Avorgbedor Forgive, McCoy Thomas P, Wideman Laurie, Shriver Lenka H, Buehler Cheryl, Leerkes Esther M
School of Nursing, University of North Carolina at Greensboro, Greensboro, North Carolina.
Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina.
AJPM Focus. 2022 Sep 9;1(2):100029. doi: 10.1016/j.focus.2022.100029. eCollection 2022 Dec.
Structural racism leads to neighborhood-level socioeconomic disadvantage, which determines adverse birth outcomes. Individual socioeconomic disadvantage is associated with compromised healthy pregnancy outcomes. This study aimed to investigate the pathways by which race, neighborhood socioeconomic disadvantage, and household socioeconomic disadvantage predict subsequent maternal postpartum weight retention.
A total of 176 (N=176) racially diverse women were studied from the third trimester to 6 months after delivery. Neighborhood socioeconomic disadvantage was defined by information from the American Community Survey based on women's census tract and self-reports of neighborhood healthy food availability, safety, violence, and walking environment. Household socioeconomic disadvantage included food insecurity, income-to-needs ratio, and maternal education. Pregnancy health risk was operationalized using a summative index that included prepregnancy overweight/obesity, excessive gestational weight gain, and diagnosed hypertensive disorders during pregnancy. Postpartum weight retention was operationalized as a 6-month postpartum weight minus prepregnancy weight. Data were analyzed using structural equation modeling with bootstrapped CIs to estimate indirect effects.
One third of participants retained more than 22 lbs. of pregnancy weight gain 6 months after delivery. Increased household socioeconomic disadvantage (β=0.64, =0.039) and pregnancy health risk (β=0.34, =0.002) were directly associated with higher postpartum weight retention. Maternal race/ethnicity had an indirect impact on postpartum weight retention through neighborhood socioeconomic disadvantage and household socioeconomic disadvantage. Non-Hispanic Black women had greater neighborhood socioeconomic disadvantage than non-Hispanic White women (White vs Black β= -0.62; <0.001) and all other women (other vs Black β= -0.22; =0.013). In addition, Black women had greater household socioeconomic disadvantage than White women (White vs Black β= -0.35; =0.004), both of which in turn predicted higher postpartum weight retention.
To prevent postpartum weight retention, education on behavior change to lose weight is essential, but it must be offered in the context of basic resources, at both the neighborhood and household levels.
结构性种族主义导致社区层面的社会经济劣势，这决定了不良的出生结局。个体社会经济劣势与不良的健康妊娠结局相关。本研究旨在探讨种族、社区社会经济劣势和家庭社会经济劣势预测随后产妇产后体重滞留的途径。
共对176名种族多样的女性进行了研究，从孕晚期至产后6个月。社区社会经济劣势由美国社区调查的信息定义，该信息基于女性的人口普查区以及对社区健康食品供应、安全、暴力和步行环境的自我报告。家庭社会经济劣势包括粮食不安全、收入需求比和母亲教育程度。妊娠健康风险通过一个综合指数来衡量，该指数包括孕前超重/肥胖、孕期体重过度增加以及孕期诊断出的高血压疾病。产后体重滞留定义为产后6个月体重减去孕前体重。使用带有自抽样置信区间的结构方程模型分析数据，以估计间接效应。
三分之一的参与者在产后6个月保留了超过22磅的孕期体重增加。家庭社会经济劣势增加（β = 0.64， = 0.039）和妊娠健康风险增加（β = 0.34， = 0.002）与更高的产后体重滞留直接相关。母亲的种族/族裔通过社区社会经济劣势和家庭社会经济劣势对产后体重滞留产生间接影响。非西班牙裔黑人女性比非西班牙裔白人女性有更大的社区社会经济劣势（白人 vs 黑人β = -0.62；<0.001）以及比所有其他女性（其他种族 vs 黑人β = -0.22； = 0.013）。此外，黑人女性比白人女性有更大的家庭社会经济劣势（白人 vs 黑人β = -0.35； = 0.004），这两者反过来又预测了更高的产后体重滞留。
为防止产后体重滞留，关于行为改变以减肥的教育至关重要，但必须在社区和家庭层面的基本资源背景下提供。
