Latina Mom and Baby Health Research: Maternal Obesity

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This is part of our Latina Mom and Baby Health: A Research Review »

Maternal obesity a factor

Studies have shown that maternal obesity and lower social class are both associated with a tendency to formula feed and a greater risk of obesity in children.4 In fact, parental obesity is considered a strong predictor of obesity in offspring, which can be due to both environmental and genetic components.5,6

Results from the Viva La Familia Study in 2009 outlined genetic and environmental risk factors linked to childhood obesity in 1,030 Latino children from Houston.7 Findings confirmed that maternal obesity was indeed an independent risk factor for childhood obesity within this population; Latina mothers ≥30 kg/m2 gave birth to children that were 1.8 times more likely to be obese.7

Another study of Latino families in 2009 corroborated that maternal BMI positively correlated with a child’s weight.8 The association between maternal weight and childhood obesity is of particular interest for the Latino community, as nearly 50 percent of Latina mothers are overweight or obese when entering pregnancy, and are more likely to fall within these categories versus non-Latino white mothers.9–13

Gestational weight gain associated with increased risk

Gestational weight gain (GWG) during pregnancy has also been associated with an increased risk of obesity in offspring.14–18 A multicenter cohort study in 12 U.S. sites demonstrated that each 1 kg of GWG correlated with a 3 percent increase in the odds of the child being overweight at age 7.18

This was recently supported by a study of Greek mothers and their children, where a 1 kg increase in GWG yielded a 1.014 times greater risk of the child being overweight/obese by age 8; this risk was even greater among mothers who exceeded the Institute of Medicine (IOM) maternal weight gain recommendations.19

In addition, children in this study were less likely to be overweight/obese if the mother reported moderate exercise during pregnancy versus remaining sedentary. These findings stress the importance of physical activity and healthy GWG during pregnancy in order to promote healthy childhood weight. They also suggest that healthcare practitioners should advise women to maintain GWG within a specified range and to undertake moderate exercise during pregnancy.

Physical activity during pregnancy: Issues

Several professional associations in the United States currently outline recommendations surrounding physical activity during pregnancy. For instance, ACOG recommends that pregnant women are allowed to undertake 30 or more minutes of moderate exercise on most, if not all days of the week, assuming there are no health problems or obstetric complications.20

In addition, the American Ministry of Health suggests that pregnant women participate in at least 150 minutes of moderate-intensity aerobic exercise a week, even if they did not participate in such activities before pregnancy.21

Looking specifically at Latinos during pregnancy, this ethnic group is the most physically inactive in the United States.22,23

Studies have shown that Latino women are only half as likely to comply with ACOG guidelines for physical activity during pregnancy versus non-Latino whites.23,24 In addition, 52 percent of overweight and 75 percent of obese Latino women experience excessive GWG that exceeds IOM guidelines.25 In addition, high BMI and excessive GWG appear to be increasing over time for Latina women.26,27

Although few studies have assessed the underlying factors influencing GWG among Latina mothers, focus groups of Latina prenatal care patients reported receiving advice on GWG primarily from nutritionists and family members, as opposed to their physicians.28 For overweight/obese women, the majority did not receive any recommendations on the topic of GWG from their physicians. The lack of physician-guided instruction on this topic may be especially problematic for Latina mothers, as family members commonly perceived GWG as leading to a healthier baby, while also emphasizing that rest during pregnancy, rather than exercise, is important for protecting the baby.28,29

Several studies have investigated factors that may act as barriers or facilitators to physical activity during pregnancy among Latina women. Findings from a focus group series among Mexican women demonstrated that knowledge of how to exercise safely during pregnancy and concern over unsafe streets were two major barriers to physical activity in this population.30

Another focus group-based study among Mexican women identified social isolation, lack of social support from husbands, a lack of friends to exercise with, and a lack of childcare as barriers.29 The lack of social support as a barrier was reported more commonly by Latina women compared with non-Latino white or African American focus groups.31

Focus groups of Puerto Rican and Dominican women identified barriers including physical limitations and restrictions, and a lack of resources, energy, and time.32 Conversely, powerful facilitators of physical activity during pregnancy included factors such as social support, access to resources, information, and proper diet.32

Physical activity during pregnancy: Solutions

In the Proyecto Buena Salud prospective cohort study of patients with Puerto Rican/Dominican heritage, 45 percent of Latina women were overweight or obese prior to pregnancy and the number of women who met ACOG guidelines for sports/exercise activity decreased from 24.7 percent in pre-pregnancy to 7.1 percent in early pregnancy.33

By including household/caregiving, transportation, and occupational activities into physical activity calculations, the number of Latina women meeting ACOG standards was higher, but still decreased from 69.7 percent pre-pregnancy to 45 percent in early pregnancy. Notably, household/caregiving activities comprised between 56 percent and 60 percent of all perinatal activity for Latina women. Interestingly, those with one or more children and those with the highest levels of activity pre-pregnancy were less likely to become inactive during pregnancy. This suggests that targeting inactive women prior to the onset of pregnancy may benefit physical activity levels during pregnancy.

In 2011, the Behaviors Affecting Baby and You study investigated the impact of an individually tailored 12-week exercise program in a population of patients that was 60 percent Latino.34

Overall, 86 percent of participants reported that the study materials were interesting and useful. Following the intervention, pregnant women in the exercise group had a smaller decrease in total activity and a greater increase in sports/exercise compared with controls.34 These findings support the concept that interventions aimed at increasing physical activity during pregnancy may be beneficial and well received in Latino populations.

Two recent meta-analyses went on to conclude that interventions aimed at increasing physical activity during pregnancy may lead to less GWG compared with controls.35,36 However, the ability of increased physical activity to lower GWG has been limited and most studies focus on non-Latino white populations.

In the prospective Proyecto Buena Salud study, over half (51.9%) of the 1,276 pregnant Latina women participating experienced excessive GWG according to IOM guidelines.37 Those with higher levels of education, those who were overweight prior to pregnancy, and those who lived longer in the U.S. showed a significantly greater risk for excessive GWG. While those who did not comply with physical activity guidelines in late pregnancy tended to have greater and more rapid GWG versus those who met guidelines, this study showed that even the highest levels of physical activity during pregnancy were not sufficient to prevent excessive GWG overall.

These findings demonstrate the need for additional studies assessing the possibility of increasing physical activity during pregnancy in Latina women in an effort to better control GWG.

Additional studies investigating the link between perinatal physical activity, GWG, and offspring obesity in Latino populations are also needed, as well as interventions facilitating social support, providing information and resources, and promoting the benefits of physical activity during pregnancy among Latina women.

More from our Latina Mom and Baby Health: A Research Review »

References for this section »

4. Owen CG, Martin RM, Whincup PH, Smith GD, Cook DG. Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence. Pediatrics. 2005;115(5):1367-1377. doi:10.1542/peds.2004-1176.

5. Poskitt EM, Cole TJ. Nature, nurture, and childhood overweight. Br Med J. 1978;1(6113):603-605.

6. Maffeis C, Micciolo R, Must A, Zaffanello M, Pinelli L. Parental and perinatal factors associated with childhood obesity in north-east Italy. Int J Obes Relat Metab Disord J Int Assoc Study Obes. 1994;18(5):301-305.

7. Butte NF. Impact of infant feeding practices on childhood obesity. J Nutr. 2009;139(2):412S – 6S. doi:10.3945/jn.108.097014.

8. Villa-Caballero L, Arredondo EM, Campbell N, Elder JP. Family history of diabetes, parental body mass index predict obesity in Latino children. Diabetes Educ. 2009;35(6):959-965. doi:10.1177/0145721709348069.

9. Chu SY, Callaghan WM, Bish CL, D’Angelo D. Gestational weight gain by body mass index among US women delivering live births, 2004-2005: fueling future obesity. Am J Obstet Gynecol. 2009;200(3):271.e1-e7. doi:10.1016/j.ajog.2008.09.879.

10. Taveras EM, Gillman MW, Kleinman K, Rich-Edwards JW, Rifas-Shiman SL. Racial/ethnic differences in early-life risk factors for childhood obesity. Pediatrics. 2010;125(4):686-695. doi:10.1542/peds.2009-2100.

11. Kieffer EC, Tabaei BP, Carman WJ, Nolan GH, Guzman JR, Herman WH. The influence of maternal weight and glucose tolerance on infant birthweight in Latino mother-infant pairs. Am J Public Health. 2006;96(12):2201-2208. doi:10.2105/AJPH.2005.065953.

12. Chasan-Taber L, Fortner RT, Gollenberg A, Buonnaccorsi J, Dole N, Markenson G. A prospective cohort study of modifiable risk factors for gestational diabetes among Hispanic women: design and baseline characteristics. J Womens Health (Larchmt). 2010;19(1):117-124. doi:10.1089/jwh.2009.1416.

13. Chasan-Taber L, Schmidt MD, Pekow P, Sternfeld B, Solomon CG, Markenson G. Predictors of excessive and inadequate gestational weight gain in Hispanic women. Obesity (Silver Spring). 2008;16(7):1657-1666. doi:10.1038/oby.2008.256.

14. Oken E, Taveras EM, Kleinman KP, Rich-Edwards JW, Gillman MW. Gestational weight gain and child adiposity at age 3 years. Am J Obstet Gynecol. 2007;196(4):322.e1-e8. doi:10.1016/j.ajog.2006.11.027.

15. Rooney BL, Mathiason MA, Schauberger CW. Predictors of obesity in childhood, adolescence, and adulthood in a birth cohort. Matern Child Health J. 2011;15(8):1166-1175. doi:10.1007/s10995-010-0689-1.

16. Mamun AA, Callaway LK, O’Callaghan MJ, et al. Associations of maternal pre-pregnancy obesity and excess pregnancy weight gains with adverse pregnancy outcomes and length of hospital stay. BMC Pregnancy Childbirth. 2011;11:62. doi:10.1186/1471-2393-11-62.

17. Schack-Nielsen L, Michaelsen KF, Gamborg M, Mortensen EL, Sørensen TIA. Gestational weight gain in relation to offspring body mass index and obesity from infancy through adulthood. Int J Obes (Lond). 2010;34(1):67-74. doi:10.1038/ijo.2009.206.

18. Wrotniak BH, Shults J, Butts S, Stettler N. Gestational weight gain and risk of overweight in the offspring at age 7 y in a multicenter, multiethnic cohort study. Am J Clin Nutr. 2008;87(6):1818-1824.

19. Mourtakos SP, Tambalis KD, Panagiotakos DB, et al. Maternal lifestyle characteristics during pregnancy, and the risk of obesity in the offspring: a study of 5,125 children. BMC Pregnancy Childbirth. 2015;15(1):66. doi:10.1186/s12884-015-0498-z.

20. ACOG Committee opinion. Number 267, January 2002: exercise during pregnancy and the postpartum period. Obstet Gynecol. 2002;99(1):171-173.

21. 2008 Physical Activity Guidelines for Americans: Index. http://www.health.gov/paguidelines/guidelines/. Accessed June 15, 2015.

22. Giardina E-G V., Laudano M, Hurstak E, et al. Physical activity participation among Caribbean Hispanic women living in New York: relation to education, income, and age. J Womens Health (Larchmt). 2009;18(2):187-193. doi:10.1089/jwh.2008.0946.

23. Evenson KR, Wen F. National trends in self-reported physical activity and sedentary behaviors among pregnant women: NHANES 1999-2006. Prev Med (Baltim). 2010;50(3):123-128. doi:10.1016/j.ypmed.2009.12.015.

24. Evenson KR, Savitz DA, Huston SL. Leisure-time physical activity among pregnant women in the US. Paediatr Perinat Epidemiol. 2004;18(6):400-407. doi:10.1111/j.1365-3016.2004.00595.x.

25. Siega-Riz AM, Adair LS, Hobel CJ. Institute of Medicine maternal weight gain recommendations and pregnancy outcome in a predominantly Hispanic population. Obstet Gynecol. 1994;84(4):565-573.

26. Schieve LA, Cogswell ME, Scanlon KS. Trends in pregnancy weight gain within and outside ranges recommended by the Institute of Medicine in a WIC population. Matern Child Health J. 1998;2(2):111-116.

27. Helms E, Coulson CC, Galvin SL. Trends in weight gain during pregnancy: a population study across 16 years in North Carolina. Am J Obstet Gynecol. 2006;194(5):e32-e34. doi:10.1016/j.ajog.2006.01.025.

28. Tovar A, Chasan-Taber L, Bermudez OI, Hyatt RR, Must A. Knowledge, attitudes, and beliefs regarding weight gain during pregnancy among Hispanic women. Matern Child Health J. 2010;14(6):938-949. doi:10.1007/s10995-009-0524-8.

29. Thornton PL, Kieffer EC, Salabarría-Peña Y, et al. Weight, diet, and physical activity-related beliefs and practices among pregnant and postpartum Latino women: the role of social support. Matern Child Health J. 2006;10(1):95-104. doi:10.1007/s10995-005-0025-3.

30. Kieffer EC, Willis SK, Arellano N, Guzman R. Perspectives of pregnant and postpartum latino women on diabetes, physical activity, and health. Heal Educ Behav Off Publ Soc Public Heal Educ. 2002;29(5):542-556.

31. Evenson KR, Moos M-K, Carrier K, Siega-Riz AM. Perceived barriers to physical activity among pregnant women. Matern Child Health J. 2009;13(3):364-375. doi:10.1007/s10995-008-0359-8.

32. Marquez DX, Bustamante EE, Bock BC, Markenson G, Tovar A, Chasan-Taber L. Perspectives of Latina and non-Latina white women on barriers and facilitators to exercise in pregnancy. Women Health. 2009;49(6):505-521. doi:10.1080/03630240903427114.

33. Lynch KE, Landsbaugh JR, Whitcomb BW, Pekow P, Markenson G, Chasan-Taber L. Physical activity of pregnant Hispanic women. Am J Prev Med. 2012;43(4):434-439. doi:10.1016/j.amepre.2012.06.020.

34. Chasan-Taber L, Silveira M, Marcus BH, Braun B, Stanek E, Markenson G. Feasibility and efficacy of a physical activity intervention among pregnant women: the behaviors affecting baby and you (B.A.B.Y.) study. J Phys Act Health. 2011;8 Suppl 2:S228-S238.

35. Streuling I, Beyerlein A, von Kries R. Can gestational weight gain be modified by increasing physical activity and diet counseling? A meta-analysis of interventional trials. Am J Clin Nutr. 2010;92(4):678-687. doi:10.3945/ajcn.2010.29363.

36. Streuling I, Beyerlein A, Rosenfeld E, Hofmann H, Schulz T, von Kries R. Physical activity and gestational weight gain: a meta-analysis of intervention trials. BJOG an Int J Obstet Gynaecol. 2011;118(3):278-284. doi:10.1111/j.1471-0528.2010.02801.x.

37. Chasan-Taber L, Silveira M, Lynch KE, Pekow P, Solomon CG, Markenson G. Physical activity and gestational weight gain in Hispanic women. Obesity (Silver Spring). 2014;22(3):909-918. doi:10.1002/oby.20549.

By The Numbers By The Numbers

84

percent

of Latino parents support public funding for afterschool programs.

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