Health Disparities in Early Nutrition : Where the Problem Begins ? Racial-Ethnic Differences in Pregnancy-Related Weight 1 – 3

This review examines published literature to answer 2 questions: 1) Are there racial-ethnic differences in excessive or inadequate gestational weight gain (GWG) and postpartum weight retention (PPWR)? and 2) Is there evidence that approaches to promote healthy weight during and after pregnancy should vary by race-ethnicity? We identified a limited number of articles that explicitly looked at racial-ethnic differences in either GWG or PPWR after controlling for relevant covariates. These studies suggest that black and Hispanic women are more likely to gain inadequately based on the Institute of Medicine’s pregnancy weight gain guidelines compared to white women. Black women are more likely to retain considerable amounts of weight postpartum compared to both Hispanic and white mothers. Studies were inconclusive as to whether Hispanic women retained more or less weight postpartum, so more research is needed. Interventions to increase GWG were few and those designed to reduce GWG and PPWR showed mixed results. Future studies should address the methodological and conceptual limitations of prior research as well as investigate biological mechanisms and behavioral risk factors to determine the reasons for the racial-ethnic differences in pregnancyrelated weight outcomes. Interventions would benefit from a mixed-methods approach that specifically identifies race-relevant barriers to weight management during and after pregnancy. Attention to the greater social context in which pregnancy-related weight exists is also needed. Adv. Nutr. 3: 83–94, 2012. Introduction Racial-ethnic differences exist in the US for several maternal and child health outcomes. Black, Puerto Rican, and American Indian/Alaska Native women continue to have considerably higher rates of infant mortality compared to white women (Fig. 1) (1). Black women in particular have a greater risk for low birth weight (Fig. 2), preterm birth, stillbirth, and maternal mortality compared to white or Hispanic U.S. mothers (2). Childhood and adolescent obesity is also more prevalent in black, Hispanic, and American Indian/Alaska Natives compared to whites (Fig. 3) (3,4). These health differences are due in part to the disproportionate obesity epidemic among racial-ethnic groups in the US; whereas 35% of all women > 20 y old are obese, the prevalence is higher for black (50%) and Hispanic (43%) women; similar trends are seen among childbearing women 20–39 y old (2). Maternal GWG contributes to the racial-ethnic differences in health outcomes. Both inadequate and excessive GWGmay negatively influence the fetal environment during key developmental windows of metabolic and epigenetic plasticity contributing to later life chronic disease in the offspring (5). A recent systematic review examined the 1990 IOM GWG recommendations and reported strong evidence for associations between inadequate GWG and small for gestational age as well as excessive GWG and large for gestational age (6). This review of 35 studies found moderate evidence for the association between excessive GWG and PPWR; it also considered evidence linking excessive GWG 1 Published as a supplement to Advances in Nutrition. Presented as part of the symposium entitled “Health Disparities in Early Nutrition: Where the Problem Begins? ” given at the Experimental Biology 2011 meeting, April 12, 2011, in Washington, DC. The symposium was sponsored by the American Society for Nutrition and supported in part by an educational grant from DSM Nutrition Products LLC. The symposium was chaired by Rafael Pérez-Escamilla and Odilia Bermudez. Guest Editors for this symposium publication were Rafael Perez-Escamilla and Odilia Bermudez. Guest Editor disclosure: Neither Guest Editor had conflicts to disclose. 2 Supported by the National Institutes of Minority Health Disparities (1 R01 MD006104-01). 3 Author disclosures: I. E. Headen, E. M. Davis, M. S. Mujahid, and B. Abrams, no conflicts of