Browsing by Author "Bodnar, Lisa M."

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    The impact of setting a pregnancy weight gain goal on total weight gain
    (Wiley, 2021) Bodnar, Lisa M.; Abrams, Barbara; Simhan, Hyagriv N.; Scifres, Christina M.; Silver, Robert M.; Parry, Samuel; Crosland, Brian A.; Chung, Judith; Himes, Katherine P.; Obstetrics and Gynecology, School of Medicine
    Background: Expert groups recommend that women set a pregnancy weight gain goal with their care provider to optimise weight gain. Objective: Our aim was to describe the concordance between first-trimester personal and provider pregnancy weight gain goals with the Institute of Medicine (IOM) recommendations and to determine the association between these goals and total weight gain. Methods: We used data from 9353 women in the Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be. In the first trimester, women reported their personal pregnancy weight gain goal and their provider weight gain goal, and we categorised personal and provider weight gain goals and total weight gain according to IOM recommendations. We used log-binomial or linear regression models to relate goals to total weight gain, adjusting for confounders including race/ethnicity, maternal age, education, smoking, marital status and planned pregnancy. Results: Approximately 37% of women reported no weight gain goals, while 24% had personal and provider goals, 31% had only a personal goal, and 8% had only a provider goal. Personal and provider goals were outside the recommended ranges in 12%-23% of normal-weight women, 31%-41% of overweight women and 47%-63% of women with obesity. Women with both personal and provider pregnancy weight gain goals were 6%-14% more likely than their counterparts to have a goal within IOM-recommended ranges. Having any goal or a goal within the IOM-recommended ranges was unrelated to pregnancy weight gain. Excessive weight gain occurred in approximately half of normal-weight or obese women and three-quarters of overweight women, regardless of goal setting group. Conclusions: These findings do not support the effectiveness of early-pregnancy personal or provider gestational weight gain goal setting alone in optimising weight gain. Multifaceted interventions that address a number of mediators of goal setting success may assist women in achieving weight gain consistent with their goals.
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    Incremental Propensity Score Effects for Time-Fixed Exposures
    (Wolters Kluwer, 2021) Naimi, Ashley I.; Rudolph, Jacqueline E.; Kennedy, Edward H.; Cartus, Abigail; Kirkpatrick, Sharon I.; Haas, David M.; Simhan, Hyagriv; Bodnar, Lisa M.; Obstetrics and Gynecology, School of Medicine
    When causal inference is of primary interest, a range of target parameters can be chosen to define the causal effect of interest, such as average treatment effects (ATEs). However, ATEs may not always align with the research question at hand. Furthermore, the assumptions needed to interpret estimates as ATEs, such as exchangeability, consistency, and positivity, are often not met. Here, we present the incremental propensity score (incremental PS) approach to quantify the effect of shifting each person’s exposure propensity by some pre-determined amount. Compared to the ATE, incremental PS may better reflect the impact of certain policy interventions, and do not require that positivity hold. Using the Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be (nuMoM2b), we quantified the relation between total vegetable intake and the risk of preeclampsia, and compared it to average treatment effect estimates. The ATE estimates suggested a reduction of between two and three preeclampsia cases per 100 pregnancies for consuming at least 1/2 a cup of vegetables per 1,000 kcal. However, positivity violations obfuscate the interpretation of these results. In contrast, shifting each woman’s exposure propensity by odds ratios ranging from 0.20 to 5.0 yielded no difference in the risk of preeclampsia. Our analyses show the utility of the incremental propensity score effects in addressing public health questions with fewer assumptions.
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    Racial or Ethnic and Socioeconomic Inequalities in Adherence to National Dietary Guidance in a Large Cohort of US Pregnant Women
    (Elsevier, 2017-06) Bodnar, Lisa M.; Simhan, Hyagriv N.; Parker, Corette B.; Meier, Heather; Mercer, Brian M.; Grobman, William A.; Haas, David M.; Wing, Deborah A.; Hoffman, Matthew K.; Parry, Samuel; Silver, Robert M.; Saade, George R.; Wapner, Ronald; Iams, Jay D.; Wadhwa, Pathik D.; Elovitz, Michal; Peaceman, Alan M.; Esplin, Sean; Barnes, Shannon; Reddy, Uma M.; Obstetrics and Gynecology, School of Medicine
    BACKGROUND: The significance of periconceptional nutrition for optimizing offspring and maternal health and reducing social inequalities warrants greater understanding of diet quality among US women. OBJECTIVE: Our objective was to evaluate racial or ethnic and education inequalities in periconceptional diet quality and sources of energy and micronutrients. DESIGN: Cross-sectional analysis of data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort. PARTICIPANTS AND SETTING: Nulliparous women (N=7,511) were enrolled across eight US medical centers from 2010 to 2013. MAIN OUTCOME MEASURES: A semiquantitative food frequency questionnaire assessing usual dietary intake during the 3 months around conception was self-administered during the first trimester. Diet quality, measured using the Healthy Eating Index-2010 (HEI-2010), and sources of energy and micronutrients were the outcomes. STATISTICAL ANALYSES: Differences in diet quality were tested across maternal racial or ethnic and education groups using F tests associated with analysis of variance and χ2 tests. RESULTS: HEI-2010 score increased with higher education, but the increase among non-Hispanic black women was smaller than among non-Hispanic whites and Hispanics (interaction P value <0.0001). For all groups, average scores for HEI-2010 components were below recommendations. Top sources of energy were sugar-sweetened beverages, pasta dishes, and grain desserts, but sources varied by race or ethnicity and education. Approximately 34% of energy consumed was from empty calories (the sum of energy from added sugars, solid fats, and alcohol beyond moderate levels). The primary sources of iron, folate, and vitamin C were juices and enriched breads. CONCLUSIONS: Diet quality is suboptimal around conception, particularly among women who are non-Hispanic black, Hispanic, or who had less than a college degree. Diet quality could be improved by substituting intakes of refined grains and foods empty in calories with vegetables, peas and beans (legumes), seafood, and whole grains.