Capitalizing on pregnancy as a teachable moment for healthy eating and diabetes prevention among Central American immigrants in Washington, D.C.
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Background: Innovative and culturally appropriate communication interventions for promoting healthy eating and prevention of diabetes are needed for low income minority populations. A life course approach timed to coincide with transitional events in an individual's life, such as pregnancy, can tap receptivity and motivation to change and result in significant behavior modification. Approximately 7% of pregnant women develop gestational diabetes mellitus (GDM), with higher rates among Latina women. Research investigating pregnancy as a teachable moment for healthy eating can prevent and manage GDM, and potentially prevent later Type 2 diabetes. Methods: We conducted the research at Mary’s Center, a Federally Qualified Health Center (FQHC) in Washington, D.C. under an academic--community collaboration. We used quantitative and qualitative methods (1) to examine gestational weight gain as a predictor of GDM in electronic clinical records for pregnant Latina women at Mary's Center from 2008-2013, (2) to conduct in-depth interviews (IDIs) and chart reviews with Central American immigrant women accessing prenatal care and their health care providers. The total sample comprised 43 IDIs: 13 IDIs with providers, 20 IDIs with pregnant women (10 GDM; 10 non-GDM), and 10 IDIs with postpartum women (7 GDM; 3 non-GDM). Results: Greater gestational weight gain during the 1st and 2nd trimester of pregnancy was associated with an increased risk of GDM incidence among pregnant Latina women, with stronger effects for obese women. These results signal critical points early in pregnancy as teachable moments for nutritional and weight gain counseling to potentially prevent GDM. Pregnant women perceived a strong link between their eating and nourishing the baby, and were highly motivated to learn about and make healthy dietary changes. Providers play an instrumental role in capitalizing on pregnancy as a teachable moment particularly to promote sustainable dietary change. Conclusions: Pregnancy is a potent teachable moment for healthy eating and diabetes prevention. The period of high receptivity and motivation for behavior change holds important implications for promoting healthy eating over the life course and reducing the risk of diet-related chronic disease. The life course approach has potential to reduce health disparities for low-income Latinas.