Erica P Gunderson | Kaiser Permanente (original) (raw)

Papers by Erica P Gunderson

Obesity, 2004

Objective: To prospectively evaluate whether childbearing leads to development of overweight in w... more Objective: To prospectively evaluate whether childbearing leads to development of overweight in women and to evaluate the role of other known risk factors.Research Methods and Procedures: A prospective, multicenter observational study, the Coronary Artery Risk Development in Young Adults (CARDIA) Study from 1986 to 1996, examined subjects at baseline and in follow-up years 2, 5, 7, and 10. Included were

Circulation, Mar 25, 2014

ABSTRACT Introduction: Gestational weight gain (GWG) has significant health implications for the ... more ABSTRACT Introduction: Gestational weight gain (GWG) has significant health implications for the mother and her infant. Excess GWG is associated with increased birth weight, but whether it has long term consequences for the offspring is less clear. Therefore, we sought to evaluate the impact of GWG on overweight/obesity in children ages 2-4. Methods: We identified 3,638 mother/child pairs among women who completed a health survey between 2007-2009 and had a subsequent pregnancy delivered as a live birth at Kaiser Permanente Northern California. Children were classified as overweight or obese if their weight met or exceeded the 85th percentile of the 2000 CDC BMI growth charts, based on age and sex. GWG was dichotomized (exceeding versus being at or below the 2009 IOM GWG recommendations). Results: Half of the cohort was from non-white racial/ethnic groups, 45% were overweight/obese before pregnancy, and 68% exceeded the IOM recommendations. Overall, 18% of children were overweight/obese. Exceeding the IOM recommendations was associated with a 24% increase in risk of having a child who was overweight/obese [RR (95% CI): 1.24 (1.02-1.51)], after adjusting for maternal pre-pregnancy BMI, race/ethnicity, age, education, pregnancy glucose tolerance, and infant gestational age. The association appeared stronger among women who were not overweight/obese before pregnancy [RR (95% CI): 1.43 (1.07-1.90) at BMI <25 versus 1.13 (0.87-1.46) at BMI ≥ 25]. Conclusions: The impact of excess GWG on subsequent childhood overweight/obesity may be stronger among women who were not initially overweight or obese. Lifestyle interventions to help women achieve appropriate GWG may also reduce childhood obesity.

A comparison of serum femtin and other parameters of iron status was made between 46 women taking... more A comparison of serum femtin and other parameters of iron status was made between 46 women taking oral contraceptive agents (OCAs) for two or more years continuously and 71 women who never took OCAs. The mean serum ferritin level for the OCA users was 39.5 ± 21.5 ng/ml and the control group mean level was 25.4 ± 15.96 ng/ml, which

International Journal of Obesity and Related Metabolic Disorders Journal of the International Association For the Study of Obesity, Dec 1, 2000

OBJECTIVES: To assess the relationships between gestational gain, raceaethnicity, reproductive hi... more OBJECTIVES: To assess the relationships between gestational gain, raceaethnicity, reproductive history, age, education and the risk of becoming overweight after pregnancy. STUDY DESIGN: Prospective cohort study of adult women from four raceaethnicity groups who had two consecutive births between 1980 and 1990 at the University of California, San Francisco (UCSF). MEASUREMENTS: Height and pregravid weights for each pregnancy were self-reported. Women were classi®ed as overweight or not overweight according to the Institute of Medicine (IOM) criteria for pregnancy. Gestational gain was de®ned as the difference between the pregravid weight and the last weight before delivery of the ®rst study pregnancy. SUBJECTS: 1300 healthy women aged 18 ± 41 y who had a singleton, full-term, live birth (index or ®rst study pregnancy) followed by a second birth. Self-reported pregravid weights and heights were used to calculate body mass index (BMI). Women with a pregravid BMI below 26.0 kgam 2 before the index pregnancy were classi®ed as not overweight (n 1128). Overweight status following the index pregnancy was based on pregravid BMI for the second pregnancy. RESULTS: Seventy-two women (6.4%) became overweight following the index pregnancy. Statistically signi®cant independent predictors of the risk of becoming overweight included: maternal age 24 ± 30 vs above 30 y, high gestational gain, short interval from menarche to ®rst ever birth (`8 y), and young age at menarche (`12 y). The risk of becoming overweight was increased 2.5 ± 3 times for each of these risk factors. Whites were 4.5 times more likely to become overweight than Asians, but blacks and Hispanics did not appear to differ from whites. Parity, time interval, smoking habit, education, marital status and other factors were not associated with the risk of becoming overweight. CONCLUSIONS: These ®ndings suggest that young age at menarche, maternal age and short time from menarche to ®rst ever birth may be as important as high gestational weight gain in determining the risk of becoming overweight after pregnancy.

Circulation, Mar 13, 2012

Clinical Obstetrics and Gynecology, Jul 1, 2003

Diabetes care, Jan 6, 2016

Gestational diabetes mellitus (GDM) predicts incident cardiovascular disease (CVD). However, mech... more Gestational diabetes mellitus (GDM) predicts incident cardiovascular disease (CVD). However, mechanisms linking GDM to CVD beyond intervening incident diabetes are not well understood. We examined the relation of GDM with echocardiographic parameters of left ventricular (LV) structure and function, which are important predictors of future CVD risk. We studied 609 women (43% black) from the Coronary Artery Risk Development in Young Adults study who delivered one or more births during follow-up and had echocardiograms in 1990-1991 (mean age 28.8 years) and 2010-2011. During the 20-year follow-up, 965 births were reported, with GDM developing in 64 women (10.5%). In linear regression models adjusted for sociodemographic factors, BMI, physical activity, parity, smoking, use of oral contraceptives, alcohol intake, family history of coronary heart disease, systolic blood pressure, and lipid levels, women with GDM had impaired longitudinal peak strain (-15.0 vs. -15.7%, P = 0.025), circumf...

Diabetes Care, 2015

In 2010, the American Diabetes Association (ADA) added hemoglobin A1c (A1C) to the guidelines for... more In 2010, the American Diabetes Association (ADA) added hemoglobin A1c (A1C) to the guidelines for diagnosing type 2 diabetes. However, existing models for predicting diabetes risk were developed prior to the widespread adoption of A1C. Thus, it remains unknown how well existing diabetes risk prediction models predict incident diabetes defined according to the ADA 2010 guidelines. Accordingly, we examined the performance of an existing diabetes prediction model applied to a cohort of African American (AA) and white adults from the Coronary Artery Risk Development Study in Young Adults (CARDIA). We evaluated the performance of the Atherosclerosis Risk in Communities (ARIC) diabetes risk prediction model among 2,456 participants in CARDIA free of diabetes at the 2005-2006 exam and followed for 5 years. We evaluated model discrimination, calibration, and integrated discrimination improvement with incident diabetes defined by ADA 2010 guidelines before and after adding baseline A1C to the prediction model. In the overall cohort, re-estimating the ARIC model in the CARDIA cohort resulted in good discrimination for the prediction of 5-year diabetes risk (area under the curve [AUC] 0.841). Adding baseline A1C as a predictor improved discrimination (AUC 0.841 vs. 0.863, P = 0.03). In race-stratified analyses, model discrimination was significantly higher in whites than AA (AUC AA 0.816 vs. whites 0.902; P = 0.008). Addition of A1C to the ARIC diabetes risk prediction model improved performance overall and in racial subgroups. However, for all models examined, discrimination was better in whites than AA. Additional studies are needed to further improve diabetes risk prediction among AA.

Journal of the American Society of Hypertension (JASH)

Klatsky AL, Gunderson E. Alcohol and hypertension: a review. J Am Soc Hypertens. 2008 Sep-Oct;2(5... more Klatsky AL, Gunderson E. Alcohol and hypertension: a review. J Am Soc Hypertens. 2008 Sep-Oct;2(5):307-17. doi: 10.1016/j.jash.2008.03.010. Epub 2008 Jun 24. PubMed PMID: 20409912

Journal of studies on alcohol, 2006

Heavy alcohol drinking is associated with increased prevalence of systemic hypertension (HTN), bu... more Heavy alcohol drinking is associated with increased prevalence of systemic hypertension (HTN), but the relationship between moderate drinking and HTN remains unclear. We explored the possible role of underreporting among moderate drinkers. In a cross-sectional analysis of 105,378 persons, we defined a subset among persons reporting three or fewer drinks per day that was likely to include a disproportionate number of underreporters. This subset included persons who, on another occasion, indicated intake of three or more drinks per day or who ever had a diagnosis of an alcohol-related condition; these persons are called "positive." Persons who never reported three or more drinks per day and who had no alcohol-related diagnosis were called "negative." Logistic regression models estimated the odds ratios (ORs) for prevalent HTN (140/90 mm Hg or greater) in the positive and negative subgroups, compared with lifelong abstainers as referent. All persons and four race-ge...

Journal of the American Society of Hypertension, 2008

In recent decades alcohol use has joined other correlates of hypertension (HTN), such as obesity ... more In recent decades alcohol use has joined other correlates of hypertension (HTN), such as obesity and salt intake, as a major research focus about HTN risk factors. In cross-sectional and prospective epidemiologic studies, higher blood pressure (BP) has consistently been found among persons reporting usual daily intake of three standard-sized drinks or more. Although definitive mechanisms have not been established, several aspects of the data, including short and intermediate term experiments, suggest a causal relationship. Heavier drinking may, in fact, be the commonest cause of reversible HTN, and reduction of heavy alcohol intake plays an important public health role in HTN management. Additional to the mechanism, unresolved issues about the alcohol-BP relationship include whether there is a threshold dosage of alcohol for association with HTN, the sequelae of alcohol-associated HTN and the roles of interactions with gender, ethnicity, other lifestyle traits, drinking pattern, and choice of beverage. This article reviews these areas and includes new data about the beverage choice aspect. J Am Soc Hypertens 2008;2(5): 307-317.

American Journal of Public Health, Oct 10, 2011

Mustillo et al. | Peer Reviewed | Research and Practice | 2125  RESEARCH AND PRACTICE 

The Journal of Clinical Endocrinology Metabolism, Jul 2, 2013

Context: Preterm birth is associated with maternal cardiovascular risk, but mechanisms are unknown.

Diabetes Care, 2015

To compare the effectiveness of diabetes prevention strategies addressing postpartum weight reten... more To compare the effectiveness of diabetes prevention strategies addressing postpartum weight retention for women with gestational diabetes mellitus (GDM) delivered at the health system level: mailed recommendations (usual care) versus usual care plus a Diabetes Prevention Program (DPP)-derived lifestyle intervention. This study was a cluster randomized controlled trial of 44 medical facilities (including 2,280 women with GDM) randomized to intervention or usual care. The intervention included mailed gestational weight gain recommendations plus 13 telephone sessions between 6 weeks and 6 months postpartum. Primary outcomes included the following: proportion meeting the postpartum goals of 1) reaching pregravid weight if pregravid BMI <25.0 or 2) losing 5% of pregravid weight if BMI ≥25.0; and pregravid to postpartum weight change. On average, over the 12-month postpartum period, women in the intervention had significantly higher odds of meeting weight goals than women in usual care (odds ratio [OR] 1.28 [95% CI 1.10, 1.47]). The proportion meeting weight goals was significantly higher in the intervention than usual care at 6 weeks (25.5 vs. 22.4%; OR 1.17 [1.01, 1.36]) and 6 months (30.6 vs. 23.9%; OR 1.45 [1.14, 1.83]). Condition differences were reduced at 12 months (33.0 vs. 28.0%; OR 1.25 [0.96, 1.62]). At 6 months, women in the intervention retained significantly less weight than women in usual care (mean 0.39 kg [SD 5.5] vs. 0.95 kg [5.5]; mean condition difference -0.64 kg [95% CI -1.13, -0.14]) and had greater increases in vigorous-intensity physical activity (mean condition difference 15.4 min/week [4.9, 25.8]). A DPP-derived lifestyle intervention modestly reduced postpartum weight retention and increased vigorous-intensity physical activity.

Archives of Pediatrics Adolescent Medicine, Apr 1, 2009

Objective-To examine the impact of pregnancy on adolescent growth and adiposity relative to nulli... more Objective-To examine the impact of pregnancy on adolescent growth and adiposity relative to nulligravidas of similar maturation stage.

The Faseb Journal, Apr 1, 2014

International Journal of Obesity and Related Metabolic Disorders Journal of the International Association For the Study of Obesity, Jun 1, 2001

OBJECTIVES: To examine differences in the pattern of weight changes during and after pregnancy am... more OBJECTIVES: To examine differences in the pattern of weight changes during and after pregnancy among four pregravid body mass index (BMI) groups. STUDY DESIGN: Prospective cohort study of women who had two consecutive births at the University of California, San Francisco (UCSF) between 1980 and 1990. MEASUREMENTS: Maternal body weights were available before conception and delivery, and at 6 weeks postpartum for the ®rst (index) pregnancy, and before conception for the second study pregnancy. Height and two pregravid weights were selfreported. Weights at delivery and 6 weeks postpartum were measured. Net delivery weight was de®ned as delivery weight minus infant birth weight. Three non-overlapping sequential weight changes were constructed: (1) net gestational gain (net delivery weight minus pregravid weight at the index pregnancy); (2) early net postpartum weight change (6-week postpartum weight minus net delivery weight); and (3) late postpartum weight change (pregravid weight at the second pregnancy minus 6-week postpartum weight). SUBJECTS: A total of 985 healthy women (age 18 ± 41 y) from four raceaethnicity groups (Asian, Hispanic, black and white) who had a singleton, full-term, live birth for the index pregnancy followed by a second consecutive birth. RESULTS: Four raceaethnicity groups were combined (no interaction) to contrast average weight changes among pregravid BMI groups. Means adjusted for eight covariates (parity, raceaethnicity, education, mode of delivery, smoking, hypertension of pregnancy, age, height) and time intervals were not altered appreciably. Early net postpartum weight losses were similar for all pregravid BMI groups. Late (median of 2 y) postpartum weight losses were 4 kg higher in the low and average BMI groups compared with the highest BMI group. About half of the net gestational gain was lost by 6 weeks postpartum, and the percentage that was lost decreased over time. CONCLUSIONS: This study suggests that early postpartum weight loss does not vary by maternal pregravid BMI group, but late postpartum weight change does. Serial weight measurements are needed in epidemiologic studies to differentiate retention of gestational gain from weight gain during the late postpartum period.

Annals of internal medicine, Jan 24, 2015

Lactation improves glucose metabolism, but its role in preventing type 2 diabetes mellitus (DM) a... more Lactation improves glucose metabolism, but its role in preventing type 2 diabetes mellitus (DM) after gestational diabetes mellitus (GDM) remains uncertain. To evaluate lactation and the 2-year incidence of DM after GDM pregnancy. Prospective, observational cohort of women with recent GDM. (ClinicalTrials.gov: NCT01967030). Integrated health care system. 1035 women diagnosed with GDM who delivered singletons at 35 weeks' gestation or later and enrolled in the Study of Women, Infant Feeding and Type 2 Diabetes After GDM Pregnancy from 2008 to 2011. Three in-person research examinations from 6 to 9 weeks after delivery (baseline) and annual follow-up for 2 years that included 2-hour, 75-g oral glucose tolerance testing; anthropometry; and interviews. Multivariable Weibull regression models evaluated independent associations of lactation measures with incident DM adjusted for potential confounders. Of 1010 women without diabetes at baseline, 959 (95%) were evaluated up to 2 years l...

Obesity During Pregnancy in Clinical Practice, 2013

Obesity, 2004

Objective: To prospectively evaluate whether childbearing leads to development of overweight in w... more Objective: To prospectively evaluate whether childbearing leads to development of overweight in women and to evaluate the role of other known risk factors.Research Methods and Procedures: A prospective, multicenter observational study, the Coronary Artery Risk Development in Young Adults (CARDIA) Study from 1986 to 1996, examined subjects at baseline and in follow-up years 2, 5, 7, and 10. Included were

Circulation, Mar 25, 2014

ABSTRACT Introduction: Gestational weight gain (GWG) has significant health implications for the ... more ABSTRACT Introduction: Gestational weight gain (GWG) has significant health implications for the mother and her infant. Excess GWG is associated with increased birth weight, but whether it has long term consequences for the offspring is less clear. Therefore, we sought to evaluate the impact of GWG on overweight/obesity in children ages 2-4. Methods: We identified 3,638 mother/child pairs among women who completed a health survey between 2007-2009 and had a subsequent pregnancy delivered as a live birth at Kaiser Permanente Northern California. Children were classified as overweight or obese if their weight met or exceeded the 85th percentile of the 2000 CDC BMI growth charts, based on age and sex. GWG was dichotomized (exceeding versus being at or below the 2009 IOM GWG recommendations). Results: Half of the cohort was from non-white racial/ethnic groups, 45% were overweight/obese before pregnancy, and 68% exceeded the IOM recommendations. Overall, 18% of children were overweight/obese. Exceeding the IOM recommendations was associated with a 24% increase in risk of having a child who was overweight/obese [RR (95% CI): 1.24 (1.02-1.51)], after adjusting for maternal pre-pregnancy BMI, race/ethnicity, age, education, pregnancy glucose tolerance, and infant gestational age. The association appeared stronger among women who were not overweight/obese before pregnancy [RR (95% CI): 1.43 (1.07-1.90) at BMI <25 versus 1.13 (0.87-1.46) at BMI ≥ 25]. Conclusions: The impact of excess GWG on subsequent childhood overweight/obesity may be stronger among women who were not initially overweight or obese. Lifestyle interventions to help women achieve appropriate GWG may also reduce childhood obesity.

A comparison of serum femtin and other parameters of iron status was made between 46 women taking... more A comparison of serum femtin and other parameters of iron status was made between 46 women taking oral contraceptive agents (OCAs) for two or more years continuously and 71 women who never took OCAs. The mean serum ferritin level for the OCA users was 39.5 ± 21.5 ng/ml and the control group mean level was 25.4 ± 15.96 ng/ml, which

International Journal of Obesity and Related Metabolic Disorders Journal of the International Association For the Study of Obesity, Dec 1, 2000

OBJECTIVES: To assess the relationships between gestational gain, raceaethnicity, reproductive hi... more OBJECTIVES: To assess the relationships between gestational gain, raceaethnicity, reproductive history, age, education and the risk of becoming overweight after pregnancy. STUDY DESIGN: Prospective cohort study of adult women from four raceaethnicity groups who had two consecutive births between 1980 and 1990 at the University of California, San Francisco (UCSF). MEASUREMENTS: Height and pregravid weights for each pregnancy were self-reported. Women were classi®ed as overweight or not overweight according to the Institute of Medicine (IOM) criteria for pregnancy. Gestational gain was de®ned as the difference between the pregravid weight and the last weight before delivery of the ®rst study pregnancy. SUBJECTS: 1300 healthy women aged 18 ± 41 y who had a singleton, full-term, live birth (index or ®rst study pregnancy) followed by a second birth. Self-reported pregravid weights and heights were used to calculate body mass index (BMI). Women with a pregravid BMI below 26.0 kgam 2 before the index pregnancy were classi®ed as not overweight (n 1128). Overweight status following the index pregnancy was based on pregravid BMI for the second pregnancy. RESULTS: Seventy-two women (6.4%) became overweight following the index pregnancy. Statistically signi®cant independent predictors of the risk of becoming overweight included: maternal age 24 ± 30 vs above 30 y, high gestational gain, short interval from menarche to ®rst ever birth (`8 y), and young age at menarche (`12 y). The risk of becoming overweight was increased 2.5 ± 3 times for each of these risk factors. Whites were 4.5 times more likely to become overweight than Asians, but blacks and Hispanics did not appear to differ from whites. Parity, time interval, smoking habit, education, marital status and other factors were not associated with the risk of becoming overweight. CONCLUSIONS: These ®ndings suggest that young age at menarche, maternal age and short time from menarche to ®rst ever birth may be as important as high gestational weight gain in determining the risk of becoming overweight after pregnancy.

Circulation, Mar 13, 2012

Clinical Obstetrics and Gynecology, Jul 1, 2003

Diabetes care, Jan 6, 2016

Gestational diabetes mellitus (GDM) predicts incident cardiovascular disease (CVD). However, mech... more Gestational diabetes mellitus (GDM) predicts incident cardiovascular disease (CVD). However, mechanisms linking GDM to CVD beyond intervening incident diabetes are not well understood. We examined the relation of GDM with echocardiographic parameters of left ventricular (LV) structure and function, which are important predictors of future CVD risk. We studied 609 women (43% black) from the Coronary Artery Risk Development in Young Adults study who delivered one or more births during follow-up and had echocardiograms in 1990-1991 (mean age 28.8 years) and 2010-2011. During the 20-year follow-up, 965 births were reported, with GDM developing in 64 women (10.5%). In linear regression models adjusted for sociodemographic factors, BMI, physical activity, parity, smoking, use of oral contraceptives, alcohol intake, family history of coronary heart disease, systolic blood pressure, and lipid levels, women with GDM had impaired longitudinal peak strain (-15.0 vs. -15.7%, P = 0.025), circumf...

Diabetes Care, 2015

In 2010, the American Diabetes Association (ADA) added hemoglobin A1c (A1C) to the guidelines for... more In 2010, the American Diabetes Association (ADA) added hemoglobin A1c (A1C) to the guidelines for diagnosing type 2 diabetes. However, existing models for predicting diabetes risk were developed prior to the widespread adoption of A1C. Thus, it remains unknown how well existing diabetes risk prediction models predict incident diabetes defined according to the ADA 2010 guidelines. Accordingly, we examined the performance of an existing diabetes prediction model applied to a cohort of African American (AA) and white adults from the Coronary Artery Risk Development Study in Young Adults (CARDIA). We evaluated the performance of the Atherosclerosis Risk in Communities (ARIC) diabetes risk prediction model among 2,456 participants in CARDIA free of diabetes at the 2005-2006 exam and followed for 5 years. We evaluated model discrimination, calibration, and integrated discrimination improvement with incident diabetes defined by ADA 2010 guidelines before and after adding baseline A1C to the prediction model. In the overall cohort, re-estimating the ARIC model in the CARDIA cohort resulted in good discrimination for the prediction of 5-year diabetes risk (area under the curve [AUC] 0.841). Adding baseline A1C as a predictor improved discrimination (AUC 0.841 vs. 0.863, P = 0.03). In race-stratified analyses, model discrimination was significantly higher in whites than AA (AUC AA 0.816 vs. whites 0.902; P = 0.008). Addition of A1C to the ARIC diabetes risk prediction model improved performance overall and in racial subgroups. However, for all models examined, discrimination was better in whites than AA. Additional studies are needed to further improve diabetes risk prediction among AA.

Journal of the American Society of Hypertension (JASH)

Klatsky AL, Gunderson E. Alcohol and hypertension: a review. J Am Soc Hypertens. 2008 Sep-Oct;2(5... more Klatsky AL, Gunderson E. Alcohol and hypertension: a review. J Am Soc Hypertens. 2008 Sep-Oct;2(5):307-17. doi: 10.1016/j.jash.2008.03.010. Epub 2008 Jun 24. PubMed PMID: 20409912

Journal of studies on alcohol, 2006

Heavy alcohol drinking is associated with increased prevalence of systemic hypertension (HTN), bu... more Heavy alcohol drinking is associated with increased prevalence of systemic hypertension (HTN), but the relationship between moderate drinking and HTN remains unclear. We explored the possible role of underreporting among moderate drinkers. In a cross-sectional analysis of 105,378 persons, we defined a subset among persons reporting three or fewer drinks per day that was likely to include a disproportionate number of underreporters. This subset included persons who, on another occasion, indicated intake of three or more drinks per day or who ever had a diagnosis of an alcohol-related condition; these persons are called "positive." Persons who never reported three or more drinks per day and who had no alcohol-related diagnosis were called "negative." Logistic regression models estimated the odds ratios (ORs) for prevalent HTN (140/90 mm Hg or greater) in the positive and negative subgroups, compared with lifelong abstainers as referent. All persons and four race-ge...

Journal of the American Society of Hypertension, 2008

In recent decades alcohol use has joined other correlates of hypertension (HTN), such as obesity ... more In recent decades alcohol use has joined other correlates of hypertension (HTN), such as obesity and salt intake, as a major research focus about HTN risk factors. In cross-sectional and prospective epidemiologic studies, higher blood pressure (BP) has consistently been found among persons reporting usual daily intake of three standard-sized drinks or more. Although definitive mechanisms have not been established, several aspects of the data, including short and intermediate term experiments, suggest a causal relationship. Heavier drinking may, in fact, be the commonest cause of reversible HTN, and reduction of heavy alcohol intake plays an important public health role in HTN management. Additional to the mechanism, unresolved issues about the alcohol-BP relationship include whether there is a threshold dosage of alcohol for association with HTN, the sequelae of alcohol-associated HTN and the roles of interactions with gender, ethnicity, other lifestyle traits, drinking pattern, and choice of beverage. This article reviews these areas and includes new data about the beverage choice aspect. J Am Soc Hypertens 2008;2(5): 307-317.

American Journal of Public Health, Oct 10, 2011

Mustillo et al. | Peer Reviewed | Research and Practice | 2125  RESEARCH AND PRACTICE 

The Journal of Clinical Endocrinology Metabolism, Jul 2, 2013

Context: Preterm birth is associated with maternal cardiovascular risk, but mechanisms are unknown.

Diabetes Care, 2015

To compare the effectiveness of diabetes prevention strategies addressing postpartum weight reten... more To compare the effectiveness of diabetes prevention strategies addressing postpartum weight retention for women with gestational diabetes mellitus (GDM) delivered at the health system level: mailed recommendations (usual care) versus usual care plus a Diabetes Prevention Program (DPP)-derived lifestyle intervention. This study was a cluster randomized controlled trial of 44 medical facilities (including 2,280 women with GDM) randomized to intervention or usual care. The intervention included mailed gestational weight gain recommendations plus 13 telephone sessions between 6 weeks and 6 months postpartum. Primary outcomes included the following: proportion meeting the postpartum goals of 1) reaching pregravid weight if pregravid BMI <25.0 or 2) losing 5% of pregravid weight if BMI ≥25.0; and pregravid to postpartum weight change. On average, over the 12-month postpartum period, women in the intervention had significantly higher odds of meeting weight goals than women in usual care (odds ratio [OR] 1.28 [95% CI 1.10, 1.47]). The proportion meeting weight goals was significantly higher in the intervention than usual care at 6 weeks (25.5 vs. 22.4%; OR 1.17 [1.01, 1.36]) and 6 months (30.6 vs. 23.9%; OR 1.45 [1.14, 1.83]). Condition differences were reduced at 12 months (33.0 vs. 28.0%; OR 1.25 [0.96, 1.62]). At 6 months, women in the intervention retained significantly less weight than women in usual care (mean 0.39 kg [SD 5.5] vs. 0.95 kg [5.5]; mean condition difference -0.64 kg [95% CI -1.13, -0.14]) and had greater increases in vigorous-intensity physical activity (mean condition difference 15.4 min/week [4.9, 25.8]). A DPP-derived lifestyle intervention modestly reduced postpartum weight retention and increased vigorous-intensity physical activity.

Archives of Pediatrics Adolescent Medicine, Apr 1, 2009

Objective-To examine the impact of pregnancy on adolescent growth and adiposity relative to nulli... more Objective-To examine the impact of pregnancy on adolescent growth and adiposity relative to nulligravidas of similar maturation stage.

The Faseb Journal, Apr 1, 2014

International Journal of Obesity and Related Metabolic Disorders Journal of the International Association For the Study of Obesity, Jun 1, 2001

OBJECTIVES: To examine differences in the pattern of weight changes during and after pregnancy am... more OBJECTIVES: To examine differences in the pattern of weight changes during and after pregnancy among four pregravid body mass index (BMI) groups. STUDY DESIGN: Prospective cohort study of women who had two consecutive births at the University of California, San Francisco (UCSF) between 1980 and 1990. MEASUREMENTS: Maternal body weights were available before conception and delivery, and at 6 weeks postpartum for the ®rst (index) pregnancy, and before conception for the second study pregnancy. Height and two pregravid weights were selfreported. Weights at delivery and 6 weeks postpartum were measured. Net delivery weight was de®ned as delivery weight minus infant birth weight. Three non-overlapping sequential weight changes were constructed: (1) net gestational gain (net delivery weight minus pregravid weight at the index pregnancy); (2) early net postpartum weight change (6-week postpartum weight minus net delivery weight); and (3) late postpartum weight change (pregravid weight at the second pregnancy minus 6-week postpartum weight). SUBJECTS: A total of 985 healthy women (age 18 ± 41 y) from four raceaethnicity groups (Asian, Hispanic, black and white) who had a singleton, full-term, live birth for the index pregnancy followed by a second consecutive birth. RESULTS: Four raceaethnicity groups were combined (no interaction) to contrast average weight changes among pregravid BMI groups. Means adjusted for eight covariates (parity, raceaethnicity, education, mode of delivery, smoking, hypertension of pregnancy, age, height) and time intervals were not altered appreciably. Early net postpartum weight losses were similar for all pregravid BMI groups. Late (median of 2 y) postpartum weight losses were 4 kg higher in the low and average BMI groups compared with the highest BMI group. About half of the net gestational gain was lost by 6 weeks postpartum, and the percentage that was lost decreased over time. CONCLUSIONS: This study suggests that early postpartum weight loss does not vary by maternal pregravid BMI group, but late postpartum weight change does. Serial weight measurements are needed in epidemiologic studies to differentiate retention of gestational gain from weight gain during the late postpartum period.

Annals of internal medicine, Jan 24, 2015

Lactation improves glucose metabolism, but its role in preventing type 2 diabetes mellitus (DM) a... more Lactation improves glucose metabolism, but its role in preventing type 2 diabetes mellitus (DM) after gestational diabetes mellitus (GDM) remains uncertain. To evaluate lactation and the 2-year incidence of DM after GDM pregnancy. Prospective, observational cohort of women with recent GDM. (ClinicalTrials.gov: NCT01967030). Integrated health care system. 1035 women diagnosed with GDM who delivered singletons at 35 weeks' gestation or later and enrolled in the Study of Women, Infant Feeding and Type 2 Diabetes After GDM Pregnancy from 2008 to 2011. Three in-person research examinations from 6 to 9 weeks after delivery (baseline) and annual follow-up for 2 years that included 2-hour, 75-g oral glucose tolerance testing; anthropometry; and interviews. Multivariable Weibull regression models evaluated independent associations of lactation measures with incident DM adjusted for potential confounders. Of 1010 women without diabetes at baseline, 959 (95%) were evaluated up to 2 years l...

Obesity During Pregnancy in Clinical Practice, 2013