Influence of Pregnancy Weight on Maternal and Child Health Workshop Report (2007) / Chapter Skim
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6 Promoting Appropriate Maternal Weight During and After Pregnancy
6 Promoting Appropriate Maternal Weight During and After Pregnancy
Pages 65-79
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From page 65... ...
In addition to the presentations on determinants of gestational weight gain summarized in Chapter 3, the approaches described in this chapter may help guide Title V maternal and child health programs to assist women of childbearing age to achieve and maintain recommended weight before, during, and after pregnancy. INDIVIDUAL APPROACHES Rena Wing presented an overview of strategies to encourage appropriate weight gain during pregnancy.
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From page 66... ...
One of the strongest predictors of doing so was their self-reported caloric intake; women who exceeded IOM recommendations reported consuming 2,186 calories per day, about 300 calories more per day than those with optimal gestational weight gain. This study also reported that increased intake of sugar and fat was related to increased risk of excessive gestational weight gain.
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From page 67... ...
If women continued to exceed the gestational weight gain goal, they received either face-to-face counseling at their clinic visits or phone-based counseling. They also received increasingly structured behavioral goals, both for physical activity and for diet.
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From page 68... ...
In another study of postpartum weight retention interventions (e.g., O'Toole et al., 2003) , only 23 of the 40 women finished the program.
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From page 69... ...
Psychosocial Factors During Pregnancy Stress High stress can have an adverse effect on gestational weight gain, either through behavioral pathways that often are not fully specified or biological pathways leading to inadequate or excessive gestational weight gain. The relationship between stress and BMI is curvilinear, not linear.
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From page 70... ...
Depression is hypothesized to have an adverse effect on gestational weight gain through behavioral or biological pathways, which may lead either to inadequate or excessive gestational weight gain. About half of the studies looking at a relationship between depression and pregnancy outcomes reported no effect; the remainder indicated mixed effects for subgroups or different associations between high and low gestational weight gain (Brawarsky et al., 2005; DiPietro et al., 2003; Hickey et al., 1995; Siega-Riz and Hobel, 1997; Stevens-Simon and McAnarnery, 1992; Walker and Kim, 2002; Zuckerman et al., 1989)
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From page 71... ...
Summary of Psychosocial Approaches Although the evidence on how psychosocial factors relate to weight both during pregnancy and postpartum is inconsistent, the impact of psychosocial factors may be underestimated because of measurement and data analytic issues. Future research could provide a better foundation for examining psychosocial factors, with model-driven tests of the impact of psychosocial factors on gestational weight gain and postpartum weight retention, which could build in some of the behavioral components.
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From page 72... ...
The results of this study could be confounded with cultural norms of Cree communities; physical activity is not considered appropriate during pregnancy, and being plump is normal. The second intervention study, Staying in the Range, sought to decrease weight retention at 1-year postpartum by promoting appropriate gestational weight gain in a health care system in Cooperstown, New York (Olson et al., 2004)
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From page 73... ...
Based on the data collected, the intervention had a statistically significant effect on decreasing excessive gestational weight gain in the low-income women only. A three-way interaction among income, treatment, and BMI was found on postpartum weight retention.
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From page 74... ...
The American Academy for Family Physicians does not have specific documents similar to the ACOG committee reports; however, its web site provides information for members about screening and advises physicians to screen all adult patients for obesity and to offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults. The American College of Midwives expresses interest in the topic.
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From page 75... ...
Concerns include availability and cost of nutrition counseling; the number of obese women who will seek preconception counseling; and payment for preconception counseling. The practice pattern of internal medicine physicians concerning preconception counseling for obese women needs to be understood.
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From page 76... ...
A community-based intervention is based on a multilevel sustained approach to promote appropriate gestational weight gain and reduce postpartum weight retention. The study design can include home visits, social support, group classes, goal-setting, skill training, self-monitoring, and feedback.
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From page 77... ...
In addition to these approaches (individual, psychosocial, community, and clinician and health system) , the presentations on determinants of gestational weight gain in Chapter 3 offer insight for Title V maternal and child health programs to help women of childbearing age to achieve and maintain recommended weight before, during, and after pregnancy.
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From page 78... ...
2003 Modifiable behavioral factors in a biopsychosocial model predict inadequate and excessive gestational weight gain. Journal of the American Dietetic Association 103(1)
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From page 79... ...
2003 Psychosocial thriving during late pregnancy: Relationship to ethnicity, gestational weight gain, and birth weight. Journal of Obstetric Gynecologic and Neonatal Nursing 31(3)
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