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

摘要 产后体重滞留(即怀孕期间体重没有减少)影响60%的妇女一年后 送货后，许多人很快就增加了体重。产后体重滞留与 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 晚期妊娠的不良围产儿结局。迄今为止，通过生活方式干预来减轻产后体重 留任取得的成功有限。为了向新的干预措施提供信息，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，当许多女性努力改变生活方式以支持健康分娩时， 产后时期，以睡眠中断等为人父母的强烈要求为特征， 母乳喂养、照看和劳动力转变。我们的组织假设是，享受特定的 生活方式行为(体育活动、自我称重和健康饮食)受自我效能感的调节，是一种远端的 纵向预测相应生活方式行为的动机决定因素，产后体重 保留和代谢综合征，同时考虑到生命这一阶段特有的相关因素(例如，睡眠 中断)。为了实现我们为未来干预确定可修改目标的目标，我们将进行一项 有效利用不同种族/民族妇女的持续怀孕队列的纵向研究 (R01 ES019196)。这项建议将扩大对550名女性的随访，评估她们的快乐、自我 产后6周、6个月、12个月、18个月和24个月的疗效、行为、体重和其他因素。新陈代谢 综合征将在怀孕期间使用之前收集的血液样本进行评估，并在6、12和24岁时进行 产后几个月使用新收集的样本。优势包括多样化的样本和理论驱动的， 纵向重复测量设计。我们希望这些发现将促进我们对可修改的、 不同人群中肥胖和心脏代谢不良结局的个体水平决定因素 行为随时间变化的机械论方法。

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.