PERCEIVED WEIGHT GAIN, RISK, AND NUTRITION IN PREGNANCY IN FIVE RACIAL GROUPS

Presented by Aubrey Mahall

Dorothy Brooten, JoAnne M. Youngblut, Susan Golembeski, Marcia H. Magnus &Jean Hannan

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

African America

n

Caribbean Black

Caribbean

Hispanic

Central America

n Hispanic

White

Pounds to gain

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 Americ

an

Caribbean

Black

Caribbean

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

African America

n

Caribbean Black

Caribbean

Hispanic

Central America

n Hispanic

White

Encouraged foods

Poultry, fish,

vegetables,

collards, yams, beans, fruits

Milk, curry goat, curry

chicken, fish,

vegetables, fruit, yams, rice,

green plantains

Condensed milk,

fish, liver, meat,

poultry, beets, fruit,

vegetables, lentils, high-iron

foods, oatmeal

Milk, yogurt, meat, fish,

poultry, vegetable

s, high-calcium, high-iron

foods

Milk, red meat

Restricted foods

Fried foods

High carb snacks, conch

Spicy food, raw

sushi, clams, shrimp, lobster, shellfish

Spicy food, raw

sushi, caffeine

Fish, shellfish,

raw sushi, lox, tuna

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: PubMed. 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 PubMed. Accessed March 8, 2013.