A Healthier Weigh

toddFall 2012

Cynthia Elizondo Gregory, right, continued to exercise throughout her pregnancy to help avoid excessive weight gain.

Cynthia Elizondo Gregory, right, continued to exercise throughout her pregnancy to help avoid excessive weight gain.

By Nate Hinkel

Women categorized as overweight or obese before pregnancy have a much higher tendency to gain more weight than recommended during pregnancy than women at a normal weight.

But while overweight and obese women are about four times as likely to gain too much during pregnancy, one out of two normal weight women are also gaining unhealthy amounts of weight.

“This is concerning,” said Becca Krukowski, Ph.D., assistant professor in the UAMS Fay W. Boozman College of Public Health. “This means it will be important in future work to determine strategies to keep gestational weight gain within recommended guidelines, particularly among overweight and obese women. It’s a vital concern for not only the health of the mother, but a growing concern about their offspring.”

Expectant mothers gaining too much weight can develop gestational diabetes, backaches, leg pain, increased fatigue, varicose veins, increased risk of cesarean delivery, high blood pressure and many other problems. Research is finding that babies born to mothers with excessive weight gain are more likely to be overweight later in their lives.

Krukowski was part of a team of researchers looking to find the proportion of women exceeding the recommended amount of weight gain during pregnancy and explore the racial and ethnic differences of those who were.

Funded by the UAMS Center for Health Disparities, the team collaborated with the Arkansas Department of Health, which held the expertise and the key to a wealth of data through its Pregnancy Risk Assessment Monitoring System (PRAMS).

Developed by the federal Centers for Disease Control and Prevention, PRAMS is an ongoing state- and population-based survey that collects information on self-reported maternal behaviors and experiences that occur before, during and shortly after pregnancy among women who deliver a live-born infant.

“The questionnaire is mailed to a sample of mothers randomly selected from state birth certificate records,” said Mary McGehee, Ph.D., a senior research analyst at the Health Department who collaborated with the College of Public Health on the study. “Responses are accumulated during the calendar year, combined with birth certificate data, and then weighted to be representative of all mothers who had a live-born infant in the state.”

Krukowski said some have assumed that during pregnancy African-American women would be more likely to gain more than the recommended amount of weight because that group has a higher obesity rate. The question was timely, she said, because in 2009 the Institute of Medicine changed its gestational weight gain guidelines. Before 2009, obese women were advised to gain at least 15 pounds with no upper limit. The new guidelines recommend obese women gain 11 to 20 pounds, “a much more restricted range,” Krukowski said.

The study shows that contrary to what researchers initially believed, African-American women and Hispanic women are not more likely than Caucasian women to have excessive weight gain. It also showed that women’s pre-pregnancy weight category is the best predictor of meeting the gestational weight gain guidelines.

“Having programs that focus on achieving a healthy weight prior to pregnancy would be tricky because most pregnancies aren’t planned,” Krukowski said. “However there is promise for programs that help women gain a healthy amount during pregnancy. These findings will help us target programs to the women most vulnerable to excessive gestational weight gain that could make a difference in the lives and health of Arkansans.”