Public Health is…Healthy Pregnancies

 

by Mandy Murphy, RD and Brittany Giles

When do healthy habits begin? As a teenager?  As a tween? As a toddler?  Research reveals that healthy habits begin in the womb and continue to be formed throughout the first two years of life.

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Choices made during pregnancy are paramount for maternal and child health far beyond those initial nine months of development.  Foods eaten during pregnancy have been shown to influence the child’s taste preferences later in life.1  Weight gained during pregnancy may determine not only the child’s birth weight, but also the child’s long term weight trajectory, metabolism, and risk for certain chronic diseases.2,3

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Knowing the potential effects of all these seemingly inconsequential decisions  (i.e. the mundane choice of what to eat for lunch) suddenly appears daunting for mothers.

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What if pregnancies were instead viewed as a window of opportunity rather than a threat? 

What if pregnancies were an opportunity to empower women in  making healthy choices and gaining the appropriate amount of weight?

Although the connection between gestational weight gain and maternal and child health is well established,2,3 it has been shown that many health care providers avoid the subject of weight gain.4

Where is the disconnect?

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Why the lack of information?

If providers do not take leadership in approaching the subject of weight gain and its consequences, the opportunity to educate, engage, and empower mothers is missed.

In one study group with San Francisco Bay Area prenatal care providers,4 three common themes were identified as to why the subject of weight is often avoided.

blog5Providers expressed that:

1) they felt undertrained in the field of nutrition,

2) they perceived their counseling skills as ineffective in changing the mother’s behavior, and

3) they would further stress mothers by bringing up the sensitive subject of weight during an already stressful time.

Pregnancy is the ideal time for intervention. It is a window in which women’s habits are not only malleable, but the mother, on her own, often strives for change to ensure optimal pregnancy outcomes and baby health.  Pregnancy is also ideal because the mother has regular checkups, allowing for multiple opportunities throughout the pregnancy for her to converse with the provider, educate herself, and take ownership of her care decisions. The national trends of more than three-fourths of women gaining above the Institute of Medicine’s recommended weight gain5 will continue if providers are not leveraging this opportunity to educate.

How can this system change?

How can we utilize this window of opportunity to improve the health of mothers and their children?

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Hope for a healthier generation:

1) Start the conversation early on.  Providers need to discuss weight and health as a normal part of prenatal care.

2) Improve medical training.  Providers should receive more extensive nutritional training and counseling skills while in school.

3) Bring in the team! When the main provider feels undertrained or strapped for time, they should tap into resources, referring to a dietitian or WIC nutritionist.

4) Create support groups for moms. Organize a community of moms through prenatal clinics that want more information and will foster health together.

What ideas do you have?  How do you see pregnancy as hope for a healthier generation?

 

References

1.  Beauchamp GK, Mennella JA. Early flavor learning and its impact on later feeding behavior. J Pediatr Gastroenterol Nutr. 2009;48(Suppl 1): S25-30.

2.  Nistala R, Hayden MR, DeMarco VG, Henriksen EJ, Lackland DT, Sowers JR. Prenatal programming and epigenetics in the genesis of the cardiorenal syndrome. Cardiorenal Med. 2011;1(4):243-254.

3.  Heerwagen MJ, Miller MR, Barbour LA, Friedman JE. Maternal obesity and fetal metabolic programming: a fertile epigenetic soil. Am J Physiol Regul Integr Comp Physiol. 2010;299(3):R711-22.

4. Stotland NE, Gilbert P, Bogetz A, Harper CC, Abrams B, Gerbert B. Preventing excessive weight gain in pregnancy: how do prenatal care providers approach counseling? J Womens Health. 2010;19(4):807-814.

5. Ferrari RM, Siega-Riz AM. Provider advice about pregnancy weight gain and adequacy of weight gain. Matern Child Health J. 2012;1-9.

2 thoughts on “Public Health is…Healthy Pregnancies

  1. All that contact time with the provider is such valuable time to be helping the mother learn healthy habits. Great tips and nice job with the research 🙂 I also think that support groups with a knowledgable counselor and rotating maternal and child health professionals would help women gather a stronger support system and more resources. This would be great ancillary services with their health care.

  2. I like the “window of opportunity” analogy, and think it is true for this blog as well – it is a place where pregnant women and providers might be able to get more information, even if they aren’t able to access academic articles like the ones you reference. What exactly is “the Institute of Medicine’s recommended weight gain” for pregnancy? Are these guidelines posted by the Mayo Clinic correct: http://www.mayoclinic.com/health/pregnancy-weight-gain/PR00111 ?
    If so, think having the recommended weight gain guidelines in your blog post could make it even more useful to interested providers and pregnant women.

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