Breaking Some Sweat

Waving her hands and jumping from side to side, Tonya Lewis Lee broke some sweat on a Saks Fifth Avenue department store stage alongside fitness instructor Laurent Amzallag in an aerobics routine that kicked off September 2011 Infant Mortality Awareness Month. Granted, as the spokeswoman for the Office of Minority Health’s A Healthy Baby Begins with You campaign, Ms. Lee is more used to giving speeches from behind a podium than burning calories, but her more energized effort seemed an appropriate way to make a critical point about the link between preconception care and baby health.

“You may not realize this,” Ms. Lee told a captivated crowd of shoppers and onlookers who endured heavy rain to attend the “In Good Taste and Health” event at the Northern Virginia Tysons Galleria mall, “but the shape you’re in today is so important to the health of your future baby.”

Her observation is poignant. Doctors in the maternal and child health field say there is a connection between a mother’s health and infant health. Yet, all too often, the same dire situation is played out in hospital rooms across the country: mothers experiencing bad birth outcomes, including low birth-weight or premature babies, due in whole or in part to their own poorly managed, pre-existing health conditions like obesity, hypertension or diabetes.

What is more, statistics bear out the fact that minorities disproportionately carry the greatest burden of these poor reproductive outcomes, including high infant mortality rates. While infant mortality substantially impacts African Americans and Native-Americans, for US Latinos, the picture is mixed. South and Central American Hispanics have an infant mortality rate of 4.8 per 1,000 live births, but the rate climbs for Puerto Ricans to 7.7 per 1,000, representing an increase of nearly 40 percent over the rate of non-Hispanic whites. (Puerto Rican babies are also twice as likely to die from causes related to low birth-weight when compared with non-Hispanic white babies.)

Dr. Michael Lu, an associate professor in both the UCLA School of Public Health and the David Geffen School of Medicine, actively studies the disparities in birth outcomes in ethnic and racial minorities. From his years of work, one key observation keeps resurfacing: the preconception health of a parent-to-be lays the foundation for the health of her/his future offspring. He uses the term “life course perspective” to describe this observation. It’s a way of looking at life, Dr. Lu explains, that recognizes that each stage of life is influenced by all the life stages that preceded it and influences all the life stages that follow it. All the stresses on the body over the lifetime accumulate, he adds, and this “load” is what a mother brings to bear on her pregnancy.

As Dr. Lu notes, prenatal care is critical for the health of an unborn child, but prenatal care cannot reverse years of poor health in a mother’s life that came before her pregnancy. The bottom line is that common issues, such as obesity, smoking, and chronic health problems are much better addressed before a pregnancy is even considered. The importance of preconception health is paramount for Hispanics in light of the disheartening prevalence of certain health conditions in the Latino community today. We know, for example, that obesity is a risk factor for a number of diseases and, with respect to obesity levels, Latinas are significantly affected. In 2009, Hispanic women were 1.3 times as likely to be obese as non-Hispanic white women and among Mexican American women, 73 percent were obese or overweight. Latino children also disproportionately suffer higher obesity and overweight rates, with Mexican-American children experiencing a rate that is 1.4 times that of non-Hispanic children. Diabetes among Latino people is also rampant and, as a group, Latinos have the largest number of uninsured or underinsured people.

Adopting a healthier lifestyle throughout the years before pregnancy through better diet, increased exercise, regular checkups, and management of chronic conditions serves a number of important functions. Not only does preconception health decrease a Latina’s risk for poor birth outcome, but it also increases her chances for a longer and more disease-free life.

Infant mortality cannot be fully eliminated, but the health status of parents-to-be is as important as the medical care an unborn baby receives during the pregnancy months. And children learn by example, so the healthy habits that a Latino mother and father follow today instill in their child life-long lessons that benefit not only the individual child, but the community in which that child lives and learns.

Recently, the World Health Organization came out with a report that put the US in 40th place in the world in an international ranking of infant mortality rates, behind most other industrialized nations. If we consider that the health of our babies is a reflection of the future health of our people and our nation, the onus is on us to do more as individuals and collectively to improve our national bill of health.

We can start by putting on our gym clothes and breaking some sweat. Call 1-800-444-6472 or go to to learn more.

Garth Graham, M.D., M.P.H., is the Deputy Assistant Secretary for Minority Health with the U.S. Department of Health and Human Services’ Office of Minority Health. He is also a practicing physician.