Almost half of all US women of reproductive age are ovenweight (OW) or obese, with higher rates among black women and Deep South residents. Gestational weight gain (GWG) and retention of weight post-partum have increased over time, resulting in higher risk for numerous adverse health outcomes for mother and offspring. As such, pregnancy is a critical period for understanding and intervening on factors contributing to excess GWG and subsequent increased risk for conditions and diseases which disproportionately impact racial/ethnic minorities. The OW/OB population is at greatest risk for the adverse outcomes, and therefore most likely to benefit and yield informative results; however, there is a lack of definitive evidence about what factors most influence GWG. While select individual characteristics explain some of the observed racial/ethnic differences in outcomes, wide disparities exist even when controlling for individual factors. Further the relationship between obesity and race and complex. Grounded in a multideterminants framework of prenatal health, the proposed study seeks to examine the relative contribution of social determinants of health (e.g., social, cultural, and built environments) and interpersonal characteristics (e.g., age, race) on maternal GWG and short-term health outcomes of 200 black and 200 white mother-infant pairs in Birmingham, AL and Jackson, MS. Further, we seek to use this information to inform community-driven approaches to promote health equity in these communities. The following aims will be accomplised by a transdiciplinary team from the University of Alabama at Birmingham (UAB), the University of Mississippi Medical Center (UMMC), and Jackson State University (JSU): (1) compare racial differences in social determinants of health; (2) Compare GWG (primary outcome) and obstetric complica- tions (e.g., GDM/insulin resistance, C-section, hypertensive disorders), birth weight, umbilical cord blood c-peptide concentration, infant weight and postpartum weight loss at 6-months (secondary outcomes); (3) Examine the relationship between individual factors and social determinants of health on primary and secondary outcomes, and (4) pilot test community-driven strategies to address social determinants of health.
Obesity and exessive gestation weight gain increases maternal and fetal complications. Racial/ethnic disparities in these health outcomes seem to persist even when individual factors are conrolled for, suggesting that alternative influences (e.g., social determinants of health) may play a significant role.
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