Use of home-delivered meals to reduce excessive gestational weight gain for high-risk women

使用送餐上门来减少高危女性妊娠期体重过度增加

• 批准号: 10626837
• 负责人: Gareth R Dutton
• 金额: $ 18.56万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10626837
• 关键词: Address; Adherence; Affect; African American; Behavior Therapy; Behavioral; Birth; Cardiovascular Diseases; Child; Clinical effectiveness; Cognitive; Confusion; Control Groups; Cost Savings; Counseling; Data; Diet; Effectiveness; Exploratory/Developmental Grant; Face; Failure; Future; Gestational Diabetes; Guidelines; Habits; Health; Health Food; Healthy Eating; High Risk Woman; Home; Home environment; Hospital Records; Individual; Informal Social Control; Institute of Medicine (U.S.); Insurance Carriers; Insurance Coverage; Intake; Intervention; Kidney Diseases; Low income; Maternal and Child Health; Medical; Metabolic; Metabolism; Minority Women; Mothers; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Overweight; Participant; Patient Outcomes Assessments; Patients; Pilot Projects; Population; Pregnancy; Pregnant Women; Preparation; Privatization; Problem Solving; Protocols documentation; Public Health; Public Policy; Quasi-experiment; Randomized, Controlled Trials; Recommendation; Reporting; Resources; Risk; Self Efficacy; Serious Adverse Event; Stress; Testing; Time; Transportation; Travel; Underserved Population; United States; Weight maintenance regimen; Woman; acceptability and feasibility; behavior change; cooking; cost; cost effective; cost effectiveness; delivered meals; design; ethnic minority; experience; feasibility testing; food insecurity; gestational weight gain; improved; innovation; intervention delivery; novel; nutrition; obesity risk; offspring; perinatal complications; perinatal outcomes; post intervention; postpartum weight; prenatal; prepregnancy; prevent; programs; psychologic; racial minority; recruit; satisfaction; skills; standard care; stressor; success

PROJECT SUMMARY/ABSTRACT In the United States, more than 50% of women have pre-pregnancy overweight/obesity, and half of women experience gestational weight gain (GWG) in excess of the Institute of Medicine recommendations. Low-income and racial/ethnic minority women are disproportionately affected. Pre-pregnancy overweight and excessive GWG increase the risk for prenatal and perinatal complications. Behavioral interventions aimed at reducing excessive GWG have had limited success, particularly among women with overweight/obesity. Most GWG interventions involve high participant burden and fail to sufficiently address both the psychological (e.g., stress, low self-efficacy) and material (e.g., food insecurity, transportation) barriers and needs of low-income, minority women. One promising and novel alternative approach capable of overcoming many of these barriers is the provision of healthy, home-delivered meals. In non-pregnant populations, meal delivery has been used to help manage various conditions including overweight/obesity, type 2 diabetes, and cardiovascular disease with cost- effective and encouraging results. While the use of meal delivery for managing weight in pregnancy has not been tested, there is evidence that meal replacement shakes and bars are effective for reducing GWG. However, poor compliance to the meal replacement prescription was common. Instead, the use of culturally appropriate, home- delivered meals may be more palatable and offer a unique approach to managing GWG. Importantly, meal delivery for GWG management may be sustainable given the cost-savings demonstrated in other populations and the recent expansion by public and private insurers to cover home-delivered meals. The purpose of the proposed R21 exploratory/developmental grant is to test the feasibility, acceptability, and preliminary efficacy of a meal delivery intervention for managing GWG among predominantly African American and low-income pregnant women with overweight/obesity using a rigorous and efficient quasi-experimental design. In particular, the specific aims of this project are to: 1) explore the feasibility and acceptability of the meal delivery intervention; 2) investigate the preliminary efficacy of the meal delivery intervention on GWG and estimate the effect size of the intervention relative to a non-randomized but weighted standard care control group derived from de-identified hospital records; and 3) investigate pre- to post-intervention changes in patient-reported food insecurity, stress, diet satisfaction, self-efficacy, and diet quality. This project will provide essential data to inform the design of a future large-scale and fully-powered randomized controlled trial on the effectiveness and cost of the meal delivery intervention on GWG adherence and maternal-child health outcomes. Ultimately, results could inform public policy to leverage existing programs (e.g., supplemental nutrition assistance programs) and/or modify insurance coverage to promote sustainability, which would have a meaningful public health impact on maternal-child health.

项目总结/摘要 在美国，超过50%的女性孕前超重/肥胖，半数女性 妊娠期体重增加（GWG）超过医学研究所的建议。低收入 少数种族/族裔妇女受到的影响尤为严重。怀孕前超重和过度 GWG增加产前和围产期并发症的风险。行为干预，旨在减少 过量的GWG的成功有限，特别是在超重/肥胖的女性中。大多数GWG 干预涉及高参与者负担并且不能充分解决心理（例如，压力， 低自我效能）和材料（例如，粮食无保障、交通）的障碍和需求 妇女一种能够克服许多这些障碍的有前途的新颖替代方法是 提供健康的家庭送餐服务。在非怀孕人群中，送餐已被用来帮助 管理各种疾病，包括超重/肥胖、2型糖尿病和心血管疾病， 有效和令人鼓舞的结果。虽然在怀孕期间使用膳食交付来管理体重还没有被证明是有效的。 经过测试，有证据表明，代餐奶昔和酒吧是有效的减少GWG。然而，穷 对代餐处方的依从性是常见的。相反，使用文化上合适的，家庭- 送餐可能更可口，并提供了一种独特的方法来管理GWG。重要的是，餐 考虑到在其他人群中显示的成本节约，GWG管理的交付可能是可持续的 以及最近公共和私人保险公司扩大到覆盖上门送餐。的目的 拟议的R21探索/发展赠款是为了测试的可行性，可接受性和初步疗效， 一种用于管理主要是非洲裔美国人和低收入人群中GWG的膳食交付干预措施 超重/肥胖孕妇使用严格和有效的准实验设计。特别是， 本研究的具体目的是：1）探讨送餐干预的可行性和可接受性; 2)调查送餐干预对GWG的初步疗效，并估计 相对于非随机化但加权的标准治疗对照组的干预， 医院记录;和3）调查干预前后患者报告的食物不安全、压力， 饮食满意度、自我效能和饮食质量。该项目将提供必要的数据，以告知设计一个 未来关于送餐的有效性和成本的大规模和完全把握度的随机对照试验 干预对GWG依从性和母婴健康结局的影响。最终，结果可以告知公众 利用现有计划的政策（例如，补充营养援助计划）和/或修改保险 这将对母婴健康产生有意义的公共卫生影响。