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期体重增加（GWG）会增加母亲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、肥胖和代谢疾病的风险增加。处于社会经济不利地位（SED）的妇女，特别是来自非洲裔美国人（AA）人口的妇女，特别容易受到不良妊娠相关结果的影响，因为她们的肥胖患病率很高。因此，SED、AA妇女妊娠期间成功的体重管理具有相当大的公共卫生意义。我们在SED非孕妇中测试生活方式干预方面有经验，这些干预措施已在社区组织中实施和维持，如家长作为教师（PAT），这是一项国家家访计划，为产前和产后高需求的妇女提供免费的亲子教育和服务，每年最多25次家访，直到幼儿园。 我们建议在肥胖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PAT家长教育者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-）改善孕产妇和新生儿/婴儿体重、代谢和健康结局的能力。一项广泛的方案评价将通过衡量方案范围、执行情况、可接受性和可持续性，确定PAT+干预措施在真实的世界环境中的适用性。如果有效的话，PAT+可以通过这个全国性组织进行传播，该组织目前接触到249 000多名母亲和319 000名儿童，他们参加了所有50个州的2 173个PAT方案。

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.