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CU College of Nursing - Research Stories

College of Nursing
 

Research Targets Obesity in its Incubators: Pregnant Women

Obesity is a critical U.S. health care issue


Woman with baby

The first thing you notice when you meet Teri Hernandez, PhD, RN, is her energy—energy that infuses her pedagogy as well as her scholarship. And Hernandez, assistant professor of medicine and nursing, commits her research energy to a critical U.S. health care issue: obesity.

Hernandez’s studies are helping create an obesity-free future by addressing obesity in, literally, its present-day incubators: pregnant women. Hernandez has identified pregnancy as a pivot point for obesity/diabetes in future generations.

“It’s one of human life’s astonishing ingenuities,” Hernandez explains. “Pregnancy automatically makes a woman’s cells insulin-resistant, keeping sugar in the blood.” Nature understands that placental blood must be glucose-rich to meet the demands of the developing fetus. But according to Hernandez, society’s trend toward obesity is doubling-down on nature’s elegant design: Heavy women with obesity-linked insulin resistance get pregnant, adding pregnancy-linked insulin resistance. In addition, pregnancy linked weight gain adds to the existing obesity-linked adipose build-up. The results: (1) in utero exposure to the mother’s diabetes is a major diabetes risk factor for the growing fetus, and (2) obesity during pregnancy correlates strongly with high birth-weight newborns, predisposing the newborns to future obesity. Thus, children may be entering the world already facing a two-strike count—not hopeless, but definitely precarious.

Hernandez’s research shows a simple solution: dietary control. To stop the negative cascade of intergenerational effects, the pregnant woman simply must watch what she eats.

There’s no gimmick here. For example, Hernandez says that Atkins-type carbophobia counter-productively “inhibits insulin secretion and yields high levels of free fatty acids”—so cutting carbs is not the way to go. Ultimately, there is no dietary shortcut to the health of the pregnant woman and, in turn, the future newborn—just a good balance of good foods. This good-food balance is found in Hernandez’s Challenge Diet.

Her Challenge Diet is not a diet in the popular sense. It’s pegged to BMI, so it’s not hypo-caloric. It has a 60/25/15 breakdown of carbs/fats/protein, so it’s not extreme. Most important, it allows pregnant women consistently to meet gestational weight and blood-level targets, creating healthy in utero environments for future newborns.

Don’t believe the hype that carbs/sugars alone are behind the spike in obesity, diabetes and babies predisposed to obesity and diabetes. “Something besides glucose is causing these big babies,” Hernandez concludes. “Something is going on with fat—and there’s a lot more to discover about fat.”

Hernandez’s research is driven by her love of science and fueled by interdisciplinary outreach. Her eclectic research team reflects this: Hernandez herself started as a clinical nurse and morphed into nurse-researcher, earning her PhD from the CU College of Nursing in 2009. Her research partner is a physician, Linda Barbour, and her team includes; Chris Law, a surgeon, and experts from pediatrics, bionutrition, maternal-fetal medicine, gastroenterology, endocrinology, epidemiology, and physiology. Hernandez describes research-team meetings as “everybody sharing ideas, and we’re all better for it.” The variety of backgrounds, perspectives and input lets the group triangulate to truth—the members stake out different positions, and then, each inches toward the middle.

“I have the best job,” Hernandez says. “I get to ask questions for a living. Who gets to do that? I do! Just think what we could do if we had more nurses in the mix.”

 

Editor’s Note: Interested in this research? Read Hernandez, Teri L.; Friedman, Jacob E.; Van Pelt, Rachael E.; and Barbour, Linda A.“Patterns of Glycemia in Normal Pregnancy: Should the current therapeutic targets be challenged?” Diabetes Care. July 2011 vol. 34 no. 7. 1660-1668. Available online at http://care.diabetesjournals.org/content/34/7/1660.full#