1. Diana E. Ramos, MD, MPH Director Reproductive Health Los Angeles County Public Health Assistant Clinical Professor, Keck USC School of Medicine Los Angeles Managing Obesity in Moms

2. 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

3. 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

4. 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

5. 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

6. Overweight & Obesity Increase Risk For: http://www.aicr.org/learn-more-about-cancer/infographic-obesity-and-cancer.html

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

8. 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

9. LA MOMs Impacts Beyond

11. Social Determinants of Health

12. Water10,000 Steps Breastfeeding housing stress contraception depression financial lack of childcare baby in NICU relationship nutrition

13. 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

14. 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

15. 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

16. Hispanics & African-Americans Leading the Way to Social Media http://pewinternet.org/Presentations/2011/Jan/Social-Media-Trends- Among-Communities-of-Color.aspx

18. Access to website, social media, text messages Register Stress Assessmen t Mental Health Assessmen t Physical Activity Assessmen t Nutrition Assessmen t Physical Indicators Assessmen t Breastfeedin g Assessment Appropriate Referrals/Support DATA COLLECTED Breastfeeding Water Intake 10,000 steps/day DCFS – Los Angeles County Department of Children and Family Services RCO – Reducing Childhood Obesity WIC – Women, Infants, and Children Program CCRC-Child Care Referral Center CPSP-Comprehensive Perinatal Service Program WIC – Women, Infants, and Children Program LA MOMs Overview

19. 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

20. LA MOMs Next Steps Pilot testing Partners identified Evaluation Completion 2016

21. Paradigm Shift in Obesity Before Birth Infancy & Childhood Adolescence Adult…older Life Course Perspective

22. Thank you! dramos@ph.lacounty.gov DrDianaRamosMD