Healthy Eating for "Two"

When eating for two some women might be inclined to overindulge, but pregnant women who are obese need to take special precautions. The National Institute of Medicine released updated weight gain guidelines in May 2009.  The new guidelines were developed because of the overweight and obesity epidemic in the U.S.  According to the National Center for Health Statistics, two out of three women of childbearing age are overweight and close to one in three are obese at the beginning of their pregnancy - a 70% increase in the last decade.

Using the BMI (Body Mass Index) chart which considers height and weight, having a BMI over 30 is categorized as being obese.  The new guidelines suggest that women who are obese gain only 11 – 20 pounds during pregnancy.  Being overweight or obese can affect both the mother and baby. Excess pounds can increase the risk of developing gestational diabetes and hypertension, which can also lead to health problems for the mother after pregnancy.  Other increased risks include: premature births, delivery by cesarean sections and sometimes difficulties performing routine screenings, such as ultrasound scans and fetal health monitoring.  

It is recommended that women of all racial and ethnic groups use the updated guidelines.  It is also recommended that teenagers follow the adult guidelines until additional research can be done to determine whether special consideration is needed for teens.
Women who are pregnant with twins however, are given provisional guidelines.

Spreading the message

Along with these updated guidelines, the National Institute of Medicine recommends more diet and exercise counseling for all expectant mothers.  Studies show that a large percentage of women are not counseled on how much weight is healthy for them to gain or they are told to gain less or more weight than what the guidelines recommend. Healthcare providers are encouraged to adhere to the new guidelines and educate their patients on healthy weight gain during pregnancy.  

To maintain a healthy pregnancy weight women should:

• Eat three meals and several small snacks OR five to six small meals each day
• Avoid second helpings or large portions
• Drink plenty of water
• Choose healthy snacks such as fruit, a cup of carrots or yogurt
• Cut down on greasy foods and sweets

To slow weight gain (if gaining too fast):

• Watch portion size when eating out; ask for half your meal to be boxed to take home and choose lower fat items
• Avoid whole milk products. While at least four servings of milk products are recommended each day use skim or 1% milk and choose low-fat or fat-free yogurt and cottage cheese
• Limit sweet or sugared drinks
• Do not add salt to food when cooking or at the table since salt causes the body to retain water
• Prepare meals using low-fat cooking methods such as broiling and grilling

Along with healthy eating, women need to be reminded to keep moving. Exercising can help pregnant women sleep better, reduce back pain, boost energy levels, make her stronger for labor and help her get back in shape once the baby is born. For more information see our "Eating for Two?" brochure.

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HOPES for NC babies

In North Carolina, almost all babies are born in a hospital. However, until recently, nobody was working directly with hospitals to educate staff and parents about one of the leading causes of infant death, Sudden Infant Death Syndrome (SIDS). Since 2007, the North Carolina Healthy Start Foundation's Hospital Outreach and Partnerships Educating about Infant Safe Sleep (HOPES) project, has allowed the Foundation to collaborate with hospitals across the state to provide education, training and assistance with policy development to promote infant safe sleep.

This project was funded by the CJ Foundation for SIDS from 2007 – 2010 and has been supported by the N.C. Division of Public Health. In October, for National SIDS Awareness Month, the Foundation will partner with more than 50 hospitals to give onesies (baby garments) to every baby born in participating hospitals. Each onesie has an attractive safe sleep message, "Stomach to Play, Back to Sleep, For Baby's Safe Sleep." A bilingual (Spanish/English) fact sheet with infant safe sleep tips and additional educational materials will also be provided. Through this exciting collaboration more than 9,000 babies are expected to go home with the safe sleep onesies and their parents will be better prepared to keep them safe when they sleep.

Since this program's inception, more than 50 hospitals across the state have participated in HOPES (more than half the hospitals delivering babies). With training, technical assistance, educational resources and support provided by HOPES, hospital staff has been provided many opportunities to learn best practices, educate new parents and model safe sleep behaviors.

Safe sleep tips for new parents include:

• Put your baby on his or her back to sleep for naps and at night
• Use a firm mattress for baby's crib
• Keep pillows, comforters, soft blankets, stuffed animals and toys out of the crib
• Baby should sleep in his or her own crib
• Do not let anyone smoke near your baby
• Breastfeed your baby. In addition to many other benefits, it can reduce the risk of SIDS by 50%
• Keep baby and the room temperature comfortable
  (68˚ - 75˚F) – not too hot

If your local hospital is interested in participating with HOPES in the future, please contact Marta Pirzadeh at 919-828-1819. Additional information about HOPES or baby's safe sleep can be found here, or visit the baby safe sleep section of our Web site.

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Breaking Barriers in Greensboro

Pregnancy can be a joyful period in a woman's life, but without necessary resources and access to health care it can be both challenging and potentially dangerous for mom and baby. According to a 2008 survey conducted by the NC Pregnancy Risk Assessment Monitoring System (PRAMS), nearly half of all women experienced a barrier in obtaining prenatal care during their pregnancy, ranging from lack of health insurance to lack of transportation to get to the doctor.

Stephanie Amoako, RICHES Member and Healthy Beginnings Coordinator for the YWCA of Greensboro, is working to break some of the barriers women face during pregnancy through the YWCA's Healthy Moms Healthy Babies program. The program aims to help women of childbearing age have healthy birth outcomes, raise healthy children and work toward positive futures.

"Many mothers living in Greensboro are challenged by racism, cultural barriers, poverty, chronic stress, violence, homelessness or lack of safe housing," she said. "As a result, they face an increased risk of preterm labor, low birthweight, birth defects and infant mortality."

The Healthy Moms Healthy Babies program, which serves teens and young adults ranging in age from 13 to 30, has two primary initiatives, Healthy Beginnings and the Teen Parent Mentor program. The Healthy Beginnings program targets young adult women ages 19 to 30 and offers support groups and childbirth classes. Even though the program just started in 2008, Amoako believes it has made a difference in the lives of the women they serve. "From July 1, 2009 to June 30, 2010, 97% of women participating in this program have delivered full term babies who were more than 5½ pounds at birth (a healthy weight)."

The Teen Parent Mentor program shares similar success. Since 1984, the program has served pregnant and parenting teens ages 13 through 18, offering guidance and support to reduce repeat pregnancies. "99% of teens participating in our program have not experienced a repeat pregnancy," Amoako said. "97% of our teen moms continue school, which greatly increases their chances of graduating."  To improve upon their success the two programs are incorporating the RICHES Health Journal Tool Kit developed by the North Carolina Healthy Start Foundation. The toolkit, an easy-to-use, table-top flipchart, can be used by providers to get conversations going about health and how to take steps toward a healthier lifestyle. Amoako said she is excited about all the possibilities. "I have already started incorporating the Health Journal on my home visits and we will definitely use it in our group programming," she said.

The Healthy Babies Healthy Moms initiative is committed to eliminating the barriers that women face accessing health care. "A misconception that we often encounter with our clients is that they feel they are not in control due to the many challenges they face," she said. "We empower them and give them the tools they need to take charge of their health."

Through RICHES, Amoako is hoping to connect with other organizations with similar goals. "I decided to join RICHES because the more I connect with other nonprofits, the more I know about the great resources that are out there. This will definitely help me better serve my clients."

For more information on RICHES and how you can join, please visit www.NCHealthyStart.org or email us.

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Understanding Acculturation

In the September 2010 issue of Happenings we wrote about the 'Hispanic Paradox' and the fact that acculturation studies show that health outcomes worsen the longer an immigrant is in the United States. What does acculturation mean and how is it measured? Although researchers may disagree on some points, being aware of the basics of acculturation can help us better understand Latino attitudes about health and health behaviors.

Acculturation is defined as "the process whereby immigrants change their behavior and attitudes toward those of the host society" or as "the acquisition of the cultural elements of the dominant society - language, food choice, dress, music, sport."  Research studies often measure acculturation by using proxy measures such as birth place and language preference:

• What country were you born in?
• What languages do you speak?
• What language do you prefer?
• What was the first language you learned to speak?  

Depending on the study, there may be additional questions to help understand the nuances. For example: In what language do you prefer to watch TV, read a book, listen to the radio? A few studies may also ask about the language used by parents to speak to their children, friends and co-workers.  Length of stay in the United States is another frequently used proxy. Separately, these measures do not give us a full picture. Socio-economic status, as well as age, marital status and gender also need to be considered.  

Studies vary significantly on how they measure acculturation, sometimes without providing a clear definition of the issue.  As a result, some literature reviews suggest that the use of acculturation in health studies be suspended until the ambiguity can be resolved. Other reviews recommend focusing on what we know that is less controversial and continuing to educate on behaviors and practices that are known to be beneficial to health. Examples of this include: reinforcing positive health behaviors such as the consumption of fruits and vegetables and implementing educational programs that prevent unhealthy behaviors such as smoking and drinking.

While acculturation measurements are far from perfect, it's important to consider that service providers may need to tailor their activities depending on the acculturation level of their clients.  Providers should ask about language preference, place of birth and length of time in the U.S. as more practical measures that can help programs be more resource efficient. For example, if you are serving Latino youth and you find they prefer to read in English, you don't need to provide translated materials. Perhaps you can redirect those funds to hire an interpreter for a meeting with their parents who may only speak Spanish. 

Although acculturation studies may bring up more questions than answers, they can help frame our understanding of the issue and better enable us to analyze what we are doing as practitioners and help us think of ways to improve our programs and better serve the Latino community.

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Infant Safe Sleep Progress

What do babies do most of the time?  They sleep. Who tucks them in at night or puts them down for their afternoon nap? During their first year of life, it's likely babies will be cared for not only by their parents but grandparents, aunts, uncles, neighbors, babysitters and childcare providers. That's a lot of people who need to know how to safely put a baby in their care to sleep. 

Since 1994, the North Carolina Healthy Start Foundation, in collaboration with the N.C. Division of Public Health, has coordinated a statewide public education campaign to raise awareness about infant safe sleep. The goal? To reduce the number of babies who die of Sudden Infant Death Syndrome (SIDS). Over the years this evidence-based campaign has expanded its messages and now includes a variety of ways to reduce this risk.  It also addresses the prevention of other infant sleep-related deaths such as accidental suffocation and strangulation.

Compelling evidence now demonstrates that years of institutionalizing infant safe sleep messages is making a difference in North Carolina.

What strategies seem to be working?

• Reaching the public directly and changing infant sleep practices
• Requiring safe sleep policies and staff training in licensed childcare facilities
• Hospital staff modeling infant safe sleep practices when the baby is born

Reaching the public directly
The Foundation has used a variety of statewide and targeted strategies to reach the public – including radio and television ads, Internet, distribution of free educational materials, press conferences and community-based trainings. Since the
N.C. Pregnancy Risk Assessment Monitoring System (N.C. State Center for Health Statistics) started in 1997, the percentage of babies being put on their backs to sleep has increased from 42% to 70% of babies.

Improving practices in licensed childcare facilities
SIDS used to be the major cause of child deaths in childcare settings. Since 2003 the state has experienced a seven year trend of minimal SIDS deaths in licensed facilities.  What worked? In 2002, the Foundation, in partnership with the N.C. Division of Child Development, developed the ITS-SIDS curriculum, trained trainers, evaluated outcomes and provided technical assistance.  More than 30,000 childcare providers were trained in the first three years and the training is now institutionalized.  The 2003 Prevent SIDS Law, which mandated policies, safe sleep practices and staff training in childcare facilities, (using the ITS-SIDS training), made the difference.

Hospitals model infant safe sleep practices and educate new parents
With three-year funding from the CJ Foundation for SIDS and additional support from the N.C. Division of Public Health, the Foundation has worked with more than half the hospitals delivering babies in the state. See the Happenings article in this issue about "HOPES".

As evidenced by the success of various educational and training efforts to reduce the risk of SIDS in North Carolina, there is much to celebrate. And yet we know we must remain vigilant in our efforts. In 2009, 98 babies died of SIDS. While we may not know all the reasons for every SIDS death, research tells us there are many things that can be done to lower the risks. We owe the smallest and most fragile of our new citizens our best efforts in helping to ensure their bright futures.

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 N.C. Healthy Start Foundation | 1300 St. Mary's Street, Suite 204 | Raleigh, NC 27605 | 919-828-1819
Information@NCHealthyStart.org