Weight Management in Obese Pregnant Underserved African American Women

描述（由申请人提供）：产妇肥胖和不适当的妊娠期体重增加（GWG）会增加产妇和新生儿的发病率和死亡率。此外，肥胖女性的后代神经发育迟缓、肥胖和发展代谢性疾病的风险增加。社会经济弱势妇女（SED），特别是非洲裔美国人（AA）群体，由于其高肥胖率，特别容易受到不良妊娠相关结果的影响。因此，在SED、AA妇女怀孕期间成功控制体重具有相当大的公共卫生意义。我们有在SED非孕妇中测试生活方式干预措施的经验，这些措施已在社区组织中实施并持续下去，如家长即教师（PAT），这是一个全国性的家访计划，通过每年多达25次的家访，为高需求妇女提供免费的亲子教育和服务，包括产前和产后，直到幼儿园。我们建议对肥胖SED AA妇女进行24个月（产前6个月和产后18个月）的随机对照试验，以评估创新生活方式干预计划（PAT-i-）的能力，该计划由PAT父母教育者在产前和产后家访期间提供，以改善孕产妇和新生儿/婴儿体重，代谢和健康结局。广泛的规划评估将通过衡量规划范围、实施、可接受性和可持续性来确定PAT+干预在现实世界环境中的适用性。如果有效，PAT+可以通过这个全国性组织进行传播，目前该组织在全美50个州参与了2173个PAT项目，覆盖了超过24.9万名母亲和31.9万名儿童。

DESCRIPTION (provided by applicant): Maternal obesity and inappropriate gestational weight gain (GWG) increase both maternal and neonatal morbidity and mortality. In addition, offspring of obese women are at increased risk for neurodevelopment delay, becoming obese, and developing metabolic diseases. Women who are socio-economically disadvantaged (SED), especially from African American (AA) populations, are particularly susceptible to adverse pregnancy-related outcomes because of their high prevalence rates of obesity. Therefore, successful weight management during pregnancy in SED, AA women has considerable public health implications. We have experience in testing lifestyle interventions among SED non-pregnant women that have been implemented and sustained within community organizations such as Parents As Teachers (PAT), a national home visiting program that provides parent-child education and services free-of-charge to high needs women, prenatally and post-partum, through up to 25 home visits per year until kindergarten. We propose to conduct a 24-month (6-month prenatal and 18-month post-partum) randomized, controlled trial in obese SED AA women to evaluate the ability of an innovative lifestyle intervention program (PAT-i-), delivered by PAT parent educators during prenatal and post-partum home visits, to improve maternal and neonatal/infant weight, metabolic and health outcomes. An extensive programmatic evaluation will determine the applicability of the PAT+ intervention in real world settings by measuring programmatic reach, implementation, acceptability, and sustainability. If effective, PAT+ can be disseminated through this national organization, which currently reaches over 249,000 mothers and 319,000 children participating in 2,173 PAT programs across all 50 states.