Directions for Research on Women and Nutrition

Critical issues in the care of pregnant women with eating disorders and the impact on their children

Pregnancy and eating disorders is a subject that has received relatively little attention in the literature. Nevertheless, serious complications have been found in both the mother and the baby during both pregnancy and post partum period. This article alerts practitioners to the physical and psychological risks that imperil pregnant women with histories of recent eating disorders, describes the experiences of three women with eating disorders during pregnancy whose children developed eating difficulties, and suggests some guidelines for the screening and care of women with eating disorders and their babies.

Weight, nutrition, and immune status in postpartal women

Postpartal weight loss, nutritional intake, and immune status were examined in 65 women. Although 80% of the women lost weight and were not overweight by the 4th postpartal month, the majority had diets that were inadequate in fat content (> or = 30% of calories from fat) or protein content (< or = 12% of calories from protein), or in terms of caloric intake (< or = 1,200 calories or > or = 2,200 calories). Differences in some immune cell subsets were noted between women with high-fat and normal-fat diets. Women with high-fat diets had lower percentages of specific immune cell subsets than women with normal-fat diets. Protein intake was not related to immune cell phenotypes.

Gender Equity Issues in Clinical Research

Past research on the health of women has focused primarily on reproductive concerns such as breast cancer, infertility, contraception, menstrual disorders, and menopause. Today, the notion of women's health research includes such diverse areas as cardiovascular and cerebrovascular diseases, osteoporosis, mental health and substance abuse, obesity, and diabetes. In effect, the emphasis on women's health has changed from that of diseases which only affect women to include diseases which also affect women. Although the amount of research on women's health has increased since 1970, gender equity issues in clinical research are still in existence. This article describes why changes are occurring in the national research agenda on women's health. Gender differences in health statistics and examples of problem areas in women's health research are presented. Current changes at the National Institutes of Health (NIH) and Public Health Service (PHS) and potential changes in the United States Food and Drug Administration (FDA) and the pharmaceutical industry are also discussed.

Excessive maternal weight and pregnancy outcome

OBJECTIVES

This study was undertaken to determine the influences of increased maternal prepregnancy weight and increased gestational weight gain on pregnancy outcome.

STUDY DESIGN

This was a longitudinal retrospective study of 7407 term pregnancies delivered from 1987 through 1989. After excluding cases with multiple fetuses, stillbirths, fetal anomalies, no prenatal care, selected medical and surgical complications, and those with incomplete medical records, 3191 cases remained for analyses by determination of odds ratios for obstetric outcomes, by chi 2 tests for significant differences and by adjustment for risk factors with stepwise logistic regression.

RESULTS

Both increased maternal prepregnancy weight (body mass index) and increased maternal gestational weight gain were associated with increased risks of fetal macrosomia (p less than 0.0001), labor abnormalities (p less than 0.0001), postdatism (p = 0.002), meconium staining (p less than 0.001), and unscheduled cesarean sections (p less than 0.0001). They were also associated with decreased frequencies of low birth weight (p less than 0.001). The magnitude of the last was less than that of the other outcomes.

CONCLUSIONS

Increased maternal weight gain in pregnancy results in higher frequencies of fetal macrosomia, which in turn lead to increased rates of cesarean section and other major maternal and fetal complications. Because these costs of increased maternal weight gain appear to outweigh benefits, weight gain recommendations for pregnancy warrant careful review.