Academic journal article Childhood Obesity

Infant Growth Following Maternal Participation in a Gestational Weight Management Intervention

Academic journal article Childhood Obesity

Infant Growth Following Maternal Participation in a Gestational Weight Management Intervention

Article excerpt

[Author Affiliation]

Emily F. Gregory. 1 General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, MD.

Matthew A. Goldshore. 2 Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

Janice L. Henderson. 3 Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD.

Robert D. Weatherford. 3 Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD.

Nakiya N. Showell. 1 General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, MD.

Address correspondence to: Emily F. Gregory, MD, MHS, Children's Hospital of Philadelphia, 3535 Market Street, Room 1417, Philadelphia, PA, 19104, E-mail: gregorye@email.chop.edu

Introduction

Pediatric obesity is difficult to reverse1-3 and currently has a prevalence of 17% in the United States.4 Prevention is therefore critical to promoting long-term health, particularly among those at high risk for obesity. Maternal obesity is a known risk factor for development of obesity among children.5,6 Currently, close to one third of women becoming pregnant in the United States are obese.4,7,8

Because pediatric obesity develops early in life, obesity prevention starting in the prenatal period is theoretically promising.9 Life course science describes the importance of discrete developmental periods that influence health far into the future. The prenatal period is recognized as a critical period for physiological development, when biological embedding can be protective or harmful for lifelong health.10,11 In addition, pregnancy is an important period for health behavior change. Successful behavior change during pregnancy has been attributed to increased contact with the healthcare system and increased motivation to change.12,13

Obesity during pregnancy increases medical risks for women including increased rates of intrauterine fetal death, pre-eclampsia, and cesarean delivery.14 In 2009, the Institute of Medicine (IOM) issued new guidelines addressing appropriate gestational weight gain (GWG).15 However, only around 30% of women are meeting the recommended GWG targets.16 Obstetrical practice is changing to address these guidelines, and data suggest that meeting IOM guidelines does improve pregnancy outcomes.16-19 Changes in obstetrical practice may also influence offspring growth patterns. However the influence of obstetrical changes on pediatric outcomes remains largely unexamined.

This project assessed one obstetrical clinic's response to increased obesity in their patient population. This clinic's novel obstetrical model aims to limit GWG, but also addresses behaviors relevant to infant feeding, such as portion size and consumption of sugar-sweetened beverages. This clinic is of interest because it represents an early innovation in response to obstetrical obesity, targets a high-risk population of low-income, urban women in the United States, and represents a potentially reproducible clinical model because it does not rely on external grants. Drawing on past work linking infant growth profiles to childhood obesity, we assess whether infants born to mothers who participated in this program demonstrated different growth trends during infancy compared to infants born before the initiation of this program.

Methods

Setting

The Nutrition in Pregnancy clinic (NIP) was established in late 2011 at Johns Hopkins Hospital (Baltimore, MD), an urban tertiary care referral center. Women with Medicaid insurance who have a prepregnancy BMI of 30 kg/m2 or greater are automatically referred to NIP, but may opt to receive care outside of NIP if they have a conflict with the clinic time or prefer a non-NIP clinician. …

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