Diana E. Ramos, MD, MPHDirector

Reproductive Health Los Angeles County Public Health

Assistant Clinical Professor, Keck USC School of Medicine

Los Angeles Managing Obesity in Moms

25 yo Hispanic

•BMI 52

•Irregular periods

•Infertility

•SAB x2

•IUP 39 6/7wk

•18 lb total wt gain

•Normal GTT

•Labile BP

•EFW 4500gm

4450gm

APGAR 8’9

NICU

Perpetuating Scenario

Up to 50% obesity if one parent is obese; 80% if both parents obese

Age-adjusted prevalence of obesity, by sex and race and Hispanic origin, among adults aged 20 and over:

2011–2012

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2011–2012 http://www.cdc.gov/nchs/data/databriefs/db131.htm

Impact of Maternal Obesity on the Development of Childhood Disease

Heerwagen M J R et al. Am J Physiol Regul Integr Comp Physiol 2010;299:R711-R722

Impact of Obesity in the Mother

• 1 in 3 reproductive age women are overweight or obese

• Hispanic and African American women are affected more

• Average 11lb weight retention if overweight or obese

Overweight & Obesity Increase Risk For:

http://www.aicr.org/learn-more-about-cancer/infographic-obesity-and-cancer.html

Delivery Issues in Obesity

• Obstetric hemorrhage (1.6X)

• Shoulder dystocia• Thromboembolism• Increased risk of

macrosomia• Increased risk C/S and

complications• VBAC less successful• Difficulty Breast Feeding

Obesity & Obstetric Complications inLate Pregnancy

Cedergren, MI. Maternal Morbid Obesity and the Risk of Adverse Pregnancy Outcome. Obstet Gynecol, Vol 103, No 2. Feb 2004.

Why LA MOMs?

• Obesity health related issues are appearing earlier and earlier

• 1 in 5 is overweight or obese

by the time they are 6 years old

• >50% of obese children are overweight before their second birthday

• Parents are the first teachers and role model in their child’s life

• A supportive environment is critical in shaping children’s lifelong behaviors and development

LA MOMs Impacts Beyond

Social Determinants of Health

Water10,000 StepsBreastfeeding

•housing•stress

•contraception

•depression•financial

•lack of childcare

•baby in NICU

•relationship

•nutrition

•Text messaging

•Text4babies

•Mobile website

•Facebook support groups

What Makes LA MOMs Unique

•Focus on Newly Delivered Moms

•Vaginal Delivery

•C-section

•Medical complication

•Modules tailored to obese/new moms

•Culturally sensitive

•Spanish

•83% of US Adults own a cell phone

•Text messaging is an epidemic among 18-24 year-olds. On average send/receive 109.5 text messages PER DAY

•Latino and Black cell phone owners are more likely than whites to send and receive text messages

http://pewinternet.org/Commentary/2012/February/Health-Technology-Communities-of-Color.aspx

People of Color Have Equal or Greater Rates of Usage on Most Major Social Media Platforms

http://www.slideshare.net/PewInternet/whos-on-what-social-media-trends-among-communities-of-color?from=share_email

Hispanics & African-AmericansLeading the Way to Social Media

http://pewinternet.org/Presentations/2011/Jan/Social-Media-Trends-Among-Communities-of-Color.aspx

Access to website, social media, text messages

Register

Physical Indicators

Assessment

Appropriate Referrals/Support

DCFS – Los Angeles County Department of Children and Family ServicesRCO – Reducing Childhood ObesityWIC – Women, Infants, and Children Program

CCRC-Child Care Referral CenterCPSP-Comprehensive Perinatal Service ProgramWIC – Women, Infants, and Children Program

LA MOMs Overview

•Well-woman visits

• Gestational diabetes screening

• HPV DNA testing for women 30 years and older

• STI counseling

• HIV screening and counseling

• FDA-approved contraception methods /counseling

• Breastfeeding support, supplies & counseling

• Domestic violence screening & counseling

• Prevention benefits without co-pays, co-insurance or deductibles

• Plans that start on or after August 1, 2012

LA MOMs Next Steps

• Pilot testing

• Partners identified

• Evaluation

• Completion 2016

Paradigm Shift in Obesity

Before Birth Infancy & Childhood

AdolescenceAdult…older

Life Course Perspective

Thank you!dramos@ph.lacounty.gov

DrDianaRamosMD