Date

12-2013

Document Type

Thesis

Degree Name

M.P.H.

Department

Dept. of Public Health and Preventive Medicine

Institution

Oregon Health & Science University

Abstract

Background: Postpartum weight retention (PPWR) is a significant risk factor for overweight and obesity in women of childbearing age. In the United States, the trends of high body mass indices in all age groups and the adverse outcomes associated with obesity are crucial, preventable problems in public health and medicine. The perinatal period is a complex time for maternal and child health, as new demands of parenting and care-giving arise alongside dramatic changes in the physiology of women and children. The child’s health status, whether or not they have special health care needs, is linked to changes in psychological outcomes in parents and caregivers, but connections between physical outcomes, such as PPWR, have not been thoroughly established. Purpose: The objective of this analysis was to evaluate whether an association exists between child health status, assessed as having a child with a special health care need (CSHCN), and maternal PPWR. Methods: I studied the women who had a live birth in 2005 and responded to Oregon’s Pregnancy Risk Assessment Monitoring System (PRAMS) survey and the follow-back survey (PRAMS-2) when the child was two years old. Of the 2,806 birth certificates selected for PRAMS, the weighted response was 75.6% for the first survey. For the follow-back surveys, 1,046 of women completed PRAMS-2 surveys, for a weighted response of 47.7%. The primary predictor, CSHCN status, was identified by 10 questions about needs for ongoing services for the two year old child. Self reported maternal weight measurements were of pregravid weight as reported on PRAMS (mean 3.5 months postpartum) and postpartum weight as reported on PRAMS-2 (mean 25 months postpartum); PPWR was calculated from these. The outcome of interest was high vi PPWR, defined as retention of over 4.5 kg, which was the amount of PPWR that was associated with overweight status in a 15-year prospective cohort study. Logistic regression modeling was used to measure the association between the predictor and outcome of interest. Results: In the final sample of 978 subjects, 11.4% women reported having a CSHCN and 41.3% reported high PPWR. There was a positive association between having a CSHCN and experiencing PPWR in the bivariate logistic regression model (OR: 1.85 95% CI: 1.01 – 3.39). Similarly, the odds of reporting PPWR among subjects with CSHCN were 1.98 times those of subjects without CSHCN, after adjustment for parity, pregravid BMI, maternal race/ethnicity, maternal age, breastfeeding, physical activity, food security status, household income, and maternal depression in multivariate logistic regression analysis (OR: 1.98 95% CI: 1.07 – 3.66) Discussion: Compared to women who did not have a CSHCN, I found that women who had a CSHCN were less likely to lose their pregnancy weight gain. This may be due to dietary changes that occur alongside the increased care and time demands of having a CSHCN. Women may have less time available for exercise, meal preparation, and self care. The findings of this investigation may be applied at the individual and community level to raise awareness about this connection between maternal and child health. Public health professionals and health care providers can use these findings to develop ways to prevent the short and long term consequences of obesity and overweight in new mothers.

Identifier

doi:10.6083/M47S7M3C

School

School of Medicine

Included in

Public Health Commons

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