Effectiveness of an evidence-based health coaching program for reducing cardiometabolic risk among women and infants enrolled in early home visiting services

总结 黑人和拉丁裔妇女肥胖率最高3。妊娠期肥胖妇女 妊娠期糖尿病、高血压疾病和急性心血管事件的风险过高， 分娩和分娩，与正常体重女性相比4，5。因为怀孕的女性有动力去做一个 健康的婴儿，怀孕提供了理想的“受教时刻”，不仅减少不良怀孕 结果，但最终防止妇女及其婴儿的长期CMD 28，29。生活方式干预 解决妊娠期肥胖问题有可能打破肥胖和心脏代谢疾病的恶性循环 (CMD)为黑人和拉丁裔妇女8.然而，尽管有证据表明有效， 在黑人或拉丁裔孕妇中进行了测试，或在社区环境中实施， 许多高风险孕妇和产后妇女在那里获得安全网服务。为了弥补这一差距，我们 将利用我们团队的经验，设计和测试一个基于证据的怀孕/产后健康 远程提供的辅导干预（使用激励性访谈的电话辅导+基于网络的 平台+移动的电话行为跟踪）。沿着我们的马里兰州家访伙伴，我们将适应 并将H42/H4 U实施到家访设置中，即，H42/H4 U-HV并为Latinx定制干预措施 讲西班牙语的女人早期家访是一种基于证据的公共卫生服务策略， 所有50个国家都将服务目标对准高风险社区，以解决健康的不利社会决定因素。 家访者提供健康教育，促进积极的育儿和早期学习，并将家庭与 需要的社区资源10.虽然家访计划并没有普遍优先考虑CMD风险， 服务，他们是一个理想的服务战略，为一体的健康生活方式的干预。我们将使用一个 混合型1有效性-实施随机对照试验，以比较H42/H4 U的有效性- 与常规家访服务相比，HV整合到家访中以降低产后体重 360名孕妇的保留（孕前体重与产后6个月体重之间的差异） 产后妇女。我们还将评估干预措施的实施情况， 融入家访。健康差异的影响。量身定制且有针对性的远程交付健康 在早期家访中实施的辅导干预有可能促进健康的生活方式行为 消除年轻高危人群中肥胖、不良妊娠结局和长期CMD的差异 黑人和拉丁裔孕妇和产后妇女及其婴儿。我们的研究方法允许我们不 不仅要确定H42/H4 U-HV的有效性，还要了解能够进行干预的因素 实施以告知可持续性，进一步推动从证据转化为实践的途径，以及 促进随后更大的公共卫生影响11。

SUMMARY Black and Latinx women have the highest prevalence of obesity3. Women entering pregnancy with obesity have an excess risk of gestational diabetes, hypertensive disorders, and acute cardiovascular event during labor and delivery, compared to normal weight women4,5. Because pregnant women are motivated to have a healthy baby, pregnancy provides the ideal “teachable moment” to not only reduce adverse pregnancy outcomes, but ultimately prevent long-term CMD in women and their infants28,29. Lifestyle interventions addressing obesity in pregnancy have the potential to break the cycle of obesity and cardiometabolic disease (CMD) for Black and Latinx women8. However, despite evidence of effectiveness, few lifestyle interventions have been tested among Black or Latinx pregnant women or been implemented in community-based settings, where many high risk pregnant and postpartum women access safety-net services. To address this gap, we will leverage our team's experience designing and testing an evidence-based pregnancy/postpartum health coaching intervention that is remotely delivered (phone coaching using motivational interviewing + web-based platform + mobile phone behavioral tracking). Along with our Maryland home visiting partners, we will adapt and implement H42/H4U into the home visiting setting, i.e., H42/H4U-HV and tailor the intervention for Latinx and Spanish speaking women. Early home visiting is an evidence-based public health service strategy found in all 50 states that targets services to high-risk communities to address adverse social determinants of health. Home visitors provide health education, promote positive parenting and early learning, and link families with needed community resources10. While home visiting programs don't universally prioritize CMD risk in their services, they are an ideal service-strategy for integration of a healthy lifestyle intervention. We will use a hybrid type 1 effectiveness-implementation randomized control trial to compare the effectiveness of H42/H4U- HV integrated into home visiting compared with usual home visiting services in reducing postpartum weight retention (difference between pre-pregnancy weight and weight at 6 months postpartum) among 360 pregnant and postpartum women. We will also evaluate the implementation of the intervention to enable and sustain integration into home visiting. Health Disparities Impact. A tailored and targeted remotely-delivered health coaching intervention implemented into early home visiting has potential to promote healthy lifestyle behaviors and eliminate disparities in obesity, adverse pregnancy outcomes, and long-term CMD among young high risk Black and Latinx pregnant and postpartum women and their infants. Our research approach allows us to not only establish the effectiveness of H42/H4U-HV but also understand the factors that enable intervention implementation to inform sustainability, further the pathway from evidence translation into practice, and facilitate greater subsequent public health impact11.