Motivational Determinants of Postpartum Lifestyle Behaviors, Weight Retention, and Metabolic Syndrome

摘要 产后体重保持（即，怀孕期间体重增加）影响了60%的女性一年后 许多人在分娩后不久就增加了体重。产后体重保持与 代谢综合征和肥胖，这反过来又增加了心血管疾病，糖尿病和 晚期妊娠的围产期不良结局。到目前为止，生活方式干预，以减少产后体重 保留工作取得了有限的成功。为了提供新的干预措施，这项观察性研究将填补 了解是什么促使女性在独特的过渡时期从事健康的生活方式行为 从怀孕，当许多妇女努力改变生活方式，以支持健康分娩， 产后时期，其特征是对父母身份的强烈要求，如睡眠中断， 母乳喂养、照顾和劳动力转型。我们的组织假设是， 生活方式行为（身体活动，自我称重和健康饮食），由自我效能介导，是一个远端 纵向预测相应生活方式行为的动机决定因素，产后体重 滞留和代谢综合征，同时考虑到生命这个阶段特有的相关因素（例如，睡眠 中断）。为了实现为未来干预措施确定可修改目标的目标，我们将进行一次 有效利用正在进行的不同种族/民族女性妊娠队列的纵向研究 (R01 ES 019196）。这项建议将扩大对550名妇女的后续行动，评估她们的享受、自我评价、 产后6周和6、12、18和24个月时的疗效、行为、体重和其他因素。代谢 将使用先前采集的血液样本在妊娠期间以及6、12和24小时评估综合征 使用新收集的样本进行产后3个月。优势包括多样化的样本和理论驱动， 纵向重复测量设计我们希望这些发现能促进我们对可改变的， 不同人群中肥胖和不良心脏代谢结果的个体水平决定因素， 行为随时间变化的机械方法。

ABSTRACT Postpartum weight retention (i.e., not losing weight gained in pregnancy) affects 60% of women one year after delivery, and many gain additional weight soon thereafter. Postpartum weight retention is associated with the metabolic syndrome and obesity, which in turn increase risks for cardiovascular disease, diabetes, and adverse perinatal outcomes in later pregnancies. To date, lifestyle interventions to reduce postpartum weight retention have met with limited success. To inform new interventions, this observational study will fill gaps in knowledge about what motivates women to engage in healthy lifestyle behaviors during the unique transition from pregnancy, when many women strive to make lifestyle changes to support a healthy delivery, to the postpartum period, characterized by the intensified demands of parenthood such as sleep disruption, breastfeeding, caretaking, and workforce transitions. Our organizing hypothesis is that enjoyment of specific lifestyle behaviors (physical activity, self-weighing, and healthy eating), mediated by self-efficacy, is a distal motivational determinant that longitudinally predicts corresponding lifestyle behaviors, postpartum weight retention, and metabolic syndrome, while accounting for relevant factors unique to this stage of life (e.g., sleep disruption). To achieve our goal of identifying modifiable targets for future interventions, we will conduct a longitudinal study that efficiently leverages an ongoing pregnancy cohort of racially/ethnically diverse women (R01 ES019196). This proposal will expand follow-up for 550 women with assessments of enjoyment, self- efficacy, behavior, weight, and other factors at 6 weeks and 6, 12, 18, and 24 months postpartum. Metabolic syndrome will be assessed in pregnancy using previously collected blood samples, and at 6, 12, and 24 months postpartum using newly collected samples. Strengths include a diverse sample and theory-driven, longitudinal repeated measures design. We expect the findings to advance our understanding of modifiable, individual-level determinants of obesity and adverse cardiometabolic outcomes in diverse populations, using a mechanistic approach to behavior change over time.