Please select the eligibility criteria that correspond to the clinical trial below.
Title: Breastfeeding Education and Support Trial for Obese Women (BESTOW)
Brief Summary: The primary objective of this study is to evaluate the efficacy of a specialized exclusive breastfeeding education and support program targeting obese, pregnant, low-income women in Hartford, CT. Specifically, the investigators will evaluate the impact of the intervention on exclusive and partial breastfeeding rates at birth, 1, 3 and 6 months pp. Secondary aims of this study are: a) to characterize postpartum weight loss patterns and blood pressure values of obese women, by study group; and b) to evaluate potential differences in infant morbidity (diarrhea, otitis media and rehospitalization), by study group.


Options:
A: Inclusion Criteria:

* Healthy female with a diagnosis of gestational diabetes mellitus (GDM) by Carpenter-Coustan criteria (see below) in most recent singleton or twin pregnancy (Carpenter \& Coustan, 1982)
* Women with a glucose value \>200 mg/dL after a 50-g glucose challenge test at \>12 weeks' gestation will also be included
* 18-45 years old
* No personal history of Type 1 or 2 diabetes
* Pre-pregnancy body mass index between 18 and 40 kg/m2
* Six weeks postpartum body mass index between 25 and 50 kg/m2
* Capable of providing informed consent

Exclusion Criteria:

* Pre-pregnancy diagnosis of diabetes (type 1, 2, or a secondary form of diabetes)
* Pre-pregnancy body mass index \<18 kg/m2 (underweight) or \>40 kg/m2 (morbidly obese)
* Current pregnancy
* Six weeks postpartum body mass index \<25 kg/m2 or \>50 kg/m2
* Excessive alcohol intake defined as \>1 beverage per night or past history of alcohol abuse (within the previous 5 years)
* Current or past recreational drug use (within the previous 5 years)
* Diagnosis of diseases associated with glucose metabolism
* Taking certain prescription medication including glucocorticoids, atypical antipsychotics associated with weight gain (such as respirdal(respiradone), clozapine (klozaril), olanzapine (zyprexa), quetiapine (seroquel), etc.) or weight loss medications including prescription, non-prescription or herbal medications
* Personal history of breast cancer or any other type of cancer other than a basal cell skin cancer
* Personal history of cardiovascular disease (coronary artery disease, congestive heart failure, valvular heart disease, stroke, transient ischemic attack, or intermittent claudication), kidney disease, liver disease, venous or arterial thromboembolic disease, adrenal insufficiency, depression requiring hospitalization within the past 6 months, or non-pregnancy related illness requiring overnight hospitalization in the past 6 months
* Underlying disease/treatment that might interfere with participation in/completion of the study (e.g., significant gastrointestinal conditions, major psychiatric disorders, and others at the discretion of the study clinician)
* Other active medical problems detected by examination or laboratory testing
* Plans to be in a different geographic area within the year
* Unable to give informed consent
* Non-English speaking
B: Inclusion Criteria:

* obese (prepregnant BMI 27.0 or greater)
* pregnant women delivering at Hartford Hospital
* no more than 34 weeks gestation
* considering breastfeeding this child
* low income (\<185% Federal poverty level)
* planning to remain in the greater Hartford area for 6 months postpartum
* must have access to a telephone for follow-up interviews
* delivery of a healthy, term, singleton

Exclusion Criteria:

* HIV positive or having other conditions which interfere with exclusive breastfeeding
* Infant admitted to the Neonatal Intensive Care Unit
C: Inclusion Criteria:

MATERNAL - Self-described as Mexican American, pre-pregnant BMI of 25 or greater, speaks English or Spanish, is between the ages of 18 and 40, lives in a home where she can receive home visitors, has no diagnosed chronic diseases that can affect the growth of a fetus (cardiac, respiratory, etc.), have a telephone contact, and is not intending to move from the area. Gestational diabetes will be noted but is not an exclusion criterion; however, Type 1 diabetics will be excluded. Exposure to tobacco smoke (either maternal or household smoking) will be noted as it is associated with infant obesity, but will not be an inclusion or exclusion criteria.

INFANT - We will enroll the full-term singleton infants of enrolled mothers. The infants will be enrolled if they are \> 38 weeks gestation, have a birth weight \> 2500 gm, and are without endocrine/chromosomal/genetic abnormality that could interfere with growth.

Exclusion Criteria:

MATERNAL - Not enrolled in WIC clinic or does not plan to continue with WIC clinic after delivery, high-risk pregnancy, hospitalized after discharge of infant, separated from infant, or experiencing significant postpartum complications. If these criteria develop in an enrolled mother, she will remain in the study per CONSORT guidelines, but her infant will not be followed for study outcomes. We have sufficient power with our sample size to allow for these events.

INFANT - Not discharged home with the mother or who are otherwise separated from their mothers or who has a severe illness that can affect growth. CONSORT guidelines will apply in these cases as well as in maternal cases.
D: Inclusion Criteria:

* pre-pregnancy BMI\>24
* over 18
* delivered baby in past 6 weeks
* English speaking
* driving distance to Duke University Medical Center

Exclusion Criteria:

* Hemodynamically significant heart disease
* Restrictive lung disease
* Severe anemia
* Unevaluated maternal cardiac arrythmia
* Chronic bronchitis
* Poorly controlled Type 1 diabetes
* Poorly controlled hypertension
* Orthopedic limitations
* Poorly controlled seizure disorder
* Poorly controlled hyperthyroidism

Answer: B