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

描述(申请人提供)：非裔美国女性比其他种族群体更容易怀孕、超重或肥胖。与正常体重的女性相比，超重和肥胖的女性在怀孕期间更有可能增加体重，并在产后保持这一体重，这增加了她们患肥胖症相关合并症的高风险。体力活动(PA)的减少和饮食摄入量的增加导致了这种过度的体重增加。需要有效的以行为为基础的生活方式干预措施，以帮助孕妇，特别是超重或肥胖、低收入的孕妇和非裔美国人，防止妊娠体重过度增加和产后减肥。因此，拟议项目的主要目标是开展形成性工作，以开发行为干预(第一阶段)，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裔美国女性在产后早期减肥(第二阶段)。在第一阶段，访谈将集中于了解女性在体重相关行为方面的观点、偏好、障碍和经历，以及她们首选的渠道(S)和干预提供的强度(n=10/组，共30个)。在第二阶段，超重或肥胖的18-39岁早期怀孕(D15周)的非裔美国妇女将从两个产科诊所登记，并跟踪到产后12周。女性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中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。干预将从18周内(取决于登记的时间)开始至36周妊娠，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获得与行为干预组女性相同数量的干预接触。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周的体重滞留。次要结果包括PA和饮食。这项拟议的研究具有创新性，因为它将使用定性的方法来开发行为干预，然后对高风险、高需求的群体(即超重/肥胖的非裔美国女性)进行试点测试，而这些群体得到的研究很少。 公共卫生相关性：大多数妇女怀孕时超重或肥胖，尤其是非裔美国人和低收入妇女。与体重正常的妇女相比，这些超重/肥胖妇女在分娩后发生妊娠相关体重滞留的风险更高，这进一步增加了她们患肥胖症相关合并症的高风险。这一拟议的基于理论的生活方式干预将与这一高风险和高需求群体的独特需求和障碍很好地匹配，填补文献中的空白，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.