Kiley A. Bernhard

Maternal and neonatal outcomes in obese women who lose weight during pregnancy.

Objective:To evaluate neonatal and maternal outcomes in obese pregnant women whose weight gain differed from the Institute of Medicine (IOM) recommendations.Study Design:Maternal and neonatal outcomes associated with weight change in pregnancy were retrospectively investigated in women with obesity (body mass index (BMI) ⩾30 kg m−2; N=10734) who gave birth at 12 hospitals. Using a 1:1:1:1 design (n=778 matched groups), we matched women with obesity who lost, maintained, gained appropriate (IOM recommended) and gained excessive weight during pregnancy by gestational age at delivery, maternal age, race/ethnicity, prepregnancy BMI, chronic hypertension, pregestational diabetes and smoking status. Regression techniques were used to adjust for confounders and compare outcomes across weight change categories.Result:Compared with IOM recommendations, weight loss was associated with twofold greater odds of low birth weight infants and a mean decrease in estimated blood loss of 30 ml; excessive weight gain was associated with doubled odds of gestational hypertension or preeclampsia, fourfold greater odds of macrosomia and a mean decrease in 5-min APGAR of 0.09. From lost to excessively gained weight, the odds of cesarean delivery increased 1.4 times and mean infant birth weight increased by 197 g. In contrast, the odds of small-for-gestational age were 1.8 times greater for women who lost than gained excessive weight.Conclusion:Weight loss in obese pregnant women is associated with increased risk for low birth weight neonates but significantly decreased or maintained risk for other maternal and neonatal morbidities, as compared with appropriate or excessive weight gain. This study supports re-evaluation of the current IOM guidelines for women with obesity.

Application of the Breastfeeding Personal Efficacy Beliefs Inventory and Acknowledgment of Barriers for Improving Breastfeeding Initiation Rates in an Urban Population

Introduction: Breastfeeding (BF) is recognized as the preferred method of infant nutrition by American Academy of Pediatricians, American College of Obstetricians and Gynecologists, and the World Health Organization. Despite the benefits of BF, in 1998 only 69% of new mothers in the United States initiated BF and 29% continued to breastfeed at 6 months. Objective: To assess perceived breastfeeding confidence (BFC) and determine barriers in regards to BF in an urban population. Methods: The Breastfeeding Personal Efficacy Beliefs Inventory (BPEBI) was used to determine perceived BFC. The survey was distributed to 271 women during prenatal appointments at an urban Milwaukee medical center. BF initiation rate at discharge was determined by records review. A principal component factor analysis with varimax rotation was used to examine the structure of the BPEBI in this population. Results: Survey response rate was 89%. Overall BFC was 74%. BF initiation rate at discharge was 62%, exclusively BF (EBF) at discharge (no bottle-feeding) was 55%. In multivariate models, EBF decreased with black race (p=0.02) and with residence in the low socioeconomic status zip codes of the central city of Milwaukee (p=0.01). BFC increased with prior exposure to BF (p=0.03), EBF (p=0.03) and length of BF (p=0.02). Factor analysis identified two constructs: BFC increased with prior exposure to BF (p=0.006) and EBF (p=0.001) within the motivation construct, and BFC increased with EBF (p=0.000) within the technique/environment construct. Conclusions: The main barriers to increased BFC were lack of prior exposure to BF and nonexclusive breastfeeding practices. BF initiation rate at discharge was low compared to self-reported level of confidence. EBF decreased with black race and with closer proximity to the central city of Milwaukee. (J Patient-Centered Res Rev. 2014;1:77-84.)