Optimizing health from pregnancy through one year postpartum: A sequential multiple assignment randomized trial (SMART) of perinatal lifestyle intervention

摘要

ABSTRACT We are currently recruiting women with overweight/obesity (prepregnancy BMI ≥ 25) at the beginning of pregnancy into a two-stage randomized trial of lifestyle interventions delivered across pregnancy and the first year postpartum (R01HL132578). In response to NOT-OD-21-071 “Administrative Supplements and Urgent Competitive Revisions for NIH Grants to Add or Expand Research Focused on Maternal Health, Structural Racism and Discrimination (SRD), and COVID-19,” we propose to enhance the aims of our ongoing trial of perinatal lifestyle interventions, “Optimizing Health from Pregnancy through One Year Postpartum: A Sequential Multiple Assignment Randomized Trial [SMART] of Perinatal Lifestyle Intervention” to address questions about the ways in which the COVID-19 pandemic and structural racism and discrimination (SRD) affect perinatal health and mental health. We propose to enhance the aims of our ongoing trial in several ways. First, we aim to evaluate the effects of the COVID-19 pandemic on weight, weight-related behaviors, depressive symptoms, and psychosocial stress among women with prepregnancy overweight/obesity from pregnancy to 6 months postpartum and examine the potential for behavioral and psychosocial intervention delivered during the perinatal period to attenuate negative effects of the pandemic on maternal health and mental health. Second, we propose to add assessments of food insecurity and racial discrimination. Given the disproportionate effects of the COVID-19 pandemic on Black women’s health, we will enhance our sample by recruiting 40 additional Black pregnant women (prepregnancy BMI ≥ 25). The added assessments of food insecurity and discrimination will supplement measures of dietary intake, physical activity, depressive symptoms, psychosocial stress, sleep, and weight collected in the parent R01. Intervention components such as psychoeducation, coaching, goal-setting, and support related to health behavior promotion, mood and stress management can address stressors related to the pandemic, and the myriad challenges and concerns women face during pregnancy and postpartum. The aims of this supplement are to: (1) Examine the impact of the COVID-19 pandemic on weight, weight-related behaviors, depressive symptoms, and psychosocial stress in women with overweight/obesity at the end of pregnancy and 6 months postpartum; (2) Determine whether perinatal lifestyle intervention attenuates negative pandemic-related effects on weight, weight-related behaviors and mental health; and (3) Evaluate food insecurity and perceived discrimination in relation to maternal weight, mental health outcomes, and lifestyle intervention response. Thus, we aim to leverage the ongoing R01 to contribute an evidence base to improve care by documenting the potential for lifestyle intervention to attenuate negative impacts of the COVID-19 pandemic on perinatal maternal health and mental health.