University of California, Berkeley
Presentation Abstract
Implications of Stress, Food Insecurity, and Weight Status on the Course of Pregnancy and Outcome
Pre-pregnancy weight status, dietary intake, and gestational weight gain are important health indicators during pregnancy; however, most pregnant people do not meet current recommendations. Optimized nutrition and access to nutritious foods are important conditions to achieve well-being and positive birth outcomes. Observational and intervention studies show that weight gain during pregnancy is often below or in excess of National Academy of Medicine guidelines. While there is a greater understanding of ideal weight gain targets, the prevalence of adverse birth outcomes and maternal mortality continue unchanged and, in some cases, have increased. Interventions that address stress, food insecurity, and weight related stigma, in addition to diet, are needed. The high prevalence of food insecurity during pregnancy, a major nutrition related stressor, is associated with a number of other severe maternal hardships. Current analysis from the Centers for Disease Control and Prevention Pregnancy Risk Assessment Monitoring System finds that pre-pregnancy underweight and obesity are associated with food insufficiency during pregnancy, and that food insufficiency is associated with inadequate gestational weight gain. Further, food insufficiency is positively associated with small for gestational age and inversely associated with large for gestational age, independent of weight status and socioeconomic factors. Alongside food insecurity, there is growing concern of the high prevalence and negative experience of weight stigma during pregnancy. Weight stigma is associated with lower quality care, poor mental well-being, and adverse birth outcomes. Stress reduction intervention, such as the MAMAS eight-week mindfulness intervention, find that mindfulness is associated with lower scores on perceived stress, depression and improved oral glucose tolerance test. A focus on whole-person health, one that shifts away from single factors such as weight status, is necessary to address the diversity of needs and variability between individuals. Addressing socio-structural determinants of health including mental well-being and stress, and eliminating food security and weight stigma, must be included in prenatal and postnatal care.
About Dr. Laraia
Dr. Barbara Laraia is Professor and Chair of the Public Health Nutrition Program at the University of California Berkeley School of Public Health in the Division of Community Health Sciences. Dr. Laraia received her Ph.D. degree in public health nutrition from University of North Carolina, Chapel Hill in 1999. She oversees a number of projects that investigate how human response to stress influences eating behaviors and metabolic outcomes. Her research program focuses on the influence of household food insecurity on dietary intake, cardiometabolic risk factors, and pregnancy outcomes, especially among socially diverse and low-income populations. She has written extensively on this topic and found that food insecurity carries the double burden of severe stress and poor dietary intake. A second aspect of her research focuses on early life adverse events, stress, and non-homeostatic eating behaviors, and how these lead to dietary intake and metabolic dysregulation. She implemented a stress reduction and healthy eating and movement intervention during pregnancy that led to reduced stress and depressive symptoms, improved awareness, and lower oral glucose tolerance test scores. She is currently a Principal Investigator on the R01AG059677 “Early Life Adversity, Cumulative Life Stress, Race, and Cellular Aging in Midlife Women and Offspring” with Dr. Elissa Epel. She has authored or co-authored over 140 peer-reviewed journal publications, commentaries, and book chapters. In 2012, she served as a member of the Institute of Medicine Committee on the Examination of the Adequacy of Food Resources and SNAP Allotments.
Dr. Laraia did not disclose any conflicts of interest for this workshop.