Lifestyle Interventions in Overweight and Obese Pregnant Women

描述(申请人提供)：建议进行一项随机对照试验，研究在一组不同种族和民族的超重和肥胖孕妇中，强化生活方式干预(ILI)与常规护理(UC)对妊娠体重增加(GWG)、婴儿肥胖和母亲产后体重保留的影响。ILI组的妇女将在怀孕期间接受密集咨询，并在分娩后接受关于行为、营养和体力活动改变的团体咨询。咨询人员将每周访问一次，并将进行更多的电话和互联网联系。母亲将在怀孕14周和36周，以及分娩后12周和52周接受评估。测量将包括人体测量、全身核磁共振、回声核磁共振和全身体积描记(BodPod)。婴儿的测量将是12周和52周的人体测量、全身核磁共振、回声核磁共振和全身体积描记(PeaPod)。母亲和儿童的心脏代谢风险因素将在血浆中进行测量。将收集关于母亲的饮食摄入量和体力活动(问卷和加速度计)的数据，以帮助进行咨询。其他要收集的数据包括关于生活质量、社会经济状况的问卷调查。将仔细记录提供ILI的费用，以便计算干预的成本分析。这项研究的主要结果是婴儿出生时的肥胖程度。我们需要180名参与者才能获得适当的权力。我们将招收210名学生，以便 以考虑到沿途的一些辍学生。每一位母亲都将在怀孕期间和分娩后一年内接受跟踪。每个婴儿出生后将被跟踪一年。如果有进一步的资助，我们有能力继续跟踪这些参与者，因为他们都是当地的或医院的集水区和我们自己的医生。如果达到了目标，即儿童和母亲都能从干预中受益，那么超重孕妇的治疗方式应该发生范式转变。目前，向这些妇女提供的与GWG和体力活动有关的行为建议和干预措施十分缺乏。我们研究的阳性结果将为ILI的预防性干预提供证据。

DESCRIPTION (provided by applicant): A randomized controlled trial is proposed to study the effect, in a cohort of racially and ethnically diverse group of overweight and obese pregnant women, of an Intensive Lifestyle Intervention (ILI) compared to Usual Care (UC) on gestational weight gain (GWG), infant fatness, and mothers' post-delivery weight retention. Women in the ILI arm will receive intensive counseling during pregnancy and group counseling after delivery regarding behavior, nutrition, and physical activity change. Visits to counselors will be weekly and additional telephone and internet contacts will occur. The mothers' will be assessed at 14 and 36 weeks of pregnancy and at 12 weeks and 52 weeks post-delivery. The measurements will be anthropometry, whole body MRI, EchoMRI, and whole body plethysmography (BodPod). The infants' measurements will be anthropometry, whole body MRI, EchoMRI, and whole body plethysmography (PeaPod) for fatness 12 weeks and 52 weeks. Mothers and children will have cardio-metabolic risk factors measured in plasma. Data will be collected regarding mothers' dietary intake and physical activity (questionnaires and accelerometry) to assist in counseling. Other data to be collected include questionnaires on quality of life, socio-economic status. Careful record will be kept of expenses in providing the ILI, so that cost analysis of the intervention can be calculated. The study is powered on the primary outcome, fatness of the infants at birth. We require 180 participants to attain appropriate power. We will enroll 210 so as to allow for some dropouts along the way. Each mother will be followed during pregnancy and for a year post delivery. Each infant will be followed for a year after birth. We have the ability o continue to follow these participants if further funding is forthcoming, as they are all local to or hospital's catchment area and our own physicians. If aims are achieved, namely that both children and mothers profit from the intervention, there should be a paradigm shift in how overweight pregnant women are treated. At present, there is a dearth of behavioral advice and intervention relating to GWG and physical activity provided to these women. Positive results from our study would provide evidence for ILI preventative intervention.