Kristin Maiden

Independent relation of maternal prenatal factors to early childhood obesity in the offspring.

OBJECTIVE: To examine the independent contribution of risk factors developing during pregnancy to subsequent risk of obesity in young children. METHODS: We conducted a historical cohort study using data from electronic medical records of mothers and their 3,302 singleton offspring born between 2004 and 2007 at a community-based obstetric facility who attended a 4-year well visit at a pediatric practice network. The child’s body mass index (BMI) z score at age 4 years was studied in relation to the mother’s gestational weight gain, gestational diabetes mellitus, gestational hypertension or preeclampsia, and prenatal tobacco use. Institute of Medicine categories defined excess and inadequate gestational weight gain at term. Analysis of variance and multiple linear regression were used to test their independent relation to BMI. RESULTS: Mothers were white (39%), African American (46%), and of Hispanic ethnicity (11%); 46% were privately insured. The association of net gestational weight gain with the child’s BMI z score was significant after adjustment for prepregnancy maternal factors (P<.001); gestational diabetes mellitus, gestational hypertension, and tobacco use were not significant in adjusted models. Children of mothers with excess gestational weight gain had a higher mean BMI z score (P<.001) but a significant association was observed only for inadequate gestational weight gain after adjusting for prepregnancy BMI and other covariates. Prepregnancy BMI (P<.001), Hispanic ethnicity (P<.001), and being married (P<.05) were independently associated with increasing BMI z score of the offspring. CONCLUSIONS: Preconception maternal factors had a greater influence on child obesity than prenatal factors. The gestational weight gain category was independently related to BMI z score of 4 year olds, but this association was significant only for mothers with inadequate gestational weight gain. LEVEL OF EVIDENCE: II

Predicting baby feeding method from unstructured electronic health record data

Obesity is one of the most important health concerns in United States and is playing an important role in rising rates of chronic health conditions and health care costs. The percentage of the US population affected with childhood obesity and adult obesity has been on a constant upward linear trend for past few decades. According to Center for Disease control and prevention 35.7% of US adults are obese and 17% of children aged 2-19 years are obese. Researchers and health care providers in the US and the rest of world studying obesity are interested in factors affecting obesity. One such interesting factor potentially related to development of obesity is type of feeding provided to babies. In this work we describe an electronic health record (EHR) data set of babies with feeding method contained in the narrative portion of the record. We compare five supervised machine learning algorithms for predicting feeding method as a discrete value based on text in the field. We also compare these algorithms in terms of the classification error and prediction probability estimates generated by them.

Providers’ Perceptions of Medical Interpreter Services and Limited English Proficiency (LEP) Patients Understanding the “Bigger Picture”

Patient’s ability to understand and effectively communicate health information facilitates disease prevention, self-management of illness, the adoption of healthy behaviors, and their ability to act on important public health information. However, patients who have limited English proficiency (LEP) are significantly disadvantaged. Previous studies have shown the benefit of medical interpreter services in bridging the health communication gap between patients and providers. This qualitative study, focusing on medical interpreter utilization within obstetrical and neonatal services, provides perspectives from multiple types of providers to further explore the role of medical interpreter services and specific barriers to the use of such services. Five separate focus groups were conducted with postpartum nurses, labor and delivery/triage nurses, obstetrics and gynecology (OBGYN) resident physicians, neonatal intensive-care unit (NICU) nurses, and faculty physicians, nurse practitioners, and midwives. The data show that barriers to the utilization of professional medical interpreters can be categorized by distinct but related institutional- and individual-level factors. Further interpretation of the barriers, however, suggests that providers’ use/non-use of interpreter services is merely one piece of a much “bigger picture” regarding difficulties and challenges in delivering care to a growing culturally diverse patient population, and that these cultural challenges, not just the availability of interpreter services, may affect providers’ ability to deliver effective and efficient care. It is argued that simply adding additional communication-based resources may not be sufficient to impact providers’ attitudes and behaviors or the overarching organizational culture regarding LEP patients.