perceived weight gain, risk, and nutrition in pregnancy in five racial groups presented by aubrey...
TRANSCRIPT
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.