Erica Gunderson, PhD, MS, MPH, RD, senior research scientist, Kaiser Permanente Northern California Division of Research, professor of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine discusses how cardiometabolic health and childhood obesity are linked to breastfeeding. Gunderson also discusses receiving the 2022-2023 March of Dimes Agnes Higgins Award at the Pediatric Academic Societies meeting in Washington, DC on April 30, 2023.
Hi and thank you so much for joining us. I'm Joshua Fitch of Contemporary Pediatrics® and Contemporary OBGYN®.
Erica Gunderson, PhD, MS, MPH, RD
I'm Dr. Erica Gunderson. I'm a senior research scientist at the Division of Research at Kaiser Permanente Northern California in Oakland, and I'm also professor of Health Systems Sciences at the Bernard Tyson Kaiser Permanente School of Medicine in Pasadena, California.
Dr. Gunderson, thank you so much for taking the time to join us. First congratulations on receiving the March of Dimes Agnes Higgins Award and maternal fetal nutrition at this year's Pediatric Academic Society's meeting in DC. First, can you just briefly tell us what that means to you?
I'm so honored to receive the March of Dimes award for Agnes Higgins, maternal fetal nutrition. It means a huge amount to me because of my early career was in public health, nutrition and nutritional sciences. I actually learned about Agnes Higgins and the Montreal diet dispensary, and her work with underprivileged pregnant women were in my training in graduate school. So she really inspired me to go into public health as well, and to actually do change move into employment in public health in low income communities. My first job out of graduate school, was with a WIC program in the city of Pasadena Health Department. And of course, Agnes Higgins was her foundational work was the inspiration for the Women, Infants and children's program in the United States that began in the 1960s. So I really feel like I followed in her footsteps in many ways, and from that position, I went to the West Los Angeles premature prevention project, and that was a community public health program in Los Angeles County where I led the nutrition component of that intervention it was into for 5,000 pregnant women, and they were low income and I was the nutritionist as part of the nurse practitioner teams, in clinics that served very low income women, and I went to eight different public health clinics in Los Angeles County every week to provide the new direct nutrition care. So I feel really honored to be given an award with her namesake.
Certainly sounds like an amazing story, congratulations once again. Dr. Gunderson, can you explain to our audience, your lifetime research of this critical link between breastfeeding, gestational diabetes and hypertension on future maternal health, and its relation to childhood obesity? I know a big question.
Well, there's many parts to the question, I would say, and I think that pregnancy is a challenging, physiologic condition that's imposed upon women. And it results sometimes in complications such as gestational diabetes, and hypertensive disorders of pregnancy. Those occur and about 8% of all women develop gestational diabetes and close to 5 to 10% of women develop hypertensive disorders of pregnancy and both are really important outcomes that not only impact fetal health and development but in the short term and the long-term child health, but they also have lasting impact on the woman herself and her future risk of cardiometabolic diseases. So how does how did these links between these adverse pregnancy outcomes relate to lactation, as well as future cardiovascular health and metabolic health and women? Well, the studies I've been doing have been looking at a continuum a longitudinal continuum, which is really important for women to understand, which is that the continuum of health starts with pre pregnancy or preconception, metabolic status, metabolic profiles, as well as what happens during pregnancy, and then what after pregnancy, the lactation piece is part of that continuum. So to obtain optimal health, you really want to prepare for pregnancy and be in the best health you can be before you become pregnant. Then during pregnancy, of course, there are steps to take to help you have the best outcomes for pregnancy and delivery, and then there's this post-delivery year period or longer, where recovery takes place and we're a lactation is sort of part of the natural continuum to help women recover from the, you know, incredible demands of pregnancy on metabolic and physiologic needs. And those needs are important because you got to transfer nutrients to for optimal field growth and development. But some women adapt their adaptations to those demands that are sometimes result in these pregnancy complications. And we have ways to treat those during pregnancy. But for example, hypertensive disorders, can occur without warning. So we're always looking at ways to prevent in ways to improve the pregnancy state. If you have these increases in triglycerides, increases in blood glucose during pregnancy for the woman, increases in blood pressure, and other blood volume that increases the burden on the heart, how do we recover from those? Even if you have not developed any complications, how do women recover from those adverse changes in their metabolic profiles, that are certainly much needed to support good pregnancy outcomes, but how do we recover to the pre pregnancy state that women started out? Lactation seems to offer a lot of advantages in that respect, because the production of milk results in moving these additional lipids and glucose and the decrease in insulin requirements that can help the pancreatic beta cells potentially rest and offload from the earlier demands. So that seems to help the recovery to the prior cardiometabolic profile for women and it also, of course, breastfeeding has tremendous lasting benefits for the child as well.
Dr. Gunderson, what are some of these early life behaviors that can improve metabolic profiles of children born to mothers with gestational diabetes?
Well, I think the breastfeeding recommendations are first and foremost by the American Academy of Pediatrics, that certainly seems to slow ponderal growth in the first year of life, and as much breastfeeding as feasible is really beneficial on many levels, including growth. But I think the other American Academy of Pediatrics recommendation that also needs to be emphasized is the avoidance of sugary beverages, as well as natural fruit juice during the first year of life, and really limiting the intake of these beverages in children at young ages. We have data from our studies showing that the joint impact of breastfeeding and avoidance of sugary beverages or fruit natural fruit juice provides the lowest risk of developing obesity in the child.