A pragmatic, scalable e-health intervention for management of gestational weight gain in low-income mothers

项目摘要 怀孕是影响母亲和母亲近期和长期健康的关键营养时间点。 孩子。而妇女的健康和营养状况(例如，肥胖、吸烟等)在怀孕之前可以说是 对于长期健康结果来说，最重要的是妇女在怀孕期间的营养状况，包括妊娠 体重增加，影响出生结局、健康和慢性病的长期风险。在美国，超过八分之一的女性 2015年，美国生活在贫困中，低收入女性最容易受到营养不良的影响，产妇 肥胖、孕期超重和不良的出生结局。孕期生活方式干预定位 减少过多的妊娠体重增加可能会减少妇女慢性病和儿童肥胖的风险因素。 为了影响美国最脆弱的孕妇、婴儿和儿童的健康，迫切需要 通过以社区为基础的方案，针对服务不足的少数族裔妇女提供可扩展和有效的医疗服务。 美国农业部妇女、婴儿和儿童特别补充营养计划(WIC)--一项全国性计划-- 非常适合为低收入和营养风险高的孕妇提供可扩展和有效的生活方式干预 女人。然而，缺乏测试有效的、设计良好的、与文化相关的和 适当的干预措施旨在促进低收入孕妇的健康体重增加。在……里面 对国家卫生研究院筹资机会的回应(PA-18-135)；产妇营养和孕前 肥胖：对母亲、婴儿和儿童的影响，这项研究的首要目标是开发和测试 以前以患者为中心、务实和可扩展的体重管理计划SmartMom®的有效性 显示促进了健康的孕期体重增加，并增加了孕妇达到 适当的孕期体重增加。本研究将分两个阶段进行；智能妈妈的文化适应 1)，以及在路易斯安那州妇女、婴儿和儿童中心登记的432名孕妇中进行的全州随机对照试验 儿童(WIC)方案(目标2)。主要的假设是，与接受常规护理的WIC参与者相比， 参与者接受SmartMom基于智能手机的、高强度、适合健康素养和文化的培训 促进健康孕期体重增加的适应性生活方式干预将更符合2009年国际移民组织 妊娠期体重增加指南和生理和行为因素的显著改善。

Project Summary Pregnancy is critical nutritional time point that influences the immediate and long-term health of both the mother and child. While the health and nutritional status of women (eg. obesity, smoking etc.) prior to pregnancy is arguably the most important for long-term health outcomes, the nutritional status of women during pregnancy including gestational weight gain, influences birth outcomes, health, and long-term risk for chronic disease. More than one in eight women in the U.S. lived in poverty in 2015 and women with low incomes are the most vulnerable to poor nutrition, maternal obesity, excess weight gain in pregnancy and poor birth outcomes. Lifestyle interventions during pregnancy positioned to reduce excess gestational weight gain may reduce risk factors for chronic disease in women and obesity in children. To impact the health of the most vulnerable pregnant women, infants and children in the U.S., there is a critical need for scalable and effective healthcare services targeting under-served, minority women through community-based programs. The USDA Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) – a National program – is highly suited to deliver scalable and effective lifestyle interventions in low income and nutritionally at risk pregnant women. However, there is a dearth of clinical trials testing efficacious, well-designed, culturally relevant and appropriately powered interventions aimed to promote healthy weight gain in pregnant women with low incomes. In response to the National Institutes of Health funding opportunity (PA-18-135); Maternal nutrition and pre-pregnancy obesity: effects on mothers, infants and children, the overarching goal of this research is to develop and test the effectiveness of SmartMoms® a patient-centered, pragmatic and scalable weight management program previously shown to foster healthy gestational weight gain and to increase the proportion of pregnant women who achieve appropriate gestational weight gain. This research will be conducted in two phases; Acculturation of SmartMoms (Aim 1), and a state-wide, randomized controlled trial in 432 pregnant women enrolled in the Louisiana Women’s, Infants and Children (WIC) program (Aim 2). The primary hypothesis is that compared to WIC participants receiving usual care, participants receiving SmartMoms a smartphone based, high-intensity, health literacy-appropriate and culturally adapted lifestyle intervention promoting healthy gestational weight gain will have greater adherence to the 2009 IOM gestational weight gain guidelines and significant improvements in physiological and behavioral factors.