Prenatal and Maternal Health

Nearly one in four (23.4 percent) women are obese before becoming pregnant — which can increase the risk for a wide range of health complications for the baby and the mother.1 More than 6 percent (approximately one in 16) of pregnant women have or develop diabetes during pregnancy — known as gestational diabetes.2

The rate of women who were obese before becoming pregnant and participating in the WIC program has dramatically increased over the past 20 years, increasing 86 percent from 19.2 percent in 1994 to almost 36 percent in 2014.3,4 In 1994, the rates ranged from a low of 1 percent in Iowa to a high of 24.7 percent in Vermont.

By 2004, 28.8 percent of women who were enrolled in the WIC program were obese prior to becoming pregnant.5 Rates ranged from a low of 21.1 percent in Rhode Island to a high of 34.3 in Alabama. Nineteen states and Washington D.C. had more than a 20 percent increase of women being obese, with five states having more than a 45 percent increase. [19 states out of 31 and Washington, D.C. reported data in 1994 and 2004.]

And by 2014, the percent of women who were obese doubled in 13 states and Washington, D.C.6 Iowa had the greatest increase from 1 percent in 1994 to 40.8 percent in 2014, followed by Illinois, which increased by more than seven times, from 5 percent in 1994 to 35.9 percent in 2014. [19 states out of 44 and Washington D.C. reported data in 1994 and 2014.]

Women Enrolled in WIC and Were Obese Prepregnancy – 1994, 2004 and 2014

Maternal health — including obesity, poor nutrition and type 2 diabetes — can increase risk for miscarriages, birth defects, slow fetal growth, prematurity and low birth weight babies. Poor maternal nutrition can also lead to increased risk for abnormal brain development, developmental delays, diabetes, hypertension, heart disease, obesity and lower IQ in babies.7,8

  • One in nine children in the United States is born prematurely (before 37 weeks of gestation or 3 weeks early). Premature births cost the country $26.2 billion annually, or $51,600 per baby, in direct medical and lifetime added costs.9,10
  • On average, there were approximately 23,400 infant deaths per year in the United States over the past decade.11 The U.S. infant mortality rate (6.0 per 1,000 live births, 2013) is almost twice as high as some comparable countries — the average infant mortality in comparable countries is 3.5 per 1,000 live births.12 The United States ranks 24th among developed countries.13

Good prenatal healthcare is important to help reduce risks and complications. Many experts, however, now believe that much of prenatal care, which usually begins during the first three months of pregnancy, comes too late to prevent many serious maternal and childhood health problems. Even the first few weeks after conception are critical for healthy fetal development. Medical professionals recommend an increased focus on regular well-care and preventive healthcare for women throughout childbearing age, including screening for risk of obesity and related chronic health conditions.


The American Academy of Pediatrics (AAP) recommends breastfeeding as a natural source of nutrition that ?provides the healthiest start for an infant.? The NAM and AAP recommend that babies be breastfed exclusively for about the first 6 months and should continue breastfeeding through the first year of life.14,15,16

Only around half (51.8 percent) of infants are breastfeeding at 6 months — with rates of exclusive breastfeeding rates ranging from 9.3 percent in Mississippi to 33.8 percent in Montana.17

Health Benefits of Breastfeeding

There are mixed findings on the potential relationship between breastfeeding and obesity among infants.18,19,20 However, there are a number of identified health benefits for breastmilk as the ?first food.? In addition, there are weight-related benefits that have been identified for mothers who breastfeed.21,22Women who exclusively breastfeed for at least three months loose up to 3.2 pounds more compared to women who do not breastfeed or breastfeed non exclusively one-year postpartum, and are more likely to return to the same or lower BMI as pre-pregnancy.23

  • Infants: Lower risk of ear and gastrointestinal infections, necrotizing enterocolitis (a gastrointestinal disease), diabetes and obesity.25Some research suggests it may also reduce risk for asthma and allergies, childhood leukemia and sudden infant death syndrome (SIDS).25,26,27,29 Some research has found children who are breastfed longer are more likely to have better developed language skills, verbal and nonverbal intelligence during childhood, greater upward social mobility, higher neurological development and lower stress markers.29,30
  • Mothers: Lower risk of breast and ovarian cancer, type 2 diabetes and postpartum depression. It has been shown to help mothers bond with the child and mothers who nurse miss less work.31,32
  • Economic: Families can save on cost of formula. In addition, around $2.2 billion could be saved in annual medical costs if breastfeeding recommendations were met.33


1 Osterman MJK, Martin JA, Curtin SC, et al. Newly released data from the revised U.S. birth certi cate, 2011. National Vital Statistics Report 62(4), 2013. Hyattsville, MD: National Center for Health Statistics.

2 Agency for Healthcare Research and Quality. (2010). One in 16 Women Hospitalized for Childbirth has Diabetes. [News Release] (accessed October 2014).

3 Randall B, Boast L, Holst L. Study of WIC Participant and Program Characteristics, 1994. Alexandria, VA: U.S. Department of Agriculture, Food and Nutrition Service, Of ce of Analysis, Nutrition and Evaluation, 1995.

4 Thorn B, Tadler, C, Huret C, et al. Study of WIC Participant and Program Characteristics, 2014. Alexandria, VA: U.S. Department of Agriculture, Food and Nutrition Service, 2015.

5 Randall B, Barlett S, Kennedy S. Study of WIC Participant and Program Characteristics, 2004. Alexandria, VA: U.S. Department of Agriculture, Food and Nutrition Service, Of ce of Analysis, Nutrition and Evaluation, 2006.

6 Thorn B, Tadler, C, Huret C, et al. Study of WIC Participant and Program Characteristics, 2014. Alexandria, VA: U.S. Department of Agriculture, Food and Nutrition Service, 2015.

7 Chen Y, Quick WW, Yang W, et al. Cost of Gestational Diabetes Mellitus in the U.S. in 2007. Popul Health Manag 12(3): 165-174, 2009.

8 Frequently Asked Questions: Nutrition During Pregnancy. In The American College of Obstetrics and Gynecologists, 2015 (accessed May 2016).

9 Institute of Medicine. Preterm Birth: Causes, Consequences, and Prevention. Washington, D.C.: The National Academies Press, 2007 (accessed October 2014).

10 Prematurity Campaign. In March of Dimes (accessed October 2014).

11 Infant Health. In Centers for Disease Control and Prevention (accessed May 2016).

12 OECD. OECD Health Data: Health status: Health status indicators, OECD Health Statistics (database) (accessed May 2016).

13 OECD. Health at a Glance: OECD Indicators. Paris, France: OECD Publishing, 2015 (accessed May 2016).

14 AAP Reafirms Breastfeeding Guidelines. In American Academy of Pediatrics, 2012 (accessed June 2015).

15 Breastfeeding Initiatives: FAQ. In American Academy of Pediatrics (accessed June 2015).

16 Institute of Medicine. Early Childhood Obesity Prevention Policies. Washington, D.C.: National Academies Press, 2011 (accessed June 2015).

17 National Center for Chronic Disease Prevention and Health Promotion. Breastfeeding Report Care. Progressing Towards National Breastfeeding Goals, United States, 2016. Atlanta, GA: Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, 2016 (accessed August 2016).

18 Yan J, Liu L, Zhu Y, et al. The association between breastfeeding and childhood obesity: a meta-analysis. BMC Public Health, 14:1267, DOI: 10.1186/1471-2458-14-1267, 2014 (accessed July 2016).

19 Young BE, Johnson SL, and Krebs NF. Biological determinants linking infant weight gain and child obesity: current knowledge and future directions. Adv Nutr, 3: 675-686, 2012.

20 Ip S, Chung M, Raman G et al. Maternal and Infant Health Outcomes in Developed Countries. Evidence Report/Technology Assessment No. 153. AHRQ Publication No. 07-E007. Rockville, MD: Agency for Healthcare Research and Quality, 2007.

21 Stuebe A. The risks of not breastfeeding for mothers and infants. Rev Obstet Gynecol 2(4): 222-231, 2009.

22 Neville CE, McKinley MC, Holmes VA, et al. The relationship between breastfeeding and postpartum weight change?a systematic review and critical evaluation. International J Obs 38: 577-590, 2014.

23 Jarlenski M, Bennett WL, Bleich WN, et al. Effects of breastfeeding on postpartum weight loss among U.S. women. Prev Med, 69: 146-150, 2014.

24 Centers for Disease Control and Prevention. (2013). U.S. breastfeeding rates continue to rise. [Press Release] (accessed June 2015).

25 Bener A, Ehlayel MS, Alsowaidi S, Sabbah A. Role of breast feeding in primary prevention of asthma and allergic diseases in a traditional society. Eur Ann Allergy Clin Immunol, 39(10): 337-343, 2007.

26 Bener A, Hoffmann GF, A fy Z, et al. Does prolonged breastfeeding reduce the risk for childhood leukemia and lymphomas? Minerva Pediatr, 60(2): 155-161, 2008.

27 Hauck FR, Thompson JMD, Tanabe KO, et al. Breastfeeding and Reduced Risk of Sudden Infant Death Syndrome: A Meta-analysis. Pediatrics, 128(1): 103-110, 2011 (accessed June 2015).

28 AAP Reaf rms Breastfeeding Guidelines, 2012.

29 Sacker A, Kelly Y, Iacovou M, Cable N, Bartley M. Breast feeding and inter-generational social mobility: what are the mechanisms? Arch Dis Child, 98(9): 666-671, 2013 (accessed June 2015).

30 The JAMA Network, (2013). Breastfeeding Duration Appears Associated with Intelligence Later in Life. [Press Release] (accessed June 2015).

31 Chowdhury R, Sinha B, Jeeva Sankar M, et al. Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatrica 104(s467): 96-113.

32 Perrine CG, Nelson JM, Corbelli J, et al. Lactation and maternal cardio-metabolic health. Annu Rev Nutr, 36(627-645), 2016 (accessed August 2016).

33 The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis. Pediatrics, 125(5): e1048-e1056, 2010 (accessed August 2016).