Promoting Healthy Weight in Pregnancy and Postpartum Among Overweight/Obese Women

描述（由申请人提供）：非裔美国女性比其他种族的女性更容易进入超重或肥胖的孕期。与正常体重的女性相比，超重和肥胖的女性更有可能在怀孕期间体重增加，并在产后保持这种体重，从而增加了她们患肥胖相关合并症的风险。体力活动的减少和饮食摄入的增加导致了体重的过度增加。需要有效的基于行为的生活方式干预措施来帮助孕妇，特别是超重或肥胖孕妇、低收入孕妇和非裔美国孕妇，防止妊娠期体重过度增加和产后体重减轻。因此，拟建项目的主要目标是开展形成性工作，制定行为干预措施（第一阶段），然后在超重和肥胖的非裔美国妇女中测试量身定制的行为干预措施的可行性，以防止怀孕期间体重过度增加并促进产后早期体重减轻（第二阶段）。在第一阶段，访谈将侧重于了解女性对体重相关行为的观点、偏好、障碍和经历，以及她们偏好的干预渠道和干预力度（n=10/组，共30）。在第二阶段，来自两个产科诊所的年龄在18-39岁的超重或肥胖的早期怀孕（15周）的非裔美国妇女将被招募，并随访至产后12周。妇女将被随机分为行为干预组或对照组（n=20/组，共40人）。社会认知理论将为干预所针对的行为改变策略提供信息，干预的内容、渠道和强度将以第一阶段的结果为指导。干预将在妊娠18周（取决于入组时间）至妊娠36周开始，并将在产后6周至产后12周恢复。与行为干预组的女性相比，对照组的女性将通过纸质邮件收到数量相当的干预联系方式。主要结果将是怀孕最后两个月的平均体重增加率和产后12周的体重保持率。次要结局包括PA和饮食。这项提议的研究是创新的，因为它将使用定性方法来开发一种行为干预，然后对高风险、高需求群体（即超重/肥胖的非裔美国妇女）进行试点测试，这些群体很少得到研究。

DESCRIPTION (provided by applicant): African American women are more likely than other racial groups to enter pregnancy overweight or obese. Overweight and obese women are more likely to gain excessive weight during pregnancy and retain this weight postpartum than normal weight women, increasing their already high risk for obesity-related comorbidities. Reduced physical activity (PA) and increased dietary intake contribute to this excessive weight gain. Effective behaviorally grounded lifestyle interventions are needed to help pregnant women, especially those who are overweight or obese, of low income, and African American, prevent excessive gestational weight gain and lose weight during postpartum. Thus, the primary goals of the proposed project are to conduct formative work to develop a behavioral intervention (Phase 1) and then test the feasibility of a tailored behavioral intervention to prevent excessive weight gain in pregnancy and promote weight loss in early postpartum among overweight and obese African American women (Phase 2). In Phase 1, interviews will focus on understanding women's perspectives, preferences, barriers, and experiences with weight-related behaviors as well as their preferred channel(s) and intensity of intervention delivery (n=10/group, total 30). In Phase 2, overweight or obese African American women aged 18-39 years in early pregnancy (d15 weeks) will be enrolled from two obstetrical clinics and followed to 12 weeks postpartum. Women will be randomized to the behavioral intervention group or a comparison group (n=20/group, 40 total). Social cognitive theory will inform the behavior change strategies targeted in the intervention, and the content, channel, and intensity of the intervention will be guided by results from Phase 1. The intervention will be delivered beginning within 18 weeks (depending on the timing of enrollment) through 36 weeks gestation and will resume at 6 weeks postpartum through 12 weeks postpartum. Women in the comparison group will receive a comparable number of intervention contacts via print mailings as women in the behavioral intervention group. Primary outcomes will be the rate of average weight gain across the last two trimesters of pregnancy and weight retention at 12 weeks postpartum. Secondary outcomes include PA and diet. The proposed study is innovative because it will use qualitative method to develop a behavioral intervention and then pilot test the intervention to a high-risk, high-need group (i.e., overweight/obese African American women) that has received very little study. PUBLIC HEALTH RELEVANCE: The majority of women enter pregnancy overweight or obese, and this is particularly the case for African American and low income women. These overweight/obese women are at higher risk for pregnancy- associated weight retention after delivery than normal weight women, which further increases their already high risks for obesity-related comorbidities. This proposed theory-based lifestyle intervention will be well- matched to the unique needs and barriers of this high-risk and high-need group, addresses gaps in literature, and will address an important clinical and public health problem.