Opportunities in the Postpartum Period to Reduce Cardiovascular Disease Risk After Adverse Pregnancy Outcomes: A Scientific Statement From the American Heart Association

Adverse pregnancy outcomes are common among pregnant individuals and are associated with long-term risk of cardiovascular disease. Individuals with adverse pregnancy outcomes also have an increased incidence of cardiovascular disease risk factors after delivery. Despite this, evidence-based approaches to managing these patients after pregnancy to reduce cardiovascular disease risk are lacking. In this scientific statement, we review the current evidence on interpregnancy and postpartum preventive strategies, blood pressure management, and lifestyle interventions for optimizing cardiovascular disease using the American Heart Association Life's Essential 8 framework. Clinical, health system, and community-level interventions can be used to engage postpartum individuals and to reach populations who experience the highest burden of adverse pregnancy outcomes and cardiovascular disease. Future trials are needed to improve screening of subclinical cardiovascular disease in individuals with a history of adverse pregnancy outcomes, before the onset of symptomatic disease. Interventions in the fourth trimester, defined as the 12 weeks after delivery, have great potential to improve cardiovascular health across the life course.

Strategic Directions in Preventive Intervention Research to Advance Health Equity

As commissioned by the Society for Prevention Research, this paper describes and illustrates strategic approaches for reducing health inequities and advancing health equity when adopting an equity-focused approach for applying prevention science evidence-based theory, methodologies, and practices. We introduce an ecosystemic framework as a guide for analyzing, designing, and planning innovative equity-focused evidence-based preventive interventions designed to attain intended health equity outcomes. To advance this process, we introduce a health equity statement for conducting integrative analyses of ecosystemic framework pathways, by describing the role of social determinants, mechanisms, and interventions as factors directly linked to specific health equity outcomes. As background, we present health equity constructs, theories, and research evidence which can inform the design and development of equity-focused intervention approaches. We also describe multi-level interventions that when coordinated can produce synergistic intervention effects across macro, meso, and micro ecological levels. Under this approach, we encourage prevention and implementation scientists to apply and extend these strategic directions in future research to increase our evidence-based knowledge and theory building. A general goal is to apply prevention science knowledge to design, widely disseminate, and implement culturally grounded interventions that incrementally attain specific HE outcomes and an intended HE goal. We conclude with recommendations for conducting equity-focused prevention science research, interventions, and training.

Community-Based Prevention Programs for Disordered Eating and Obesity: Updates and Current Limitations

PURPOSE OF REVIEW

To review the status of community-based disordered eating and obesity prevention programs from 2014 to 2019.

RECENT FINDINGS

In the last 5 years, prevention programs have found success in intervening with children and parental figures in wellness centers, physical activity centers, childcare centers, workplaces, online, and over-the-phone through directly reducing disordered eating and obesity or by targeting risk factors of disordered eating and obesity. Community-based prevention programs for disordered eating and programs targeting both disordered eating and obesity were scarce, highlighting the critical need for the development of these programs. Qualities of the most effective programs were those in which parents and children were educated on physical activity and nutrition via multiple group-based sessions. Limitations of current prevention programs include few programs targeting high-risk populations, a dearth of trained community members serving as facilitators, inconsistent reporting of adherence rates, and few direct measurements of disordered eating and obesity, as well as few long-term follow-ups, precluding the evaluation of sustained effectiveness.

Enhanced vs Standard Parents as Teacher Curriculum on Factors Related to Infant Feeding among African American Women

OBJECTIVES

To determine the comparative impact of the standard Parents as Teachers (PAT) to the nutrition and physical activity enhanced version (PATE) of the perinatal educational curriculum on compliance with infant feeding recommendations and changes in maternal infant feeding knowledge and beliefs.

METHODS

Women at least 18 years of age, <19 weeks pregnant, and residing in three Mississippi counties were randomized to the standard PAT or the PATE version of the perinatal educational curriculum. Infant diets were assessed via 24-hour diet recall at postnatal months 1 to 12. Maternal knowledge and beliefs about infant feeding were assessed via survey at baseline and postnatal month 12. Compliance with infant feeding recommendations and differences in compliance between treatment arms were assessed using Kaplan-Meier survival curves. Longitudinal changes in maternal knowledge and beliefs were assessed with McNemar tests of symmetry.

RESULTS

Postnatal retention for the PAT and PATE arms were 83% (25/30) and 88% (21/24). Compliance with feeding recommendations for PAT and PATE participants, respectively, was 40% and 63% for no solid food before 6 months; 23% and 21% for no sugar-sweetened beverages before 12 months; 100% (both) for no fruit juice before 6 months; and 43% and 46% for no snack chips, French fries, and other fried food and candy before 12 months. Median times to feeding sugar-sweetened beverages were 10.1 and 9.6 months in PAT and PATE arms. Significant differences in compliance between arms were not found (P > 0.05). Participants' knowledge and beliefs about infant feeding were generally in agreement with expert recommendations at baseline, with few changes over time or between arms.

CONCLUSIONS

Findings suggest the need for further intervention focused on translating knowledge into action to improve diets of weaning infants in this region of the United States.

Assessment of Town and Park Characteristics Related to Physical Activity in the Lower Mississippi Delta

INTRODUCTION

Our objective was to determine aspects of the built environment that may have contributed to the low levels of physical activity reported in both the gestational and postnatal periods by women participating in a diet and physical activity intervention in the rural Lower Mississippi Delta.

METHODS

The built environments of 12 towns were measured by using the Rural Active Living Assessment tools and the Community Park Audit Tool. Correlations between town assessment scores and town size variables were computed by using Kendall τ coefficient. The street distance from a participant's home address to the nearest park was computed by using network analysis in ArcGIS.

RESULTS

Rural Active Living Assessment scores were low with mean values between 0% (town policy) and 68% (parks and playgrounds) of the highest possible scores. The mean (standard deviation) number of parks per town was 2.6 (3.2), and 55% of the 31 parks were in the 2 largest towns. Most parks (87%) had a single amenity while 1 park had more than 4 amenities. Distance from a participant's home to the nearest park ranged from less than 0.1 to 8.8 miles (mean [standard deviation], 1.2 [1.8]).

CONCLUSION

These 12 Lower Mississippi Delta towns scored low on assessments of physical environment features and amenities, town characteristics, and programs and policies associated with physical activity in rural communities. To increase the physical activity levels of rural residents, it may be necessary to first improve the built environment in which they live.

Assessment of neighborhood street characteristics related to physical activity in the Lower Mississippi Delta

Background: Physical activity levels were low for pregnant and postpartum participants in a diet and physical activity intervention. To explore micro level characteristics of participants'neighborhoods related to physical activity, an ancillary study was conducted. Methods: This cross-sectional study encompassed the neighborhood street segments of women participating in a diet and physical activity intervention that was conducted in the Lower Mississippi Delta. A neighborhood was defined as all street segments within one-fourth walking mile of a participant's home address. Street segments were measured using the Rural Active Living Assessment's Street Segment Assessment tool. In the field and on foot, raters measured street segments using neighborhood maps with segments identified. Results: Mean street segment length was 0.22 miles (SD = 0.14). All segments had flat terrain with residential (98%), open spaces (74%), and public/civic (34%) as the most prevalent land uses. Almost three-fourths of segments did not have any sidewalks (69%), sidewalk buffers or defined shoulders (73%), crosswalks or pedestrian signage (69%), or posted speed limits (74%).However, 88% had stop signs and almost all (96%) had street lighting and were paved multi lane roads (95%) with low traffic volume (90%). Most residential structures present were single family detached homes (95%) and the most common public/civic and commercial structures were churches (24%) and convenience stores (9%), respectively. Almost all of the street segments were rated as walk able (99%) and aesthetically pleasing (94%). Conclusion: Neighborhood street segments surrounding Delta Healthy Sprouts participants'homes were walk able and aesthetically pleasing. However, safety features such as sidewalks,pedestrian signage, and posted speed limit signs were lacking. To address these inadequate pedestrian safety features, infrastructure changes are needed for small rural towns.