Coming to the Aid of Low-Income Mothers

    • November 5, 2013

Pregnancy is not just a nine-month gestational stretch for infants; it’s a "teachable moment" for women.

That’s the view of Charmaine Smith Wright, a scientist who sees pregnancy as an opportunity to help women achieve healthy weight and, in so doing, improve maternal and child health.

A two-time Robert Wood Johnson Foundation (RWJF) scholar and assistant professor of medicine at the University of Pennsylvania, Wright, MD, MSHP, is doing that by testing a series of interventions designed to help low-income women achieve healthy weights during and after pregnancy. She is presenting her preliminary findings this week at the American Public Health Association’s annual meeting in Boston. She expects to complete the project by 2015.

"I really want to capitalize on this `teachable moment,'" she says. "It’s critical for long-term maternal and child health."

Wright hopes her research will lead to interventions that will help low-income women avoid excessive weight gain during pregnancy, which contributes to poor birth outcomes. And she hopes it will help them lose pregnancy weight after delivery, which will help improve their overall health in the years afterward.

Such interventions could help bridge a "big gap" in health care for low-income mothers, says Wright, who is trained in pediatrics and internal medicine. Children tend to get a lot of care and checkups early in life, but too often "no one is checking in on moms, especially low-income moms without health care," she says.

Wright, herself a mother of two, is stepping in. She began her research into the subject as an RWJF Clinical Scholar (2008-2010), administering surveys to low-income pregnant women in Philadelphia in partnership with the Maternity Care Coalition, a community-based nonprofit organization that provides care for low-income pregnant women and their families.

The surveys showed that low-income women in Philadelphia have "tons of barriers to healthy eating." They have little access to stores that sell fresh fruits and vegetables; they lack the knowledge to prepare nutritious meals; they face hurdles related to time and income; and they are at high risk for perinatal and post-partum depression, she says.

A Multipronged Intervention

After the surveys were completed, Wright and her partners held focus groups comprised of community health workers, low-income pregnant women, and mothers suffering from post-partum depression to identify strategies that would effectively help low-income women maintain healthy weights during and after pregnancy. That led to the creation of a multi-pronged intervention using motivational text messaging; walking and strength-training exercises involving the use of baby carriers and pedometers; classes about healthy feeding and eating; and lactation and other social supports.

A pilot test of the intervention, which took place over a six-week period and included two follow-up visits, led to encouraging results, Wright says. "It told us we were on the right track."

After completing the successful pilot program, Wright won a four-year, $420,000 grant in 2012 from the RWJF-supported Harold Amos Medical Faculty Development Program to conduct a randomized controlled trial (RCT) of the program to determine its effectiveness. The gold standard of scientific research, RCTs rarely take place in community-based settings, Wright says.

Now halfway through the trial, Wright is cautiously optimistic about the results. So far, 96 women have agreed to participate—36 in the control group and 61 in the group receiving the intervention. At six months post-partum, those in the control group gained an average of 6.4 pounds and had a one-inch increase in waist circumference. Those in the intervention group, meanwhile, lost an average of 3.3 pounds and dropped 1.6 inches off their waistlines.

The results were less stark at the one-year mark, but still promising. Those in the control group had gained 8.4 pounds and had added two inches to their waistlines, while those in the intervention group had lost an average of 2.4 pounds and had added one inch to their waistlines. In other words, members of the intervention group were no longer slimming down one year after delivery, but they were not adding inches to their waistlines as quickly as the control group, Wright says.

 “All of this is preliminary…but there are some promising trends.”


Related Websites

Learn more about the RWJF Clinical Scholars program.
Learn more about the Harold Amos Medical Faculty Development Program.
For an overview of RWJF scholar and fellow opportunities, visit