Preventing excessive gestational weight gain in obese women

描述(申请人提供)：在怀孕期间进行低强度的生活方式干预可以防止正常体重妇女的过度妊娠体重增加。然而，事实证明，防止肥胖女性妊娠体重过度增加更加困难。包括规定特定卡路里目标和平衡营养的密集干预措施显示了最大的希望，但与非怀孕人口类似，促进持续遵守卡路里处方仍然是一个重大挑战。在非怀孕的多民族人群中，液体膳食替代产品已被证明可以促进对卡路里和体重目标的坚持。此外，它们在怀孕期间被用作补充剂，以提高营养充分性，并被证明是安全的，并有助于改善饮食摄入量。然而，到目前为止，还没有研究评估这种方法是防止怀孕期间体重过度增加的一种手段。这项研究的主要目的是确定在怀孕期间包括部分膳食替代的多成分生活方式干预是否可以减少超过LOM建议的怀孕期间体重增加的肥胖女性的数量。在这项两个地点的随机试验中，430名肥胖妇女(50%是西班牙裔)将在地点和种族内被随机分成两组，一组是采用部分膳食替代计划的多成分生活方式改变治疗(N=215)，另一组是标准护理(N=215)。治疗将在怀孕期间进行，使用我们之前工作中的标准化干预程序。所有妇女都将在怀孕早期(10至16周)、怀孕30周、产后6个月和12个月接受招募和评估，并在分娩时和产后2个月进行人体测量。我们认为这个项目意义重大，因为它涉及到预防妊娠体重过度增加及其相关的不利母子健康后果。这项研究也是创新的；目前还没有随机对照试验评估行为生活方式干预和部分膳食替代计划对促进多民族肥胖女性健康体重增加的效果。 与公共健康相关：这项研究项目将帮助确定一个有效的计划，帮助肥胖女性在怀孕期间增加健康的体重(而不是太多)。如果有效，这种生活方式计划有可能预防肥胖女性及其后代的健康问题。

DESCRIPTION (provided by applicant): Low-intensity lifestyle interventions during pregnancy can prevent excessive gestational weight gain in normal weight women. However, preventing excessive gestational weight gain in obese women has proven more difficult. Intensive interventions involving prescription of specific calorie goals and balanced nutrition have shown the most promise, but, similar to non-pregnant populations, promoting ongoing adherence to caloric prescription remains a significant challenge. Liquid meal-replacement products have been shown to promote adherence to calorie and weight goals in non-pregnant multiethnic populations. Moreover, they have been used during pregnancy as a supplement to improve nutritional adequacy and shown to be safe and to result in improved dietary intake. However, no study to date has evaluated this approach as a means to prevent excessive weight gain during pregnancy. The principal aim of this study is to determine whether a multi-component lifestyle intervention that incorporates partial meal replacements during pregnancy can reduce the number of obese women who exceed the lOM recommendations for weight gain during pregnancy. In this two-site randomized trial, 430 obese women, 50% Hispanic, will be randomized within site and ethnicity into either a multi-component lifestyle modification treatment with partial meal replacement program (N=215) or standard care (N=215). Treatment will occur during pregnancy, using standardized intervention procedures from our previous work. All women will be recruited and assessed early in pregnancy (between 10 and 16 weeks), at 30 weeks gestation, and at 6 months, and 12 months postpartum with anthropometric measures obtained at delivery and at 2 months postpartum. We believe this project is significant because it deals with the prevention of excessive gestational weight gain and its associated adverse maternal and offspring health consequences. The study is also innovative; there have been no randomized controlled trials evaluating the effects of a behavioral lifestyle intervention with partial meal replacement program to promote healthy weight gain in multiethnic obese women. PUBLIC HEALTH RELEVANCE: This research project will help identify an effective program to help obese women gain a healthy amount of weight (and not too much) during pregnancy. If effective, this lifestyle program has the potential to prevent health problems in obese women and their offspring.