PERCEIVED WEIGHT GAIN RISK AND NUTRITION IN PREGNANCY

PERCEIVED WEIGHT GAIN, RISK, AND NUTRITION IN PREGNANCY IN FIVE RACIAL GROUPS Dorothy Brooten, Jo. Anne M. Youngblut, Susan Golembeski, Marcia H. Magnus &Jean Hannan Presented by Aubrey Mahall

Obesity and Pregnancy Statistics: � Almost half of all pregnant women in the nation gain more than they should during pregnancy. � Nearly 60% of expectant mothers enter their pregnancy as obese or overweight. Significance to baby and mother: � Women retain weight postpartum. � Newborns of obese mothers have higher rates of morbidity. � Excessive weight gain associated with several delivery complications.

Previous Research Prepregnancy weight has increased 20%-40% over the past several decades Racial/cultural diverse backgrounds need to be explored to understand difference in viewpoint Intervention studies to reduce weight gain during pregnancy have mixed results and high dropout rates.

What about OBGYN’s? Knowledge: � Some felt inadequate and learned more from magazines about counseling pregnancy nutrition. Sensitivity: � All agreed weight gain was a too-sensitive topic. Recommended Range: � 4 nurse practitioners only gave a range when women asked. � 1 OBGYN inc. range as to not stress the patient. Effectiveness: � Some felt that cultural and family would out-rule what they told patients.

Purpose To examine pregnant women’s perception of weight gain needed during pregnancy, perceived risks of excessive weight and underweight on mother and newborn, perception of actual, ideal, and realistic body size and nutritional intake during pregnancy in five racial groups.

Five Racial Groups Caribbean Black 7 � (e. g. , Jamaican, Belize, Barbados) African-American Black 12 Caribbean Hispanic 17 � (e. g. , Cuban Puerto Rican, Dominican) Central American Hispanic 9 � (e. g. , Mexican, Nicaraguan, Honduran) White Non-Hispanics 9

Sample Participants 54 participants total Mean age 28. 6 BMI proportions: � 8 (14. 8%) underweight � 25 (46. 3%) normal weight � 9 (16. 7%) overweight � 12 (22. 2%) obese

Study design & methods Cross-sectional- qualitative Recruited from physician practices in Miami � Women prior to 20 weeks gestation given a flyer � RN gave women questionnaires � Completion took 45 -60

Instruments 1: Perceived weight gain � Measured by asking women to indicate the number of pounds they believed they specifically needed to gain during pregnancy. 2: Perceived risk for maternal and infant complications � Eight visual analog scales: “no risk, ” “great risk, ” and rated their perceived risk for both women and babies

Instruments cont. 3: Perceived prepregnant actual, ideal, and realistic body size. � BIA-O � (1) as you perceive (2) you most prefer (3) realistic to maintain over a long period of time 4: Nutritional intake during pregnancy. � FFQ (110 item) � Eight-opened ended questions about encouraged and restricted foods per culture

Results: Perceived weight gain needed and risk Pounds to gain African American Caribbean Black Caribbean Hispanic Central American Hispanic White 27. 1 20. 4 22. 9 30. 6 29. 4 • In relation to their BMI, 13 women thought they should gain less, 25 women were within recommended gain range, and 14 women thought they should gain more. • Overweight status considered risk to mother, but not baby.

Results: Perceived prepregnancy body size White Non-Hispanic women reported smaller prepregnant ideal and realistic body sizes than the other four groups. Caribbean Black and Caribbean Hispanic reported highest discrepancies between actual and ideal sizes. Central American Hispanic women desired slightly larger ideal and realistic body sizes.

Results: Nutritional intake during pregnancy Rec. Intake African Caribbea America n Black n n Hispanic Central Am. Hispanic White Calories 1900 -2500 3136 1842 2058 2029 1538 Total Fat n/a 131 72 86 77 61 Dietary Iron 22 mg 23 13 15 14 12 Diet Folate 600 -800 887 515 654 651 482

Restricted/Encouraged Foods Encourage d foods African American Caribbean Black Caribbean Hispanic Poultry, fish, vegetables, collards, yams, beans, fruits Milk, curry goat, curry chicken, fish, vegetables, fruit, yams, rice, green plantains Condensed Milk, milk, fish, yogurt, liver, meat, fish, poultry, beets, fruit, vegetables, highlentils, high calcium, -iron foods, high-iron oatmeal foods Restricted Fried foods High carb snacks, conch Central American Hispanic White Milk, red meat Spicy food, Fish, raw sushi, shellfish, clams, caffeine raw sushi, shrimp, lox, tuna lobster, shellfish

Analysis/Implications 39% of women in the sample were already overweight or obese In general, women perceived relatively little risk to themselves or baby for being underweight- and associated only slight risks to mother being overweight Culture backgrounds yield extreme differences in ideals, norms, and standards for body size and nutrition.

Limitations Sample too diverse? Generalizability? � Sample size Self-reports � FFQ � Prepregnancy weight and height

Strengths Diverse cultures/ethnicities represented � Detailed grouping Pilot study

BB Questions: Anne: Do you think their perception of themselves being wrong could have a relationship with how much weight they think they needed to gain versus what they did actually gain? Do you think their dissatisfaction of their own body could have had an influence on their weight gain as well? Kirstie: � Once again, a referral to an RD would be most appropriate. We have also discussed in class that RD's may not be covered under insurance. How do you think we can change this process to become more involved with the pregnant population?

Sources Brooten D, Youngblut J, Golembeski S, Magnus M, Hannan J. Perceived weight gain, risk, and nutrition in pregnancy in five racial groups. Journal Of The American Academy Of Nurse Practitioners [serial online]. January 2012; 24(1): 32 -42. Available from: Academic Search Complete, Ipswich, MA. Accessed March 6, 2013. Stotland N, Gilbert P, Bogetz A, Harper C, Abrams B, Gerbert B. Preventing Excessive Weight Gain in Pregnancy: How Do Prenatal Care Providers Approach Counseling? . Journal Of Women's Health [serial online]. April 2010; 19(4): 807 -814. Available from: Academic Search Complete, Ipswich, MA. Accessed October 15, 2012. Boardley DJ, Sargent RG, Coker A, Hussey J, Sharpe P. The relationship between diet, activity, and other factors, and postpartum weight change by race. Obesity & Gynecology [serial online]. Nov 1995; 86(5): 834 -838 Available from: Pub. Med. Accessed March 11, 2013. Kumanyika S, Krebs-Smith S. Preventive nutrition issues in ethnic and socioeconomic groups in the United States. Preventive nutrition, Volume II Primary and Secondary Prevention [serial online]. May 2000. Available from Pub. Med. Accessed March 8, 2013.