Weight Management in Obese Pregnant Underserved African American Women

描述(由申请人提供)：母亲肥胖和不适当的妊娠体重增加增加了母亲和新生儿的发病率和死亡率。此外，肥胖女性的后代患神经发育迟缓、肥胖和发展代谢性疾病的风险增加。处于社会经济不利地位(SED)的妇女，特别是来自非裔美国人(AA)人口的妇女，由于肥胖率高，特别容易受到与怀孕有关的不良后果的影响。因此，SED、AA妇女孕期成功的体重管理具有相当大的公共卫生意义。我们在测试SED非怀孕妇女的生活方式干预措施方面拥有经验，这些干预措施已在社区组织中实施和维持，例如家长即教师(PAT)，这是一个全国性的家访计划，通过每年最多25次家访，免费为高需求的妇女提供产前和产后的亲子教育和服务。我们建议在肥胖的SED AA妇女中进行一项为期24个月(产前6个月和产后18个月)的随机对照试验，以评估由PAT父母教育人员在产前和产后家访期间提供的创新生活方式干预计划(PAT-I-)的能力，以改善母亲和新生儿/婴儿的体重、代谢和健康结果。广泛的计划评估将通过衡量计划的影响范围、实施情况、可接受性和可持续性来确定PAT+干预措施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传播，该组织目前覆盖了所有50个州的2173个PAT计划，覆盖了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.