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Integrating Obstetrical Care and WIC Nutritional Services to Address Maternal Obesity and Postpartum Weight Retention

Abstract

Objective

This pilot study evaluated a cost neutral, integrated Special Supplemental Nutrition Program for Women Infants and Children (WIC) and obstetrical service model designed to prevent postpartum weight retention in obese women.

Methods

A sample of women who received benefits from the Johns Hopkins (JH) WIC program and prenatal care from the JH Nutrition in Pregnancy Clinic, which provides obstetrical care for women with a BMI ≥ 30 kg/m2, participated in the WICNIP randomized clinical trial. Intervention participants received enhanced nutrition services and education at five visits and during one phone call between delivery and 6 months postpartum. Control participants received standard WIC services. Weight data was collected for all participants at multiple time points: pre-pregnancy, delivery, and postpartum at 4, 6 weeks, 4, and 6 months. Maternal socio-demographic factors, obesity class and the number of education contacts received were also recorded.

Results

Fifty-three African-American women were randomized into the intervention and control groups. Intervention participants retained significantly less gestational weight gain than control participants (3.0 ± 11.8 vs. 12.6 ± 20.4, p < 0.05). In both groups, participants with Class III obesity retained significantly less weight than participants in Classes I and II (p = 0.02).

Conclusions for Practice

An integrated WIC and obstetrical service model is feasible and can limit postpartum weight retention in obese women. Weight retention at 6 months postpartum between intervention and control participants was statistically significant. Further research should explore targeted interventions by obesity class to address weight retention for low-income, African American women who participate in WIC.

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References

  1. Anderson, C. K., Walch, T. J., Lindberg, S. M., Smith, A. M., Lindheim, S. R., & Whigham, L. D. (2015). Excess gestational weight gain in low-income overweight and obese women: A qualitative study. Journal of Nutrition Education and Behavior, 47(5), 404–411. https://doi.org/10.1016/j.jneb.2015.05.011.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Archer, E. (2015). The childhood obesity epidemic as a result of nongenetic evolution: The maternal resources hypothesis. Mayo Clinical Proceedings, 90(1), 77–92. https://doi.org/10.1016/j.mayocp.2014.08.006.

    Article  Google Scholar 

  3. Choi, J., Fukuoka, Y., & Lee, J. H. (2013). The effects of physical activity and physical activity plus diet interventions on body weight in overweight or obese women who are pregnant or in postpartum: A systematic review and meta-analysis of randomized controlled trials. Preventive Medicine, 56(6), 351–364. https://doi.org/10.1016/j.ypmed.2013.02.021.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Dalton, W. T., Wang, L., Southerland, J. L., Schetzina, K. E., & Slawson, D. L. (2014). Self-reported versus actual weight and height data contribute to different weight misperception classifications. Southern Medical Journal, 107, 348–355.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Deputy, N. P., Sharma, A. J., Kim, S. Y., & Hinkle, S. N. (2015). Prevalence and characteristics associated with gestational weight gain adequacy. Obstetrics and Gynecology, 125(4), 773–781. https://doi.org/10.1097/AOG.0000000000000739.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ferreira-Borges, C. (2005). Effectiveness of a brief counseling and behavioral intervention for smoking cessation in pregnant women. Preventive Medicine, 41(1), 295–302.

    Article  PubMed  Google Scholar 

  7. Gunderson, E. P. (2009). Childbearing and obesity in women: Weight before, during, and after pregnancy. Obstetrics and Gynecology Clinics of North America, 36(2), 317–332. https://doi.org/10.1016/j.ogc.2009.04.001.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hankey, C. R. (2015). Obesity and maternal weight gain. Current Obesity Reports, 4(1), 60–64.

    Article  PubMed  Google Scholar 

  9. Institute of Medicine (IOM). (2009). Weight gain during pregnancy: Reexaming the guidelines. Washington, DC: National Academies Press.

    Google Scholar 

  10. Liu, J., Wilcox, S., Whitaker, K., Blake, C., & Addy, C. (2014). Preventing excessive weight gain during pregnancy and promoting postpartum weight loss: A pilot lifestyle intervention for overweight and obese African American women. Maternal and Child Health Journal, 19(4), 840–849. https://doi.org/10.1007/s10995-014-1582-0.

    Article  Google Scholar 

  11. Magriples, U., Boynton, M. H., Kershaw, T. S., Lewis, J., Rising, S. S., Tobin, J. N., Epel, E., & Ickovics, J. R. (2015). The impact of group prenatal care on pregnancy and postpartum weight trajectories. American Journal of Obstetrics and Gynecology, 213(5), 688. https://doi.org/10.1016/j.ajog.2015.06.066.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Mannan, M., Doi, S. A., & Mamun, A. A. (2013). Association between weight gain during pregnancy and postpartum weight retention and obesity: A bias-adjusted meta-analysis. Nutrition Reviews, 71(6), 343–352. https://doi.org/10.1111/nure.12034.

    Article  PubMed  Google Scholar 

  13. Nehring, I., Schmoll, S., Beyerlein, A., Hauner, H., & Von Kries, R. (2011). Gestational weight gain and long-term postpartum weight retention: A meta-analysis. American Journal of Clinical Nutrition, 94(5), 1225–1231. https://doi.org/10.3945/ajcn.111.015289.

    CAS  Article  PubMed  Google Scholar 

  14. Ogden, C. L., Carroll, M. D., Fryar, C. D., & Flegal, K. M. (2015). Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS Data Brief, 219, 1–8.

    Google Scholar 

  15. Olson, C. M. (2008). Achieving a healthy weight gain during pregnancy. Annual Review of Nutrition, 28, 411–423. https://doi.org/10.1146/annurev.nutr.28.061807.155322.

    CAS  Article  PubMed  Google Scholar 

  16. Overcash, R. T., Hull, A. D., Moore, T. R., & LaCoursiere, D. Y. (2015). Early second trimester weight gain in obese women predicts excessive gestational weight gain in pregnancy. Maternal and Child Health Journal, 19(11), 2412–2418. https://doi.org/10.1007/s10995-015-1760-8.

    Article  PubMed  Google Scholar 

  17. Pérez, A., Gabriel, K., Nehme, E. K., Mandell, D. J., & Hoelscher, D. M. (2015). Measuring the bias, precision, accuracy, and validity of self-reported height and weight in assessing overweight and obesity status among adolescents using a surveillance system. International Journal of Behavioral Nutrition and Physical Activity, 12(Suppl 1), S2.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Phelan, S., Brannen, A., Erickson, K., Diamond, M., Schaffner, A., Muñoz-Christian, K., Stewart, A., Sanchez, T., Rodriguez, V. C., Ramos, D. I., McClure, L., Stinson, C., & Tate, D. F. (2015). ‘Fit Moms/Mamás Activas’ internet-based weight control program with group support to reduce postpartum weight retention in low-income women: Study protocol for a randomized controlled trial. Trials, 16, 59. https://doi.org/10.1186/s13063-015-0573-9.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Phelan, S., Phipps, M. G., Abrams, B., Darroch, F., Schaffner, A., & Wing, R. R. (2011). Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: The fit for delivery study. American Journal of Clinical Nutrition, 93(4), 772–779. https://doi.org/10.3945/ajcn.110.005306.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  20. Rasmussen, K. M., Catalano, P. M., & Yaktine, A. L. (2009). New guidelines for weight gain during pregnancy: What obstetrician/gynecologists should know. Current Opinion in Obstetrics and Gynecology, 21(6), 521–526. https://doi.org/10.1097/GCO.0b013e328332d24e.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Rooney, B. L., Schauberger, C. W., & Mathiason, M. A. (2005). Impact of perinatal weight change on long-term obesity and obesity-related illnesses. Obstetrics and Gynecology, 106(6), 1349–1356.

    Article  PubMed  Google Scholar 

  22. Siega-Riz, A. M., Viswanathan, M., Moos, M. K., Deierlein, A., Mumford, S., Knaack, J., Thieda, P., Lux, L. J., & Lohr, K. N. (2009). A systematic review of outcomes of maternal weight gain according to the institute of medicine recommendations: Birthweight, fetal growth, and postpartum weight retention. American Journal of Obstetrics and Gynecology, 201(4), 339.

    Article  PubMed  Google Scholar 

  23. Streuling, I., Beyerlein, A., Rosenfeld, E., Hofmann, H., Schulz, T., & Von Kries, R. (2011). Physical activity and gestational weight gain: A meta-analysis of intervention trials. BJOG: An International Journal of Obstetrics and Gynaecology, 118(3), 278–284. https://doi.org/10.1111/j.1471-0528.2010.

    CAS  Article  Google Scholar 

  24. Women, Infants and Children (WIC). About WIC-WIC’s Mission. (2017, September 17). Retrieved from https://www.fns.usda.gov/wic/about-wic-wics-mission.

  25. World Health Organization. (1998). Obesity. Preventing and managing the global epidemic. Report of a WHO consultation on obesity. WHO/NUT/NCD/981, WHO, Geneva.

    Google Scholar 

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Acknowledgements

We would like to recognize the efforts of Matthew Goldshore, MPH, Johns Hopkins University Bloomberg School of Public Health Doctoral Student and George Washington University Medical School Student, Johns Hopkins Hospital NIP physicians and staff, especially Diane Blahut Vizthum, Johns Hopkins WIC staff, especially Ms. Deborah Robinson and Ms. Shawn Darian, Johns Hopkins Hospital Data management staff, especially Clayton Sann, Johns Hopkins University Bloomberg School of Public Health students including: Laina Gagliardi; Victoria Elliot; Julia Quam; Lauren Rogers-Bell; Titilope Oduyebo; Mona Sobhani; Stephany Gabaud, Jenna Fahle and Caitlin Murphy.

Funding

Funding was provided by the Role of the WIC Program in Improving Periconceptional Nutrition: A small grants program. UCLA School of Public Health, Department of Community Health Sciences.

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Correspondence to Susan M. Gross.

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Gross, S.M., Augustyn, M., Henderson, J.L. et al. Integrating Obstetrical Care and WIC Nutritional Services to Address Maternal Obesity and Postpartum Weight Retention. Matern Child Health J 22, 794–802 (2018). https://doi.org/10.1007/s10995-018-2449-6

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Keywords

  • Postpartum weight retention
  • Gestational weight gain
  • Obesity
  • WIC
  • Nutrition