Meeting Gestational Weight Gain Guidelines: Development of a Group Intervention During Pregnancy for Low-IncomeRacial/Ethnic Minority Obese Women and Their Providers

描述（由申请人提供）：这个K23职业发展奖的总体目标是培养博士。Kominiarek博士的职业生涯是一名独立的调查员，他为肥胖的低收入少数民族孕妇及其提供者调整和整合基于证据的行为干预措施，以便达到妊娠期体重增加的目标，并最终改善围产期结局。关于肥胖妇女怀孕期间干预措施的文献缺乏坚实的证据基础，大多数干预措施都是针对非西班牙裔白人，不涉及产前护理提供者。Kominiarek博士是妇产科系母胎医学部的终身助理教授，在管理高危妊娠方面拥有丰富的临床经验，尤其是与妊娠期肥胖有关的经验。她以前的研究详细说明了怀孕期间肥胖的风险（即，增加剖腹产，更长的劳动力）和过度妊娠体重增加从一个大型的多中心数据库和2）描述了低收入少数民族妇女对这些风险的理解。Kominiarek计划将她的研究事业向前推进，并进行适合低收入少数民族妇女及其提供者的群体行为干预。伊利诺伊大学芝加哥分校（UIC）是位于芝加哥西区的一个三级护理中心，非常适合Kominiarek博士的职业发展和研究战略。在UIC接受产前护理和分娩的大多数妇女是低收入的少数民族妇女（>80%是非西班牙裔黑人或西班牙裔; >70%接受医疗补助），30%肥胖。旨在减少健康差距的研究是UIC使命的核心。机构环境中的资源包括健康研究和政策研究所（消除差异的卓越中心），临床和转化科学中心（为进行基于患者的临床研究的研究人员提供的众多资源）和UIC公共卫生学院。Kominiarek博士已经建立了一个多学科的导师团队，该团队经验丰富，致力于实现她的职业目标，并代表了这些资源。职业目标包括：（1）获得健康差距研究方面的培训，以便为低收入少数民族妇女设计文化敏感的干预措施，（2）获得定性分析和焦点小组方法沿着定量分析方面的专门知识，因为这与干预措施设计有关，（3）获得小组产前护理管理、实施和研究方面的专门知识，以便在小组环境中实施有效的干预措施，（4）应用这种培训和专业知识，为肥胖的低收入少数民族妇女及其提供者调整、测试和试点基于证据的群体行为干预，以满足体重增加的建议。拟议的研究策略可以改善以前的研究，因为文化适应，参与的产前护理提供者，并使用一组产前护理交付模式（集中怀孕）。两个具体目标指导研究策略：（1）检查和描述提供者对向肥胖、种族/少数民族妇女提供产前护理的观点，包括肥胖和GWG咨询的障碍;（2）利用从孕妇、肥胖、种族/少数民族妇女及其提供者那里获得的知识，制定和试行针对妇女及其提供者的小组产前护理干预措施。

DESCRIPTION (provided by applicant): The overall goal of this K23 Career Development Award is to train Dr. Michelle A. Kominiarek, MD for a career as an independent investigator who adapts and integrates evidenced based behavioral interventions for obese low-income minority pregnant women and their providers so that gestational weight gain goals can be met and perinatal outcomes ultimately improved. The literature on interventions during pregnancy for obese women lacks a solid evidence base and most interventions were delivered to non-Hispanic whites and did not involve the prenatal care provider. Dr. Kominiarek is a tenure-track Assistant Professor in the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine who has extensive clinical experience in the management of high-risk pregnancies especially related to obesity in pregnancy. Her previous research has 1) detailed the risks of obesity in pregnancy (i.e., increased cesareans, longer labors) and of excessive gestational weight gain from a large multicenter database and 2) described low-income minority women's understanding of these risks. In the proposed award, Dr. Kominiarek plans to move her research career forward with a group behavioral intervention that is adapted for low-income minority women and their providers. The University of Illinois at Chicago (UIC), a tertiary care center located on Chicago's West side, is well-suited for Dr. Kominiarek's career development and research strategy. The majority of women who receive prenatal care and deliver at UIC are low-income minority women (>80% either non-Hispanic blacks or Hispanics; >70% Medicaid recipients) and 30% are obese. Research aimed at reducing health disparities is central to the UIC mission. The resources in the institutional environment include the Institute for Health Research and Policy (a Center of Excellence in Eliminating Disparities), the Center for Clinical and Translational Science (numerous resources for investigators conducting patient-based clinical research) and the UIC School of Public Health. Dr. Kominiarek has developed a multidisciplinary mentorship team that is highly experienced and committed to her career goals with representation from each of these resources. The career goals include: (1) Acquire training in health disparities research so as to design culturally sensitive interventions for low-income minority women, (2) Gain expertise in qualitative analysis and focus group methodology along with quantitative analysis as it relates to intervention design, (3) Achieve expertise in group prenatal care administration, implementation, and research so as to implement an effective intervention in a group setting, (4) To apply this training and expertise to adapt, test, and pilotan evidenced-based group behavioral intervention for obese low-income minority women and their providers so that weight gain recommendations are met. The proposed research strategy can improve on prior research because of the cultural adaptations, the involvement of the prenatal care provider, and the use of a group prenatal care delivery model (Centering Pregnancy). Two Specific Aims guide the research strategy: (1) To examine and describe providers' perspectives on the delivery of prenatal care to obese, racial/ethnic minority women, including barriers to counseling about obesity and GWG; (2) To use the knowledge gained from pregnant, obese, racial/ethnic minority women and their providers to develop and pilot a group prenatal care intervention that targets women and their providers.