor Surveillance System CBG corticosteroid-binding globulin CDC Centers for Disease Control and Prevention CI confidence interval CVD cardiovascular disease DEXA dual energy X-ray absorptiometry DHEAS dehydroepiandrosterone sulfate DNA deoxyribonucleic acid 

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 WEIGHT GAIN DURING PREGNANCY ECF extracellular fluid FFA free fatty acid FFM fat-free mass FM fat mass GDM gestational diabetes mellitus GFR glomerular filtration rate GWG gestational weight gain HCG human chorionic gonadotropin HCS human chorionic somatomammotropin HDL high-density lipoprotein HHS U.S. Department of Health and Human Services HRQL health-related quality of life ICW intracellular water IDL intermediate-density lipoprotein IFPS-II Infant Feeding Practices Survey II IGF-I insulin-like growth factor I IGT impaired glucose tolerance IOM Institute of Medicine IRS-1 insulin receptor substrate 1 IUGR intrauterine growth restriction LBW low birth weight LDL low-density lipoprotein LGA large-for-gestational age LVM left ventricular mass MEPS U.S. Medical Expenditure Panel Survey NCHS National Center for Health Statistics NHANES National Health and Nutrition Examination Survey NMIHS National Maternal and Infant Health Survey NRC National Research Council OR odds ratio PACO2 partial pressure of carbon dioxide PAO2 partial pressure of oxygen PAL physical activity level PedNSS Pediatric Nutrition Surveillance System

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 APPENDIX A PNSS Pregnancy Nutrition Surveillance System PRAMS Pregnancy Risk Assessment Monitoring System PROM premature rupture of membranes PTB preterm birth QALY quality-adjusted life-years SD standard deviation SGA small-for-gestational age SNP single nucleotide polymorphism STBM syncytiotrophoblast microparticles TBK total body potassium TBN total body nitrogen TBW total body water TEE total energy expenditure TNF-α tumor necrosis factor-alpha VLBW very low birth weight VLDL very-low-density lipoprotein VO2 oxygen consumption WIC Special Supplemental Nutrition Program for Women, Infants, and Children ± plus or minus GLOSSARY1 Abruptio placenta Also called ablatio placentae. Premature detachment of the placenta from the wall of the uterus. Acetylation The introduction of one or more acetyl groups into an organic compound. 1 The following sources were used: Thomas C. L., Ed. 1985. Taber’s Cyclopedic Medi- cal Dictionary. Philadelphia, PA, F.A. David Company; The American Heritage Stedman’s Medical Dictionary. 1995. Boston, MA. Houghton Mifflin Company. Merriam-Webster’s Medical Dictionary Online (available at http://medical.merriam-webster.com/medical). Dor- land’s Medical Dictionary 29th Ed. Medline Plus (available online at http://www.nlm.nih.gov/ medlineplus). USDA Dietary Guidelines for Americans 2005 (available at http://www.health. gov/dietaryguidelines/dga2005/document/html/appendixC.htm). Mann and Truswell 2nd Ed 2002. Essentials of Human Nutrition, Oxford University Press, Oxford, UK.

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 WEIGHT GAIN DURING PREGNANCY Adipokines Also called adipose cytokines. A variety of proteins released into the systemic circulation by adipose (fat) tissue in response to changes in the metabolic status. Dysregulation of adipokine secretion (either ab- normally increased or decreased levels) may be one of the mechanisms by which insulin resistance is tied to obesity. Adipokines implicated in insulin resistance include leptin, resistin, and adiponectin. Adiponectin Also called adipocyte complement-related protein of 30 kDa (Acrp30). Protein produced in adipose (fat) tissue that accentuates sensitivity to insulin and is involved in the body’s regulation of weight. Low levels of adiponectin are found when obesity and its associated health complica- tions are present. See also Adipokines. Adrenocorticotrophic hormone (ACTH) A hormone that is produced by the anterior lobe of the pituitary gland and that stimulates the secretion of cortisone, aldosterone, and other hormones by the adrenal complex. Aldosterone A steroid hormone secreted by the adrenal cortex that functions in the regulation of the salt and water balance (metabolism of sodium, chlo- ride and potassium) in the body. Allele A set of alternate forms of a gene that may occur at a given locus. Amnion Also called amniotic sac. The thin membrane forming a closed sac about the embryo/fetus and containing the amniotic fluid. Amniotic fluid Liquid contained in the amnion that protects the fetus from injury, helps maintain an even temperature, prevents formation of adhesions between the amnion and the skin of the fetus, and prevents conformity of the sac to the fetus. Anemia A condition in which red blood cells, hemoglobin, or total volume content of the blood is less than that required to provide the oxygen demands of the body. Angiotensin A vasopressor (increases blood pressure by exerting a vasoconstrictor effect) protein that is formed in the body by interaction of chymosin and serum globulin fraction. The synthetic amide derivative of its physiologically active form, angiotensin II, is used to treat some forms of hypotension. Anion A negatively charged ion.

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 APPENDIX A Anorexia nervosa A psychophysiological disorder usually occurring in teenage women that is characterized by fear of becoming obese, a distorted self-image, a persistent aversion to food, and severe weight loss, and that is often marked by hyperactivity, self-induced vomiting, amenorrhea, and other physiological changes. Antipyrine Also called phenazone. An analgesic (pain reducer) and antipyretic (fever reducer) that was formerly widely used, but is now largely replaced in oral use by less toxic drugs such as aspirin. Attention deficit hyperactivity disorder (ADHD) A childhood syndrome that is characterized by impulsiveness and short attention span and sometimes by hyperactivity, and that often leads to learning disabilities and various behavioral problems. Basal metabolic rate (BMR) The rate of energy expenditure that occurs in the post-absorptive state, defined as the particular condition that prevails after an overnight fast (the subject not having consumed food for 12-14 hours) and resting comfortably, supine, awake, and motionless in a thermoneutral envi- ronment. This standardized metabolic state corresponds to the situ- ation in which food and physical activity have minimal influence on metabolism. Bioimpedance analysis (BIA) Also called Bioelectrical Impedance Analysis. Method of body compo- sition measurement by which a weak electric current is applied to the subject’s wrist and ankle through electrodes. Several prediction equa- tions are then used to calculate lean weight and density, total body water and 40K. Body mass index (BMI) Also called Quetelet index. An expression of body weight-for-height used for children and adults, using the formula weight/height2 × 100. In this report, metric units are used, namely: BMI = kg/m2 × 100. Bulimia nervosa A chronic eating disorder involving repeated and secretive episodes of eating, characterized by uncontrolled rapid ingestion of large quantities of food over a short period of time, followed by self-induced vomiting, purging and anorexia and accompanied by feelings of guilt, depres- sions, or self-disgust. Case-control study Also called a retrospective study or case referent study. An epidemio- logical and observational study in which persons are selected because

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00 WEIGHT GAIN DURING PREGNANCY they have a specific disease or other outcome (cases) and are compared to a control (referent comparison) group without the disease to evalu- ate whether there is a difference in the frequency of exposure to pos- sible disease risk factors. Congenital anomalies Birth defects. Consequences Health outcomes (effects) caused by the determinants. Corticosteroids Any number of hormonal steroid substances obtained from the cortex of the adrenal gland. Cortisol Also called hydrocortisone. A hormone produced by the adrenal cortex upon stimulation by ACTH that mediates various metabolic processes such as gluconeogenesis (formation of glucose from precursors other than carbohydrates), and has anti-inflammatory and immunosupres- sive properties. Cortisol levels in the blood may become elevated in response to physical or psychological stress. Creatinine One of the non-protein constituents of blood, a breakdown product of creatine (protein used to make ATP). Increased quantities of serum creatinine are found in advanced stages of renal disease. Decidua The mucous membrane lining the uterus modified during pregnancy, and cast off at parturition or during menstruation. The human decidua is made up of a part lining the uterus (parietalis), a part enveloping the embryo (capsularis), and a part participating with the chorion in the formation of the placenta (basalis). Dehydroepiandrosterone sulfate (DHEAS) A weak androgen (male hormone) produced by the adrenal cortex in both men and women that is measured in women showing symptoms of virulism (male body characteristics) or hirsutism (excessive hair growth). It is also measured in children who are maturing too early (precocious puberty). Deoxycorticosterone A steroid hormone from the adrenal gland that acts principally on salt and water metabolism. Deoxyribonucleic acid (DNA) A nucleic acid that consists of long chains of nucleotides twisted to- gether into a double helix and joined by hydrogen bonds between complementary bases adenine and thymine or cytosine and guanine. DNA carries the cell’s genetic information and heredity characteristics

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0 APPENDIX A via its nucleotides and their sequence, and is capable of self-replication and RNA synthesis. Determinants Causal (etiologic) factors. Deuterium An isotope of hydrogen with one proton and one neutron in the nucleus having a heavy atomic weight (2.014). Dyspnea Difficulty in breathing, often associated with lung or heart disease, and resulting in shortness of breath. Edema Also called dropsy, oedema. A local or generalized condition in which the body tissues contain an excessive amount of tissue fluid. Effect modifier A factor that increases or decreases the magnitude of the effect of a determinant on a particular consequence. Epidemiology The study of the distribution and determinants of health-related states and events in populations and the control of health problems. Epigenetic Mechanisms, processes, and/or biological compounds that affect a cell, organ, or individual without changing or perturbing DNA. Estrogen Female sex hormones responsible for the development of secondary sexual characteristics and for cyclic changes in the vaginal epithelium and endothelium of the uterus. Etiology Cause and origin of a diseases. Evans blue A water-soluble dye that upon injection into the bloodstream combines with serum albumin, and is used to determine blood volume colori- metrically. In pregnancy, evans blue is used to measure plasma volume expansion. Extracellular fluid (ECF) Fluid outside of the cell. Fat-free mass (FFM) Component of total body mass that includes skeletal muscle, non- skeletal muscle and soft lean tissues, and the skeleton. Fat mass (FM) Adipose tissue mass in the body.

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0 WEIGHT GAIN DURING PREGNANCY Fetus The developing organism in the human uterus after the second month of gestation. Food insecurity Whenever the availability of nutritionally adequate and safe food or the ability to acquire acceptable foods in socially acceptable ways is limited or uncertain. Free fatty acid (FFA) An uncombined fatty acid. Genotype Genetic characteristics of an individual determined by a set of alleles that make up the genome. Gestational diabetes mellitus (GDM) Metabolic derangement in glucose metabolism and profound abnor- malities in the metabolism of fat, protein, and other substances; charac- terized by hyperglycemia and glycosuria and resulting from inadequate production or utilization of insulin. The body’s need for insulin in- creases dramatically throughout pregnancy, making GDM the most common medical disorder affecting pregnancy. Gestational weight gain (GWG) The amount of weight a pregnant woman gains between the time of conception and the onset of labor. Globulin One of a group of proteins insoluble in pure water but soluble in neu- tral solutions of salts of strong acids. Glomerular filtration rate (GFR) The volume of water filtered out of the plasma through glomerular capillary walls into Bowman’s capsules per unit of time. G-protein Any of a class of GTP (energy-rich nucleotide analogous to ATP)- binding proteins that undergo GTP hydrolysis to activate signal trans- duction pathways in response to extracellular signals such as growth factor stimulation. Heterozygous Two different alleles, each at the same position on homologous chromosomes. High density lipoprotein (HDL) A complex of lipids and proteins that functions as a transporter of cholesterol in the blood and which, in high concentrations, is associated with a decreased risk of atherosclerosis and coronary heart disease.

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0 APPENDIX A Histone Any of several small simple proteins that are most commonly found in association with DNA in chromatin and are rich in the basic amino acids lysine and arginine. Homozygous Two identical alleles, each at the same position on homologous chromosomes. Human chorionic gonadotropin (HCG) A hormone that is secreted by the placenta during early pregnancy to maintain corpus luteum function and stimulate placental progesterone production; is commonly tested for as an indicator of pregnancy. Hydrodensitometry Method of body composition measurement applying Archimedes’ prin- ciple by submerging subject in water. Hyperemesis gravidarum Severe and prolonged vomiting during pregnancy. Hyperinsulinemia Also spelled hyperinsulinaemia. The presence of excess insulin in the blood. Hypertension Abnormally high arterial blood pressure that is usually indicated by an adult systolic blood pressure of 140 mm Hg or greater or a diastolic blood pressure of 90 mm Hg or greater, is chiefly of unknown cause but may be attributable to a preexisting condition (such as a renal or endocrine disorder), that typically results in a thickening and inelastic- ity of arterial walls and hypertrophy of the left heart ventricle, and that is a risk factor for various pathological conditions or events (such as heart attack, heart failure, stroke, end-stage renal disease, or retinal hemorrhage). Hypoxia Insufficient levels of oxygen in blood or tissue. In utero In the uterus. Intracellular water (ICW) The water within the tissue cells. Intrauterine growth restriction (IUGR) Also called intrauterine growth retardation. A condition resulting in a fetal weight less than the tenth percentile of predicted weight for gestational age, in which there is a pathological process present that prevents expression of normal growth potential.

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0 WEIGHT GAIN DURING PREGNANCY Ketone Any of a class of organic compounds having a carbonyl group linked to a carbon atom in each of two hyrdrocarbon radicals. Ketonemia Also called hyperketonemia. A condition marked by an abnormal in- crease of ketone bodies in the circulating blood. Large-for-gestational age (LGA) Usually defined as birth weight above the 90th percentile for gestational age, based on a given reference population. Lipolysis The decomposition of lipids by a reaction with water. Low birth weight (LBW) Infant birth weight less than 2,500 grams. Macrosomia Abnormally large size of the body; in this report it is defined as an infant being born at a weight larger than 4,500 g. Menarche Initiation of menstruation. Metabolic syndrome Also called insulin resistance syndrome, Metabolic Syndrome X. A group of conditions that increase risk of heart disease, diabetes, and stroke. The five conditions are: high blood pressure, high blood sugar levels, high levels of circulating triglycerides, low levels of circulating HDL, and excess fat in the abdominal area. Methylation One of the primary mechanisms of regulating gene expression; hyper- or hypo-methylation of a gene promoter region enhances or suppresses gene expression. Monozygotic twins Originating from a single fertilized ovum, applied to identical twins. Multiple pregnancy Carrying more than one fetus, e.g., twins or triplets. Net weight gain Total gestational weight gain minus the infant’s birth weight. Nullipara A woman who has never given birth. Obesity Increased body weight caused by excessive accumulation of fat.

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0 APPENDIX A Observational studies Study types that follow a population (either prospectively or retrospec- tively) to examine how exposure to risk factors influences one’s prob- ability of developing a disease in the absence of intervention; includes cross-sectional studies, cohort studies, and case-control studies. Odds ratio (OR) In a case-control study (see above), the exposure odds among cases compared to the exposure odds among controls, where the exposure odds are the number of individuals with the exposure relative to the number of individuals without the exposure (e.g., if 3 out of 10 people are exposed, then the exposure odds are 3:7). Osmolarity The osmotic concentration of a solution expressed as osmoles of solute per liter of solution. Parity The number of children previously born to a woman. Phenotype Physical, biochemical, and physiologic makeup of an individual; deter- mined by genetic and environmental factors. Physical activity level (PAL) As an energy component, the ratio of total energy expenditure (TEE) to basal daily energy expenditure (BEE). Placenta The membranous vascular organ in female mammals that permits metabolic interchange between fetus and mother. It develops during pregnancy from the chorion of the embryo and the decidua basalis of the maternal uterus, and permits the absorption of oxygen and nutri- tive materials into the fetal blood and the release of carbon dioxide and nitrogenous waste from it, without the direct mixing of maternal and fetal blood. Placenta previa A complication of pregnancy in which the placenta grows in the lowest part of the womb (uterus) and covers all or part of the opening to the cervix. Plasma volume Measure of volume of plasma in the blood. Postpartum Of or occurring in the period shortly after childbirth. Postterm birth Birth occurring after a gestation of 42 or more weeks.

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0 WEIGHT GAIN DURING PREGNANCY Preconceptional period A period from 1 to 3 months prior to gestation through the first 6 weeks of gestation. Preeclampsia A toxic condition developing in late pregnancy characterized by a sud- den rise in blood pressure, generalized edema, proteinuria, severe head- ache, and visual disturbances that may result in eclampsia (convulsive or coma state) if untreated. Pregnancy-induced hypertension Encompasses isolated non-proteinuric hypertension, pre-eclampsia or proteinuric, hypertension, and eclampsia; occurs in 5-15 percent of pregnancies, and is a major cause of obstetric and perinatal morbidity and mortality. Pregravid Preceding pregnancy. Prenatal Preceding birth. Preterm birth Birth occurring after a gestation of less than 37 weeks. Progesterone A steroid hormone secreted by the corpus luteum and by the placenta that acts to preparethe uterus for implantation of the fertilized ovum, to maintain pregnancy, and to promote the development of the mammary glands. Prolactin Also called luteotropic hormone; luteotropin; mammotropin. A pitu- itary hormone that induces and maintains lactation in the mammary glands. Prospective cohort study Also called prospective observational study; follow-up study; incidence study. An epidemiological and observational study in which a defined group of persons known to be exposed to a potential disease risk factor is followed over time and compared to a group of persons who were not known to be exposed to the potential risk factor, in order to evalu- ate the differences in rates of the outcome. Proteinuria Excessive amounts of protein in the urine. Renin A proteolytic enzyme of the blood that is produced and secreted by the juxtaglomerular cells of the kidney and hydrolyzes angiotensinogen to angiotensin I (the physiologically active form of angiotensin).

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0 APPENDIX A Resistin A cysteine-rich peptide hormone found generally as an oligomer and produced in adipocytes (fat cells) during their differentiation. Resistin production in adipose tissue increases during lipolytic conditions often associated with insulin resistance. Sequence variation Variants in the 3-letter codons that comprise a DNA sequence, that can translate to either the same protein as non-variant codons or to a mutated protein. Serum cholesterol Cholesterol that travels in the blood in distinct particles contain- ing both lipids and proteins. Three major classes of lipoproteins are found in the serum of a fasting individual: low-density lipoprotein (LDL), high-density lipoprotein (HDL), and very-low-density lipopro- tein (VLDL). Another lipoprotein class, intermediate-density lipopro- tein (IDL), resides between VLDL and LDL; in clinical practice, IDL is included in the LDL measurement. Sex hormone binding globulin Glycoprotein possessing high affinity binding for 17 beta-hydroxysteriod hormones such as testosterone and oestradiol. Shoulder dystocia Difficulty in delivering the shoulders of the fetus through the birth canal after its head has emerged. Single nucleotide polymorphism (SNP) Points in the genome sequence where a single nucleotide variant that occurs within a population or group. Skinfold thickness measurements Method of assessing the size of the subcutaneous fat depot. Measure- ments are usually taken in the triceps, the biceps, the subscapular (just below and laterally to the inferior angle of the left scapula), or the suprailiac area (the midaxillary line immediately superior to the iliac crest). Small-for-gestational age (SGA) Smaller in size than is normal for the embryo/fetus’ gender and gesta- tional age; occurs when an embryo/fetus undergoes intrauterine growth restriction. Standard deviation (SD) A statistic that shows how tightly all the various data points are clus- tered around the mean in a set of data. Syncytiotrophoblast microparticle (STBM) Interact with both immune and endothelial cells; may contribute to the

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0 WEIGHT GAIN DURING PREGNANCY systematic inflammatory response of both normal and preeclamptic pregnancies. Thyroxine An iodine-containing hormone that is produced by the thyroid gland, increase the rate of cell metabolism, regulates growth, and is made synthetically for treatment of thyroid disorders. Total energy expenditure (TEE) The sum of basal energy expenditure, thermic effect of food (energy expended during food consumption), physical activity, thermoregula- tion (body’s regulation of heat), and the energy expended in depositing new tissues and in producing milk. Triglyceride Also called neutral fat. Any of a group of lipids that are esters formed from one molecule of glycerol and three molecules of one or more fatty acids. Triglycerides are widespread in adipose tissue, commonly circulate in the blood in the form of lipoproteins, and are the chief constituent of fats and oils. Trophoblast Also called trophoderm. The outer layer of the blastocyst that attaches the fertilized ovum to the uterine wall and serves as a nutritive pathway for the embryo. Urea Also called carbamide. A soluble weakly basic nitrogenous compound that is the chief nitrogenous component of mammalian urine and an end product of protein metabolism and decomposition and that is ad- ministered intravenously as a diuretic drug. Uterus Also called womb. A hollow muscular organ in the pelvic cavity of female mammals that functions to contain and usually nourish the young during development prior to birth, and that consists of a body, fundus, isthmus, and cervix, and in which the fertilized egg implants and develops into the fetus. Very low birth weight (VLBW) Infant birth weight less than 1,500 grams.

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0 WEIGHT GAIN DURING PREGNANCY SUPPLEMENTAL INFORMATION ON PUBLIC HEALTH SURVEYS OF PREGNANT WOMEN, INFANTS, AND CHILDREN TABLE A-1 Description and Comparison of Public Health Surveys of Pregnant Women, Infants, and Children Survey Objectives Population/Data Collection Infant Feeding Practices To understand and improve Approximately 4,000 pregnant Survey II (IFPS-II) the health of mothers women from across the nation and children by collecting began their participation in information on infant the Infant Feeding Practices feeding behaviors and Study II (IFPS-II) between factors influencing infant May and December 2005 feeding choices and approximately 2,000 continued their participation through their infant’s first year. To qualify, a healthy women gave birth to one healthy, full-term or near-term infant weighing at least 5 pounds at birth. Data were collected using mailed questionnaires, with the exception of a brief telephone interview near the time of the infant’s birth. Pediatric Nutrition To collect, analyze, and Data are collected for infants, Surveillance System disseminate data to guide children, and adolescents from (PedNSS) public health policy and birth to 20 years of age who action go to public health clinics for routine care, nutrition education, and supplemental foods. Data is collected at the clinic level then aggregated at the state level and submitted to CDC for analysis. Forty states, 1 U.S. Territory, 5 Indian Tribal Organizations, and the District of Columbia participated in 2007.

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 APPENDIX A Data Source Available Data Strengths/Limitations A nationally distributed • Foods fed to infants, Strengths: consumer opinion panel including breast milk and • Large sample size of more than 500,000 infant formula • Prospective design U.S. households • Factors that may • Extensive testing of survey contribute to infant question feeding practices and to • Data collected on infants’ breastfeeding success feeding pattern were extremely • Mothers’ intrapartum detailed hospital experiences, • Frequency of questionnaires sources of support, and • Coverage of a wide number of postpartum depression issues • Mothers’ employment • Maternal dietary data available status and child care on prenatal and month 3 survey arrangements respondents • Infant sleeping Limitations: arrangements • Sample was not representative • Other issues such as food of the U.S. population allergies, experiences with • Nutrient intake not formally breast pumps, and WIC assessed participation • Data were self-reported • Diets of pregnant and postpartum women Special Supplemental • Demographic information Strengths: Nutrition Program for (clinic, county, date • Because it is representative Women, Infants, and of birth, date of visit, of the population served by Children (WIC) race/ethnicity, sex, zip the public health program Early and Periodic code, household income, submitting the surveillance data, Screening, Diagnosis, migrant status, and it is essential for use in planning, and Treatment Program source of data) implementing, monitoring, and (EPSDT) • Anthropometry (birth evaluating the nutritional status Title V Maternal and weight, length/height, and of children served by a specific Child Health Program weight) public health program (MCH) • Anemia (hemoglobin and Limitations: hematocrit) • Not all contributors for a • Infant feeding practices specific public health program (breastfeeding initiation, participate and therefore data duration, and exclusivity) is not representative of all WIC • Health risk behaviors programs (TV/Video viewing, • Not representative of all low- smoking in the income children or children in household) the general population continued

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 WEIGHT GAIN DURING PREGNANCY TABLE A-1 Continued Survey Objectives Population/Data Collection Pregnancy Nutrition To collect, analyze, Low-income pregnant Surveillance System (PNSS) interpret, and disseminate women who participate in data to guide public health federally funded public health policy and action programs. Data are collected at prenatal and postpartum clinic visits, and are aggregated at the contributor or state level and then submitted to CDC on a quarterly basis. Twenty-six states, 1 U.S. territory and 5 Indian Tribal Organizations participated in 2006. Pregnancy Risk Assessment To improve the health of Women who have had a recent Monitoring System mothers and infants by live birth (drawn from state (PRAMS) reducing adverse outcomes birth certificate file). such as low birth weight, Selected women are first and maternal and infant contacted by mail or morbidity or mortality interviewed by telephone. Thirty-seven states, New York City and the Yankton Sioux Tribe currently participate. SOURCES: CDC, Infant Feeding Practices Survey 2 (http://www.cdc.gov/ifps/); Fein et al., 2008; CDC, Pediatric and Pregnancy Nutrition Surveillance System (http://www.cdc.gov/ pednss/index.htm); CDC, Pregnancy Risk Assessment Monitoring System (http://www.cdc. gov/prams/).

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 APPENDIX A Data Source Available Data Strengths/Limitations Special Supplemental • Demographic Indicators Strengths: Nutrition Program for (source of data, race/ • Because it is representative Women, Infants, and ethnicity, woman’s of the population served by Children (WIC) age, education, % the public health program Title V Maternal and poverty level, program submitting the surveillance Child Health Program participation and migrant data, it is essential data for (MCH) status) use in planning, implementing, • Maternal Health monitoring, and evaluating the Indicators (prepregnancy nutritional status of women BMI, maternal weight served by a specific public health gain anemia, parity, program interpregnancy • Height and weight at first interval, diabetes prenatal visit measured by during pregnancy and clinician hypertension during Limitations: pregnancy) • Contributors voluntarily • Maternal Behavioral participate in PNSS and Indicators (medical not all contributors for a care, WIC enrollment specific public health program and multivitamin participate in PNSS, therefore it consumption) is not representative of all WIC • Smoking/Drinking programs Indicators (smoking, • Not representative of all low- smoking changes, income pregnant women or smoking in household pregnant women in the general and drinking) population • Infant Health Indicators • Prepregnancy weight and (birth weight, preterm gestational weight gain are birth, full term low birth self-reported weight and breastfeeding initiation) State-specific, • Changes in maternal and Strengths: population-based child health indicators • Provides data not available from data from birth (unintended pregnancy, other sources about pregnancy certificate files on prenatal care, breast- and the first few months after maternal attitudes and feeding, smoking, birth experiences before, drinking, infant health) • Gestational weight gain during, and after is recorded from the birth pregnancy certificate Limitations: • Height and prepregnancy weight are self-reported

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 WEIGHT GAIN DURING PREGNANCY REFERENCE Fein S. B., J. Labiner-Wolfe, K. R. Shealy, R. Li, J. Chen and L. M. Grummer-Strawn. 2008. Infant Feeding Practices Study II: study methods. Pediatrics 122(Suppl 2): S28-35. Websites: http://www.cdc.gov/ifps/ http://www.cdc.gov/pednss/index.htm http://www.cdc.gov/prams/