Gestational weight gain among Hispanic women

Determinants of excessive gestational weight gain: a systematic review and meta-analysis

Background

The prevalence of excessive gestational weight gain (EGWG) during pregnancy is increasing, and it is extremely harmful to pregnant women and newborns. Previous studies have suggested that EGWG is associated with various factors. We conducted a systematic review and meta-analysis to identify, quantify and analyze determinants of EGWG and evaluate the effect of these determinants on EGWG.

Methods

We searched for articles, from January 2009 to November 2020, related to the determinants of EGWG during pregnancy using four Chinese and four English databases. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement was utilized to guide the systematic review and meta-analysis process.

Results

Seventy studies, which identified EGWG factors in pregnant women (58 factors, 3 themes: individual [7 aspects, 37 factors]; family [4 aspects, 8 factors]; and social [4 aspects, 13 factors]), were included and analyzed in the systematic review. A meta-analysis was conducted for 13 factors (including 10 individual factors, 2 family factors, and 1 social factor) and revealed that pre-pregnancy overweight (including obesity), younger age (≤ 30 years old), unemployed, primiparity, smoking, and being unmarried (including divorced) were risk factors for EGWG, while prepregnancy underweight and inadequate antenatal care were protective factors for EGWG. There was no significant correlation between EGWG and education level, alcohol consumption, planning pregnancy, food security, and whether access to nutrition guidance during pregnancy.

Conclusions

EGWG was prevalent in pregnant women, and its prevalence seemed to be high and similar in many countries. Based on observational studies with medium-level and high-level evidence, some individual, family, and social factors were found to be associated with EGWG using qualitative and quantitative methods. In the future, exposure of pregnant women to risk factors for EGWG should be avoided, and interventions should be developed around the identified factors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00864-9.

Pre-pregnancy Health Behaviors and Gestational Weight Gain Among Hispanic/Latino Women: Hispanic Community Health Study/Study of Latinos

OBJECTIVE

To examine the association between preconception diet quality, sedentary behavior, and physical activity with gestational weight gain (GWG) among Hispanic/Latina women.

METHODS

This was a retrospective cohort study of participants from visits 1 and 2 of the Hispanic Community Health Study/Study of Latinos and singleton pregnancies between the 2 visits. Diet quality (alternative healthy eating index/AHEI-2010), sedentary behaviors, and physical activity (global physical activity questionnaire) were measured at visit 1 and accounted for preconception health behaviors. GWG was evaluated as a continuous and categorical variable according to the 2009 Institute of Medicine guidelines (inadequate, adequate, excessive). Linear and generalized logit survey regressions were used to study the association between health behaviors and GWG, using adequate GWG as the reference.

RESULTS

Of the 457 women included, deliveries occurred at 3.2 years (mean) from visit 1; 48.7% of women had excessive GWG. Mean AHEI-2010 scores were < 45% for women of all Hispanic/Latina backgrounds. There was no association between each 10-unit increase in AHEI-2010 or a 500 kcal/day increase in energy intake for mean and categorical GWG. There was no association between 30 min/day higher sedentary behavior, 30 min/day higher physical activity, or meeting the 2008 US physical activity guidelines for mean and categorical GWG.

CONCLUSIONS

We did not find any association between diet quality, sedentary behavior, and physical activity at visit 1 with GWG in pregnancies occurring between visits 1 and 2. We noted widespread poor diet quality as measured by the AHEI-2010 and low levels of physical activity among Hispanic/Latina women.

Use of the Spectroscopy-Based Veggie Meter® to Objectively Assess Fruit and Vegetable Intake in Low-Income Adults

Reflection spectroscopy is an emerging approach for noninvasively assessing dermal carotenoids as a biomarker of fruit and vegetable (FV) intake. This study sought to profile and identify determinants of scores from a reflection spectroscopy device (the Veggie Meter (VM)®) among 297 urban, primarily Hispanic low-income adults served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The repeatability of the scores and bi- and multivariate relationships between VM scores, self-reported FV intake measured by a brief screener, and participant characteristics were examined. The mean VM score was 270 (range 0-695); 3- and 6-month test-retest correlations were positive and strong (r = 0.79 and 0.55, respectively). VM scores were negatively associated with body mass index (BMI; r = -0.22) and were higher among participants of Ecuadorian, Dominican, and Mexican Hispanic origin relative to those of Puerto Rican origin; foreign- vs. US-born participants, breastfeeding vs. non-breastfeeding participants, nonsmokers vs. smokers, and participants who consumed three or more cups of FV/day relative to those who consumed less than three cups of FV/day. Foreign-born nativity, consumption of three or more cups of FV/day, and smaller body size were determinants of increased VM scores. Although replication studies are needed to confirm these findings, investigators working with similar populations are encouraged to use the VM to longitudinally track FV intake and to target determinants of the scores in observational and intervention studies of FV intake as measured by the VM.

Stress and Anxiety are Associated with Lower Gestational Weight Gain in Hispanic Women

OBJECTIVE

Prior studies indicate that inadequate and excessive gestational weight gain (GWG) are associated with poor maternal and infant outcomes, and that stress and anxiety may contribute to GWG. However, these studies often failed to use validated measures of stress and anxiety, measured only total GWG, and were limited to largely non-Hispanic White populations. We explored the association between stress and anxiety and GWG.

METHODS

We used data from 1,308 participants in Proyecto Buena Salud, a prospective cohort of predominantly Puerto Rican women 18-40 years of age (2006-2012). We measured stress with the Perceived Stress Scale and anxiety with the State-Trait Anxiety Scale, and abstracted GWG from medical records.

RESULTS

The average GWG was 31.0 ± 16.1 pounds. More than one-half of participants (51.8%) exceeded Institute of Medicine guidelines for GWG. After adjusting for age and pre-pregnancy body mass index, women in the highest quartiles of stress and anxiety in early pregnancy had approximately 4 lbs lower GWG (β = -3.89; SE = 1.54; p = .012 and β = -4.37; SE = 1.54; p = .005, respectively) as compared with those in the lowest quartiles. Similarly, women in the highest quartiles of mid/late pregnancy stress and anxiety had lower GWG (β = -3.84 lbs; SE = 1.39; p = .006, and β = -3.51 lbs; SE = 1.38; p = .011, respectively) and a lower rate of GWG in the second and third trimesters (β = -0.117 lbs/week; SE = 0.044; p = .008 and β = -0.116 lbs/week; SE = 0.043; p = .007, respectively), compared with those in the lowest quartiles.

CONCLUSIONS

High stress and anxiety were associated with lower GWG. Interventions to decrease stress and anxiety during pregnancy should include counseling on maintaining healthy GWG.

Does weight gain during pregnancy influence antenatal depressive symptoms? A systematic review and meta-analysis

OBJECTIVE

Conflicting results have been reported on the associations between inappropriate gestational weight gain (GWG) and the risk of depression during pregnancy. This systematic review and meta-analysis aimed to investigate the association between weight gain during pregnancy and the risk of antenatal depressive symptoms.

METHODS

A systematic search was performed in PubMed, EMBASE, Scopus, PsycINFO and CINAHL databases from database inception to July 31, 2020, and relevant studies were identified. Observational studies assessing the association between GWG using the Institute of Medicine (IOM) recommendations and maternal depressive symptoms during pregnancy were included. We used a random-effects model to estimate risks. Subgroup and sensitivity analyses were performed.

RESULTS

Of the 1232 studies identified, 19 met the inclusion criteria. The pooled odds ratio for the association between inadequate, excessive and total GWG and antenatal depressive symptoms was 1.09 (95% CI; 0.94-1.25), 0.94 (95% CI; 0.85-1.03), and 0.99 (95% CI, 0.88, 01.13), respectively. Sensitivity and subgroup analyses provided consistent findings.

CONCLUSION

The findings showed that neither women who gained weight below IOM recommendations, nor women who gained weight above IOM recommendations were more likely to experience depressive symptoms during pregnancy compared with women whose weight gain was within the recommended range. Studies focus on trimester-specific GWG and antenatal depressive symptoms are needed.

Risk of Excess and Inadequate Gestational Weight Gain among Hispanic Women: Effects of Immigration Generational Status

There is a dearth of information on the risk of inadequate and excess gestational weight gain (GWG) among different generations of Hispanic women in the United States. Therefore, the objective of this study was to understand the relationship of GWG and immigration across three generations of Hispanic women. The study was conducted using data from National Longitudinal Survey of Youth 1979 (NLSY79). The study sample included 580 (unweighted count) women (148 first-generation, 117 second-generation, and 315 third-/higher-generation). Sociodemographic and immigration data were extracted from the main NLSY79 survey, and pregnancy data were extracted from the child/young adult survey following the biological children born to women in NLSY79. Covariate adjusted weighted logistic regression models were conducted to assess the risk of inadequate and excess GWG among the groups. Average total GWG was 14.98 kg, 23% had inadequate GWG, and 50% had excess GWG. After controlling for the covariates, there was no difference in the risk of inadequate GWG between the three generations. First-generation women (OR = 0.47, p = 0.039) and third-/higher-generation women (OR = 0.39, p = 0.004) had significantly lower risk of excess GWG compared to second-generation women. It is important to recognize the generational status of Hispanic women as a risk factor for excess GWG.

Total and trimester-specific gestational weight gain and infant anthropometric outcomes at birth and 6 months in low-income Hispanic families

OBJECTIVE

To describe total and trimester-specific gestational weight gain (GWG) among low-income Hispanic women and determine whether these GWG exposures are associated with infant anthropometric outcomes at birth and 6 months.

STUDY DESIGN

Data were from 448 mother-infant pairs enrolled in the Starting Early child obesity prevention trial. Prenatal weights were used to calculate total GWG and 2^nd and 3^rd trimester GWG rates (kg/week) and categorized as inadequate, adequate, and excessive according to the 2009 Institute of Medicine recommendations. Multivariable linear and modified Poisson regressions estimated associations of infant anthropometric outcomes (birthweight, small-for-gestational age [SGA], large-for-gestational age [LGA], rapid weight gain, and weight-for-age, length-for-age, and weight-for-length z-scores at 6 months) with GWG categories.

RESULTS

For total GWG, 39% and 27% of women had inadequate and excessive GWG, respectively. 57% and 46% had excessive GWG rates in the 2^nd and 3^rd trimesters, respectively, with 29% having excessive rates in both trimesters. Inadequate total GWG was associated with lower infant weight and length outcomes (ß range for z-scores = -0.21 to -0.46, p < 0.05) and lower risk of LGA (adjusted Relative Risk, aRR = 0.38; 95% confidence intervals, CI: 0.16, 0.95) and rapid weight gain (aRR = 0.72; 95%CI: 0.51, 1.00). GWG rates above recommendations in the 2^nd trimester or 2^nd /3^rd trimesters were associated with greater weight outcomes at birth and 6 months (ß range for z-scores = 0.24 to 0.35, p < 0.05).

CONCLUSIONS

Counseling women about health behaviors and closely monitoring GWG beginning in early pregnancy is necessary, particularly among populations at high-risk of obesity.

The influence of socioeconomic status on gestational weight gain: a systematic review

Background

Despite a large number of publications regarding the association between socioeconomic status (SES) and gestational weight gain (GWG), the literature is inconsistent. We conducted a systematic review of current evidence relating to the association between SES and GWG, according to the Institute of Medicine (IOM) 2009 guidelines.

Methods

Six electronic databases were searched, with the final search run on first July 2016. The PRISMA Statement guidelines were followed and a modified version of the RTI Item Bank was used to assess risk of bias within studies. The primary outcome was inadequate, adequate or excessive GWG, as per the IOM guidelines.

Results

Sixteen studies were included. There was a positive skew in the number of studies that indicated that those who are less well educated are most at risk of gaining weight outside of the recommendations. Other measures of SES were not significantly associated with GWG.

Conclusions

Low educational attainment is likely to be associated with women gaining outside the IOM recommendations for GWG. Healthcare providers should provide additional support to pregnant women who are most at risk of gaining outside the recommendations, thus reducing the gap in health inequalities between those of high and low SES.

Family Support and Family Negativity as Mediators of the Relation between Acculturation and Postpartum Weight in Low-Income Mexican-Origin Women

BACKGROUND

Obesity presents a significant health concern among low-income, ethnic minority women of childbearing age.

PURPOSE

The study investigated the influence of maternal acculturation, family negativity, and family support on postpartum weight loss among low-income Mexican-origin women.

METHODS

Low-income Mexican-origin women (N=322; 14% born in the U.S.) were recruited from a prenatal clinic in an urban area of the Southwest U.S. Acculturation was assessed during a prenatal home visit (26-38 weeks gestation), and post-birth family support and general family negativity were assessed at 6 weeks postpartum. Objective maternal weight measures were obtained at five time points across the first postpartum year.

RESULTS

Higher acculturation predicted higher family support and family negativity. Higher family support predicted decreasing weight across the first postpartum year, and higher family negativity predicted higher weight at 6 weeks postpartum and increasing weight across the first postpartum year. In combination, family negativity and support mediated the impact of acculturation on postpartum weight gain.

CONCLUSIONS

Cultural and family-related factors play a significant role in postpartum weight gain and loss for low-income Mexican-origin women.

Patient-Provider Communication and Counseling about Gestational Weight Gain and Physical Activity: A Qualitative Study of the Perceptions and Experiences of Latinas Pregnant with their First Child

Latina women in the United States (U.S.) are disproportionately affected by obesity and are more likely to begin pregnancy overweight and gain excessive weight during pregnancy. The prenatal care period represents a window of opportunity for women to access the healthcare system and receive preventive services, education, nutritional support, and other social services to improve pregnancy outcomes. Excessive gestational weight gain (GWG) has numerous negative short- and long-term consequences for both the mother and newborn. We explored nulliparous Latina women's perceptions about their experiences communicating with their primary healthcare provider about GWG and physical activity (PA) to identify possible intervention targets using in-depth, semi-structured interviews. Bilingual, trained research staff conducted 23 interviews with first-time pregnant Latinas between 22 and 36 weeks of gestation. Interviews were transcribed verbatim and analyzed using content analysis. Salient text passages were extracted, shortened, coded, and grouped into categories. Women, including those who self-identified as being overweight or obese prior to pregnancy, reported receiving limited or no advice from their healthcare providers about GWG or PA. Additionally, analysis revealed that although participants value information received from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program counselors, they would like to receive more information from their primary healthcare providers about adequate GWG. Furthermore, study findings indicate that some participants received conflicting information regarding PA during pregnancy. Study findings suggest the need for increased integration of communication and counseling about GWG and PA into prenatal care services to promote healthy weight gain and PA among low-income Latina women.

Micronutrient Dietary Intake in Latina Pregnant Adolescents and Its Association with Level of Depression, Stress, and Social Support

Adolescent pregnant women are at greater risk for nutritional deficits, stress, and depression than their adult counterparts, and these risk factors for adverse pregnancy outcomes are likely interrelated. This study evaluated the prevalence of nutritional deficits in pregnant teenagers and assessed the associations among micronutrient dietary intake, stress, and depression. One hundred and eight pregnant Latina adolescents completed an Automated Self-Administered 24-hour dietary recall (ASA24) in the 2nd trimester. Stress was measured using the Perceived Stress Scale and the Prenatal Distress Questionnaire. Depressive symptoms were evaluated with the Reynolds Adolescent Depression Scale. Social support satisfaction was measured using the Social Support Questionnaire. More than 50% of pregnant teenagers had an inadequate intake (excluding dietary supplement) of folate, vitamin A, vitamin E, iron, zinc, calcium, magnesium, and phosphorous. Additionally, >20% of participants had an inadequate intake of thiamin, riboflavin, niacin, vitamin B6, vitamin B12, vitamin C, copper, and selenium. Prenatal supplement inclusion improved dietary intake for most micronutrients except for calcium, magnesium, and phosphorous, (>50% below the Estimated Average Requirement (EAR)) and for copper and selenium (>20% below the EAR). Higher depressive symptoms were associated with higher energy, carbohydrates, and fats, and lower magnesium intake. Higher social support satisfaction was positively associated with dietary intake of thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, vitamin C, vitamin E, iron, and zinc. The findings suggest that mood and dietary factors are associated and should be considered together for health interventions during adolescent pregnancy for the young woman and her future child.

Effect of diet and exercise intervention in Chinese pregnant women on gestational weight gain and perinatal outcomes: A quasi-experimental study

Aim To determine the effect of a diet and exercise intervention in pregnant women on total gestational weight gain, weekly weight gain, 42-days postpartum weight retention, mode of delivery, and infant birth weight.

METHODS

One hundred and one eligible Chinese pregnant women whose pre-pregnancy body mass index ranged from 18.5 to 24.9 were recruited between June 2013 and June 2014 from a tertiary hospital. Ninety participants, 45 in each group, completed the study. Intervention women received three face-to-face interventions and three follow-up phone calls which were developed based on the Transtheoretical Model. Gestational weight was measured at each prenatal check. Mode of delivery and infant birth weight were collected from the medical record. The 42-days postpartum weight was measured during the postpartum visits.

RESULTS

(1) The total gestational weight gain and mean weight gain per week in the intervention group were significantly less than the control group (P=0.045 and P=0.008 respectively). (2) Infant birth weight was significantly lower in the intervention group (P=0.012). (3) Postpartum weight retention was significantly less in the intervention group (P=0.001). 4) There were not significant differences in mode of delivery. 5) Infant birth weight was significantly less than the control group (P=0.012).

CONCLUSIONS

The lifestyle intervention significantly reduced gestational weight gain, optimized infant weight and lowered postpartum weight retention. Promotion of gestational weight management is needed and cultural health beliefs about pregnancy and postpartum practices should be considered when developing the intervention plan.

Predictors of Gestational Weight Gain among White and Latina Women and Associations with Birth Weight

This study examined racial/ethnic differences in gestational weight gain (GWG) predictors and association of first-trimester GWG to overall GWG among 271 White women and 300 Latina women. Rates of within-guideline GWG were higher among Latinas than among Whites (28.7% versus 24.4%, p < 0.016). Adjusted odds of above-guideline GWG were higher among prepregnancy overweight (OR = 3.4, CI = 1.8-6.5) and obese (OR = 4.5, CI = 2.3-9.0) women than among healthy weight women and among women with above-guideline first-trimester GWG than among those with within-guideline first-trimester GWG (OR = 4.9, CI = 2.8-8.8). GWG was positively associated with neonate birth size (p < 0.001). Interventions targeting prepregnancy overweight or obese women and those with excessive first-trimester GWG are needed.

Psychological factors and trimester-specific gestational weight gain: a systematic review

Excess gestational weight gain (GWG), which has reached epidemic proportions, is associated with numerous adverse pregnancy outcomes. Early pregnancy provides a unique opportunity for counseling pregnant women since many women are motivated to engage in healthy behaviors. A systematic review was conducted to summarize the relation between psychological factors and trimester-specific GWG, i.e. GWG measured at the end of each trimester. Eight databases were searched for affect, cognition and personality factors. The guidelines on meta-analysis of Observational Studies in Epidemiology were followed. The methodological quality of each study was assessed using a modified Newcastle-Ottawa Scale. Of 3620 non-duplicate titles and abstracts, 74 articles underwent full-text review. Two cohort studies met the inclusion criteria. Distress was negatively associated with first trimester GWG among both adolescents and non-adolescents. Body image dissatisfaction was associated with second trimester GWG only among non-adolescents. No association emerged between perceived stress, state and trait anxiety and body image dissatisfaction among adolescents and trimester-specific GWG. The relation between trimester-specific GWG and a number of weight-related and dietary-related cognitions, affective states and personality traits remain unexplored. Given the limited number of studies, further high-quality evidence is required to examine the association between psychological factors and trimester-specific GWG, especially for cognitive and personality factors.

Psychological antecedents of excess gestational weight gain: a systematic review

BACKGROUND

Excess gestational weight gain (GWG), which has reached epidemic proportions, is associated with adverse outcomes during pregnancy and postpartum obesity in women and children. Psychological variables represent potentially modifiable factors. Moreover, previous systematic reviews on GWG interventions have called for the need for a clearer understanding of psychological factors affecting GWG. Hence, a systematic review was conducted to summarize the relation between psychological factors and GWG.

METHODS

Eight databases were searched, and the guidelines on Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Methodological quality of the included studies was assessed using a modified Newcastle-Ottawa scale. Two assessors independently reviewed titles, abstracts and full articles, extracted data and assessed quality.

RESULTS

A total of 6198 titles and abstracts were reviewed of which 90 full text articles were retrieved. Thirty-five studies (25 cohort, eight cross-sectional and two case-control) met the inclusion criteria, assessing 26 different psychological constructs in affect, cognitions and personality. Negative affective states such as depression, anxiety and stress were not related to excess GWG. Among weight-related and dietary-related cognitions, risk factors for excess GWG included concern about weight gain, negative body image and attitude towards weight gain, inaccurate perceptions regarding weight, higher than recommended target weight gain, less knowledge about weight gain, higher levels of cognitive dietary restraint, and perceived barriers to healthy eating. Protective factors included an internal locus of control for weight gain, lower than recommended target weight gain and higher self-efficacy for healthy eating. Only one study examined the relation between personality and excess GWG.

CONCLUSION

In this systematic review, a number of cognitive factors were identified that were associated with excess GWG. To address excess GWG, more high quality, adequately powered studies are required examining cognitions, motivation and personality factors.

Depressive symptoms and obesity/weight gain factors among Black and Hispanic pregnant women

This study examined the relationships between depressive symptoms and obesity/weight gain factors in 56 Black and Hispanic pregnant women and the differences in these variables between the 2 ethnic groups. Of the women, 32% were likely depressed, 66% were overweight/obese, and 45% gained excessive gestational weight. Depressive symptoms were positively correlated with prepregnancy body mass index (BMI; r = .268, p = .046), inversely related to gestational weight gain (r = -.329, p = .013), and not associated with excessive gestational weight gain. Black women were more likely to have excessive gestational weight gain than Hispanic women. Prepregnancy BMI and gestational weight gain data can be useful in identifying pregnant women with depression.

Gestational weight gain and obesity, adiposity and body size in African-American and Dominican children in the Bronx and Northern Manhattan

Gestational weight gain (GWG) is potentially modifiable and is associated with infant size and body composition; however, long-term effects on childhood obesity have not been reported among multi-ethnic urban populations. We examined the association between GWG and child anthropometric measures and body composition at 7 years [waist circumference (WC), body mass index z-score (BMIZ), obesity (BMIZ ≥95%ile) and bioelectrical impedance analysis estimates of percentage body fat (%fat)] in African-American and Dominican dyads (n = 323) in the Columbia Center for Children's Environmental Health prospective birth cohort study from 1998 to 2013. Linear and logistic regression evaluated associations between excessive GWG [>Institute of Medicine (IOM) 2009 guidelines] and outcomes, adjusting for pre-pregnancy BMI and covariates. Pre-pregnancy BMI (mean ± standard deviation, all such values) and total GWG were 25.8 ± 6.2 kg m(-2) (45% overweight/obese) and 16.4 ± 7.9 kg (64% > IOM guidelines), respectively. Excessive GWG was associated with higher BMIZ {0.44 [95% confidence interval (CI): 0.2, 0.7], P < 0.001}, WC [β: 2.9 cm (95% CI: 1.1, 4.6), P = 0.002], %fat at 7 years [β: 2.2% (95% CI: 1.0, 3.5), P = 0.001)] and obesity [odds ratio: 2.93 (95% CI: 1.5, 5.8), P = 0.002]. Pre-pregnancy BMI was positively associated with child size, adiposity and obesity (all P < 0.05). Excessive GWG was highly prevalent and was associated with child obesity, greater percentage body fat and abdominal adiposity. Strategies to support healthy GWG are warranted to promote healthy growth and prevent childhood obesity.

Birth outcomes of Hispanic women and risks or strengths associated with ethnicity and Texas border residence

OBJECTIVE

To assess Hispanic ethnicity, border residence, or their interaction for association with risk of high gestational weight gain (GWG) and related outcomes.

DESIGN

Retrospective analysis of 2009 birth data.

SETTING

Texas.

PARTICIPANTS

Participants included 146,458 Hispanic and 104,399 non-Hispanic (NH) White women.

METHODS

We used adjusted odds ratios (AOR) in logistic regression analyses to test the association of Hispanic ethnicity, border residence, and their interaction with high GWG, cesarean birth, macrosomia, and breastfeeding status at discharge.

RESULTS

After adjusting for covariates, risk of inadequate or excessive GWG was not associated with being a border resident, but Hispanic women compared to NH White women had an increased risk of inadequate GWG (AOR = 1.21, 99% confidence interval [CI] [1.17, 1.26]) and decreased risk of excessive GWG (AOR = 0.77, 99% CI [0.74, 0.79]). Risk of cesarean birth was increased for border residents (AOR = 1.22, 99% CI [1.05, 1.42]), and this risk was increased further among border residents who were Hispanic (AOR = 1.52, 99% CI [1.30, 1.77]).

CONCLUSION

We found strengths and vulnerabilities among Hispanic and border-residing women. Hispanic women were at lower risk of excessive GWG than NH White women. Border-residing Hispanic women were at greater risk of cesarean birth than other women.