Susan W. Groth

New mothers' views of weight and exercise.

PurposeTo describe the attitudes and preferences of ethnically diverse new mothers on weight and exercise. Study Design and MethodsExploratory, qualitative study. Forty-nine ethnically diverse women were interviewed during the first year following childbirth regarding beliefs about weight, choices of exercise, walking for exercise, perceived benefits, barriers, and facilitators of exercise. Content analysis techniques were used to analyze the data. ResultsWeight was a significant concern for women, although the importance varied by race. New mothers reported that they would like to weigh less, and they endorsed walking for exercise. Common barriers to exercise were children and time constraints; health problems were also seen as a barrier to walking as a form of exercise. Scheduling the walk and having a walking partner were factors that women said would facilitate walking for physical activity during the first year after childbirth. Clinical ImplicationsBecause new mothers perceive walking as a good form of exercise, nurses can use this information to help them plan a daily walking schedule to aid in weight loss and control postpartum. Nurses should also encourage new mothers to look for a walking partner, especially another new mother or a friend, to help them continue their physical activity during the first year after childbirth.

The long-term impact of adolescent gestational weight gain.

This study involved 330 primiparous Black adolescents. The purpose of the study was to examine predictors of body mass index (BMI) change in Black adolescents 6 and 9 years after they gave birth. Predictors were gestational weight gain, pre-pregnant BMI, and age (p < .001). For older adolescents (ages 18-19), gestational weight gain was the only predictor of BMI change (p = .008). Regardless of pre-pregnant BMI category, adolescents whose gestational weight gain exceeded Institute of Medicine (IOM) recommendations were 4.6 times more likely to be obese than those whose weight gain was within recommendations. Excessive gestational weight gain and pre-pregnant overweight contribute to adolescent obesity. These findings have implications from both a clinical and public health perspective.

Depressive symptoms and proinflammatory cytokines across the perinatal period in African American women

Abstract Background: Comparatively few studies have examined the biological mechanisms that may underlie the reported racial disparities in antenatal and postpartum depression. Objective: To examine the associations among race, depressive symptoms and the proinflammatory cytokines interleukin (IL)-6 and tumor necrosis factor (TNF)-α across the perinatal period in a diverse sample of healthy pregnant women at elevated psychosocial risk. Methods: 171 subjects were enrolled. Women were interviewed and blood samples drawn at 18 and 32 weeks gestation and 6 weeks and 6 months postpartum. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale. Serum levels of IL-6 and TNF-α were assayed using high sensitivity enzyme-linked immunosorbent assay kits. Results: Compared with non-African American (AA) women, AA women had significantly higher levels of IL-6 (est. diff = 0.521, p = 0.02, confidence interval (CI): 0.088–0.954) but not TNF-α across all time points (est. diff = −0.060, p = 0.80, CI: −0.517 to 0.397). IL-6 was not associated with depressive symptoms but differences in IL-6 were accounted for by greater Body Mass Index in AA women. Conclusions: Compared with non-AA women, AA women entered pregnancy with elevated inflammatory cytokine levels that persisted across the perinatal period. This group difference in inflammation did not suggest increased risk for depression, but suggests other implications for long-term health.

Are the Institute of Medicine Recommendations for Gestational Weight Gain Appropriate for Adolescents

OBJECTIVE To explore the use of Centers for Disease Control and Prevention body mass index percentiles for adolescents to classify adolescents for gestational weight gain recommendations. DESIGN A descriptive study using secondary data analysis. SETTING Memphis, Tennessee. PARTICIPANTS Three hundred forty-seven primiparous Black adolescents, aged 12 to 19 years, who delivered full-term infants. MAIN OUTCOME MEASURES Adult and adolescent body mass index categories, gestational weight gain patterns, and neonatal birthweight. RESULTS Adolescents, especially smaller adolescents, were misclassified when the current Institute of Medicine adult body mass index categories were used to classify them for gestational weight gain when compared to the use of the Centers for Disease Control and Prevention body mass index percentiles for adolescents as a gestational weight gain classification schema. Mean neonatal birthweights were similar no matter which schema was used. A large proportion of adolescents gained more than is recommended by the Institute of Medicine. CONCLUSIONS The current gestational weight gain recommendations based on adult body mass index categories may not be sufficiently specific to attain the best maternal and neonatal outcomes for adolescents. Creation of gestational weight gain recommendations based on the Centers for Disease Control and Prevention body mass index percentiles would potentially assist clinicians in counseling adolescents regarding gestational weight gain.

How Pregnant African American Women View Pregnancy Weight Gain

OBJECTIVE To gain insight into how low-income, pregnant African American women viewed their weight gain while pregnant and how they managed their weight during pregnancy. DESIGN Descriptive study using three focus groups. SETTING Women were recruited from urban prenatal care sites and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) services in a medium-sized urban northeastern city. PARTICIPANTS Twenty-six adult, low-income, pregnant African American women, age 18 to 39; the majority were within the first 20 weeks of pregnancy. METHODS Three focus groups were conducted utilizing open-ended questions related to pregnancy weight gain. Content analysis was used to analyze the verbatim transcripts. Analysis focused on meaning, intention, and context. Groups were compared and contrasted at the within and between group levels to identify themes. RESULTS Four themes were identified that provided insight into how women viewed their pregnancy weight gain and managed weight gain during pregnancy: (a) pregnancy weight gain: no matter how much means a healthy baby; (b) weight retention: it happens; (c) there is a limit: weight gain impact on appearance; and (d) watching and waiting: plans for controlling weight. CONCLUSION Low-income African American women, though cognizant of the likelihood of retention of weight following pregnancy, are not focused on limiting their gestational weight gain. The cultural acceptance of a larger body size along with the belief that gaining more weight is indicative of a healthy infant present challenges for interventions to limit excessive gestational weight gain.

Adolescent gestational weight gain: does it contribute to obesity?

Does gestational weight gain have an impact on the future weight pattern of adolescent mothers? Pregnant adolescents gain weight with childbearing, and weight retention following pregnancy potentially contributes to long-term overweight and obesity, but the literature to date has focused on the effect of gestational weight on the neonate and not on the mother. In 1990, the Institute of Medicine (IOM) released recommendations for weight gain during pregnancy. According to these recommendations, young adolescents (≤16 years old) should gain weight at the upper end of the recommendations, while older adolescents (>16–19 years old) should gain weight similarly to adult women. The purpose of this article is to provide a current understanding of adolescent gestational weight gain and its impact on both maternal and neonatal outcomes. If adolescent weight gain during pregnancy leads to overweight and obesity without a clear benefit for the neonate, there may be resultant health implications for maternal health.This literature review demonstrates that there are no clear answers to the question of the influence of gestational weight gain on future maternal health. It is certain, however, that helping adolescents achieve good prepregnant nutritional status is an important first step in health promotion.

Adiponectin and polycystic ovary syndrome.

Introduction. Polycystic ovary syndrome (PCOS) has a prevalence of 5—8% in women of reproductive age. Women with PCOS have an increased risk of metabolic syndrome and associated comorbidities. Adiponectin is a circulating protein produced by adipocytes. Circulating levels of adiponectin are inversely related to adipocyte mass. Low levels occur with insulin resistance, type 2 diabetes, metabolic syndrome, and obesity-related cardiovascular disease. This article reviews the literature on the link between adiponectin and PCOS and the potential use of adiponectin as a biomarker for PCOS. Method. Data-based studies on adiponectin and PCOS and adiponectin measurement were identified through the Medline (1950—2009) and ISI Web of Knowledge (1973—2009) databases. Results. Fifteen studies related to adiponectin and PCOS met inclusion criteria and were included in this review. These studies present evidence that adiponectin is linked to insulin resistance, insulin sensitivity, body mass index (BMI), and adiposity. In women with PCOS, lower levels, as opposed to higher levels, of adiponectin occur in the absence of adiposity. Conclusion. The relationships between adiponectin and insulin resistance and sensitivity, metabolic syndrome, and BMI in women with PCOS suggest that adiponectin potentially could serve as a marker for disease risk and provide opportunity for earlier intervention if knowledge is successfully translated from laboratory to clinical practice. However, further study of the relationship between adiponectin and PCOS is required before there can be direct application to clinical practice.

Smoking, Substance Use, and Mental Health Correlates in Urban Adolescent Girls

This study examined the associations among smoking tobacco and/or cannabis with alcohol use, depression, disordered eating and healthy behaviors among adolescent girls enrolled in an HIV prevention intervention randomized trial. Baseline self-reported behaviors from 744 sexually active, low-income, urban participants were collected using an audio computer assisted self interview. Girls ranged in age from 15 to 19 years old with a mean age of 16.5. Over 16% of girls reported smoking cigarettes, 41% smoked cannabis and 12% used both substances. Girls who smoked either substance had higher scores for depression symptoms, alcohol use and disordered eating when compared to nonsmokers. Girls who used both substances were at a higher risk for alcohol use, depression symptoms and disordered eating. The association of cannabis and tobacco with the other health related issues differed depending on age, indicating that assessment and targeting of health behavior interventions may differ depending on a girl’s age. Disordered eating, depressive symptoms and cannabis use were higher among these adolescent girls than previously documented in the literature, suggesting that to improve the health of this population multi-focused interventions must target girls before they have engaged in smoking.

Relationships among obesity, physical activity and sedentary behavior in young adolescents with and without lifetime asthma

Abstract Objective: To examine the inter-relationships among body mass index (BMI), physical activity, sedentary behavior and gender in urban, low-income, primarily African American young adolescents with or without lifetime asthma. Methods: Data were collected in 2002–2004 from 626 12-year old adolescents who were children of women who participated in the New Mother’s Study in Memphis, TN (1990–1991). Adolescents with and without asthma were compared on BMI, physical activity and sedentary behavior. Multiple linear regression models were used to examine the association of asthma, gender and BMI with physical activity and sedentary behavior. Results: Complete data were available for 545 adolescents. Eleven percent of adolescents had lifetime asthma. Asthma and gender were associated with high-intensity physical activity (p < 0.001). Adolescents with asthma participated in less physical activity and girls participated less than boys. Gender was associated with sedentary behavior (p < 0.001): boys used personal computer (pc)/video after school more than girls. Girls with asthma had a higher BMI than girls without asthma (p = 0.027). Boys with asthma were less physically active than boys without asthma (p < 0.05). Conclusions: Adolescents with asthma are less physically active than those without asthma and girls are less active than boys. Clinicians who provide care for adolescents with asthma are encouraged to assess physical activity/sedentary behavior and provide guidance that promotes active lifestyles. A longitudinal study is needed to shed light on the unique contribution of asthma separated from the effects of overweight/obesity on physical activity and sedentary behaviors.

eMoms: Electronically-mediated weight interventions for pregnant and postpartum women. Study design and baseline characteristics

BACKGROUND The influence of childbearing in the development of obesity is situated within two different but related contexts: pregnancy-related weight gain and weight gain prevention and control in young adult women. Pregnancy related weight gain contributes to long-term weight retention in childbearing women. OBJECTIVE To present the study design, data collection procedures, recruitment challenges, and the baseline characteristics for the eMoms of Rochester study, a randomized clinical trial testing the effect of electronically-mediated behavioral interventions to prevent excessive gestational weight gain (GWG) and postpartum weight retention among women aged 18-35 years of diverse income and racial/ethnic backgrounds in an urban setting. DESIGN Randomized double blind clinical trial. A total of 1722 women at or below 20 weeks of gestation were recruited primarily from obstetric practices and randomized to 3 treatment groups: control arm; intervention arm with access to intervention during pregnancy and control at postpartum (e-intervention 1); and intervention arm with access to intervention during pregnancy and postpartum (e-intervention 2). Enrollment and consent were completed via study staff or online. Data were collected via online surveys, medical charts, and measurement of postpartum weights. The primary endpoints are gaining more weight than recommended by the Institution of Medicine guidelines and weight retained at 12 months postpartum. CONCLUSION This study will provide evidence on the efficacy of behavioral interventions in the prevention of excessive GWG and postpartum weight retention with potential dissemination to obstetric practices and/or health insurances. ClinicalTrials.gov #NCT01331564.