Kelley S. Scanlon

Increasing Prevalence of Overweight Among US Low-income Preschool Children: The Centers for Disease Control and Prevention Pediatric Nutrition Surveillance, 1983 to 1995

Objective. To determine whether the prevalence of overweight in preschool children has increased among the US low-income population. Design. Analysis using weight-for-height percentiles of surveillance data adjusted for age, sex, and race or ethnicity. Setting. Data from 18 states and the District of Columbia were examined. a Subjects. Low-income children <5 years of age who were included in the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance System. Results. The prevalence of overweight increased from 18.6% in 1983 to 21.6% in 1995 based on the 85th percentile cutoff point for weight-for-height, and from 8.5% to 10.2% for the same period based on the 95th percentile cutoff point. Analyses by single age, sex, and race or ethnic group (non-Hispanic white, non-Hispanic black, and Hispanic) all showed increases in the prevalence of overweight, although changes are greatest for older preschool children. Conclusion. Overweight is an increasing public health problem among preschool children in the US low-income population. Additional research is needed to explore the cause of the trend observed and to find effective strategies for overweight prevention beginning in the preschool years.

Medically advised, mother's personal target, and actual weight gain during pregnancy.

OBJECTIVE To evaluate whether advice on pregnancy weight gain from health care professionals, womens target weight gain (how much weight women thought they should gain), and actual weight gain corresponded with the 1990 Institute of Medicine recommendations. METHODS Predominantly white, middle-class women participating in a mail panel reported their prepregnancy weights, heights, and advised and target weight gains on a prenatal questionnaire (n = 2237), and their actual weight gains on a neonatal questionnaire (n = 1661). Recommended weight gains were categorized for women with low body mass index (BMI) (less than 19.8 kg/m2) as 25-39 lb; for women with average BMI (19.8-26.0 kg/m2) as 25-34 lb; and for women with high BMI (more than 26.0-29.0 kg/m2) and very high BMI (more than 29.0 kg/m2) as 15-24 lb. RESULTS Twenty-seven percent of the women reported that they had received no medical advice about pregnancy weight gain. Among those who received advice, 14% (95% confidence interval [CI] 12%, 16%) had been advised to gain less than the recommended range and 22% (95% CI 20%, 24%) had been advised to gain more than recommended. The odds of being advised to gain more than recommended were higher among women with high BMIs and with very high BMIs compared with women with average BMIs. Black women were more likely than white women to report advice to gain less than recommended. Advised and target weight gains were associated strongly with actual weight gain. Receiving no advice was associated with weight gain outside the recommendations. CONCLUSION Greater efforts are required to improve medical advice about weight gain during pregnancy.

Nutritional rickets among children in the United States: review of cases reported between 1986 and 2003

Reports of hypovitaminosis D among adults in the United States have drawn attention to the vitamin D status of children. National data on hypovitaminosis D among children are not yet available. Reports from 2000 and 2001 of rickets among children living in North Carolina, Texas, Georgia, and the mid-Atlantic region, however, confirmed the presence of vitamin D deficiency among some US children and prompted new clinical guidelines to prevent its occurrence. We reviewed reports of nutritional rickets among US children <18 y of age that were published between 1986 and 2003. We identified 166 cases of rickets in 22 published studies. Patients were 4-54 mo of age, although in 17 studies the maximal age was <30 mo. Approximately 83% of children with rickets were described as African American or black, and 96% were breast-fed. Among children who were breast-fed, only 5% of records indicated vitamin D supplementation during breast-feeding. The American Academy of Pediatrics (AAP) recently recommended a minimal intake of 200 IU/d vitamin D for all infants, beginning in the first 2 mo of life. AAP recommends a vitamin D supplement for breast-fed infants who do not consume at least 500 mL of a vitamin D-fortified beverage. Given our finding of a disproportionate number of rickets cases among young, breast-fed, black children, we recommend that education regarding AAP guidelines emphasize the higher risk of rickets among these children. Education should also emphasize the importance of weaning children to a diet adequate in both vitamin D and calcium.

Interventions to Prevent or Treat Obesity in Preschool Children: A Review of Evaluated Programs

Objective: To identify effective programs to prevent or treat overweight among 2‐ to <6‐year‐old children.

Reasons for Earlier Than Desired Cessation of Breastfeeding

OBJECTIVE: To describe the prevalence and factors associated with not meeting desired breastfeeding duration. METHODS: Data were analyzed from 1177 mothers aged ≥18 years who responded to monthly surveys from pregnancy until their child was 1 year old. When breastfeeding stopped, mothers were asked whether they breastfed as long as they wanted (yes or no) and to rate the importance of 32 reasons for stopping on a 4-point Likert scale. Multiple logistic regressions were used to examine the association between the importance of each reason and the likelihood of mothers not meeting their desired breastfeeding duration. RESULTS: Approximately 60% of mothers who stopped breastfeeding did so earlier than desired. Early termination was positively associated with mothers’ concerns regarding: (1) difficulties with lactation; (2) infant nutrition and weight; (3) illness or need to take medicine; and (4) the effort associated with pumping milk. CONCLUSIONS: Our findings indicate that the major reasons why mothers stop breastfeeding before they desire include concerns about maternal or child health (infant nutrition, maternal illness or the need for medicine, and infant illness) and processes associated with breastfeeding (lactation and milk-pumping problems). Continued professional support may be necessary to address these challenges and help mothers meet their desired breastfeeding duration.

Baby-Friendly Hospital Practices and Meeting Exclusive Breastfeeding Intention

OBJECTIVE: To describe mothers’ exclusive breastfeeding intentions and whether Baby-Friendly hospital practices are associated with achieving these intentions. METHODS: In the 2005–2007 Infant Feeding Practices Study II, women completed a prenatal questionnaire and approximately monthly questionnaires through 12 months. Mothers met their prenatal exclusive breastfeeding intention if their duration after the hospital stay (excluding hospital supplementation) equaled or exceeded their intention. Primary predictor variables included 6 Baby-Friendly hospital practices: breastfeeding within 1 hour of birth, giving only breast milk, rooming in, breastfeeding on demand, no pacifiers, and information on breastfeeding support. RESULTS: Among women who prenatally intended to exclusively breastfeed (n = 1457), more than 85% intended to do so for 3 months or more; however, only 32.4% of mothers achieved their intended exclusive breastfeeding duration. Mothers who were married and multiparous were more likely to achieve their exclusive breastfeeding intention, whereas mothers who were obese, smoked, or had longer intended exclusive breastfeeding duration were less likely to meet their intention. Beginning breastfeeding within 1 hour of birth and not being given supplemental feedings or pacifiers were associated with achieving exclusive breastfeeding intention. After adjustment for all other hospital practices, only not receiving supplemental feedings remained significant (adjusted odds ratio = 2.3, 95% confidence interval = 1.8, 3.1). CONCLUSIONS: Two-thirds of mothers who intend to exclusively breastfeed are not meeting their intended duration. Increased Baby-Friendly hospital practices, particularly giving only breast milk in the hospital, may help more mothers achieve their exclusive breastfeeding intentions.

Trends in overweight from 1980 through 2001 among preschool-aged children enrolled in a health maintenance organization.

Objective: To examine overweight trends over a 22‐year period among preschool‐aged children from primarily middle‐income families enrolled in a health maintenance organization.

Is maternal obesity a risk factor for anencephaly and spina bifida

&NA; To determine whether the risk of having an infant with anencephaly or spina bifida is greater among obese women than among average‐weight women, we compared 307 Atlanta‐area women who gave birth to a liveborn or stillborn infant with anencephaly or spina bifida (case group) with 2,755 Atlantaarea women who gave birth to an infant without birth defects (control group). The infants of control women were randomly selected from birth certificates and frequency‐matched to the case group by race, birth hospital, and birth period from 1968 through 1980. After adjusting for maternal age, education, smoking status, alcohol use, chronic illness, and vitamin use, we found that, compared with average‐weight women, obese women (pregravid body mass index greater than 29) had almost twice the risk of having an infant with spina bifida or anencephaly (odds ratio = 1.9; 95% confidence limits = 1.1, 3.4). A womans risk increased with her body mass index: adjusted odds ratios ranged from 0.6 (95% confidence limits = 0.3, 2.1) for very underweight women to 1.9 for obese women.

Maternal weight gain and preterm delivery: differential effects by body mass index.

We examined associations between weight gain (kg) per week of pregnancy and net weight gain per week of pregnancy (weight gain - birth weight/weeks of gestation at delivery) and preterm delivery in a population of 266,172 low-income women. Risk of preterm delivery was lowest among women with intermediate weight gain (0.35 to <0.46 kg/week) and net weight gain (0.27 to <0.37 kg/week). Both lower and higher weight gains and net weight gains per week were associated with an increased risk for preterm delivery. Associations, however, were not uniform across body mass index categories. Compared with women gaining 0.35 to <0.46 kg/week, preterm risk differences (95% confidence limits) for women gaining <0.10 kg/week were +9.5% (+6.5, +12.4) for underweight women, +6.7% (+5.6, +7.9) for average-weight women, +3.5% (+2.0, +4.9) for overweight women, and +0.4% (-0.4, +1.2) for obese women. The opposite pattern was observed with high weight gain. Preterm risk differences for weight gains >0.65 kg/week ranged from +0.8% (-0.7, +2.1) for underweight women, to +2.5% (+1.3, +3.9) for obese women. We also evaluated weight gain per week in the latter part of pregnancy (from week 14 to delivery). The same basic patterns were observed; however, variation in the associations across body mass index groups was not as marked.

Trends in Pregnancy Weight Gain Within and Outside Ranges Recommended by the Institute of Medicine in a WIC Population

Objectives: To examine the proportion of women with a pregnancy weight gain below, within, and above ranges recommended by the Institute of Medicine from 1990 to 1996. Methods; Our study population included women attending Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics in five states who delivered a liveborn singleton infant at term (N = 120,531). Pregnancy weight gain was self-reported at the postpartum visit Results: Only 34% of women gained weight within recommended ranges and there was little change in this proportion from 1990 to 1996. The proportion of women gaining less than their recommended weight decreased from 23.4% to 22.0%, and the proportion gaining more than recommended increased from 41.5% to 43.7% during the study period. Stratified analyses revealed similar trends within all race-ethnicity, age, parity, trimester of WIC initiation, and trimester of prenatal care initiation strata and among women in low, average, and high prepregnancy body mass index categories. There was no change in the weight gain distribution among obese women. Absolute and relative increases in the proportion of women gaining more weight than recommended were greatest among women who were underweight, Asian or Native American, less than 20 years of age, multiparous, and who initiated WIC and prenatal care in the third trimester. Conclusions: Pregnancy weight gain increased among this population of WIC participants from 1990 to 1996.