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

描述（由申请人提供）：非洲裔美国妇女比其他种族更有可能进入怀孕超重或肥胖。超重和肥胖的妇女更有可能在怀孕期间体重增加过多，并在产后保持这种体重比正常体重的妇女，增加他们已经很高的肥胖相关的合并症的风险。减少体力活动（PA）和增加饮食摄入量有助于这种过度的体重增加。需要有效的基于行为的生活方式干预措施来帮助孕妇，特别是那些超重或肥胖，低收入和非洲裔美国人，防止妊娠期体重过度增加并在产后减肥。因此，拟议项目的主要目标是进行形成性工作，以开发行为干预（第1阶段），然后测试量身定制的行为干预的可行性，以防止怀孕期间体重过度增加，并促进超重和肥胖的非洲裔美国妇女在产后早期减肥（第2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看法、偏好、障碍和经历，以及她们偏好的干预渠道和干预强度（n=10/组，共30人）。在第2阶段，将从两家产科诊所招募年龄在18-39岁的超重或肥胖的非洲裔美国女性，并随访至产后12周。女性将被随机分配到行为干预组或对照组（n=20/组，共40例）。社会认知理论将为干预中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36周内开始，并将在产后6周至产后12周恢复。对照组中的女性将通过印刷邮件收到与行为干预组中的女性相当数量的干预联系。主要结果将是怀孕最后两个三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。这项研究是创新的，因为它将使用定性方法来开发行为干预，然后对高风险，高需求群体（即，超重/肥胖的非洲裔美国妇女），很少得到研究。 公共卫生相关性：大多数妇女在怀孕时超重或肥胖，尤其是非洲裔美国人和低收入妇女。这些超重/肥胖女性在分娩后与妊娠相关的体重保持的风险高于正常体重女性，这进一步增加了她们与肥胖相关的合并症的高风险。这种基于理论的生活方式干预将很好地匹配这一高风险和高需求群体的独特需求和障碍，解决文献中的空白，并将解决一个重要的临床和公共卫生问题。

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.