Feasibility and Initial Efficacy Evaluation of a Community-Based Cognitive-Behavioral Lifestyle Intervention to Prevent Excessive Weight Gain During Pregnancy in Latina Women
Feasibility and Initial Efficacy Evaluation of a Community-Based Cognitive-Behavioral Lifestyle Intervention to Prevent Excessive Weight Gain During Pregnancy in Latina Women
Sabina B. Gesell 0 1 2 3 4
Jeffrey A. Katula 0 1 2 3 4
Carmen Strickland 0 1 2 3 4
Mara Z. Vitolins 0 1 2 3 4
0 J. A. Katula Department of Health and Exercise Science, Wake Forest University , Winston-Salem, NC , USA
1 S. B. Gesell The Maya Angelou Center for Health Equity, Wake Forest School of Medicine , Winston-Salem, NC , USA
2 S. B. Gesell (&) Division of Public Health Sciences, Department of Social Sciences and Health Policy, Medical Center Boulevard, Wake Forest School of Medicine , Winston-Salem, NC 27157 , USA
3 M. Z. Vitolins Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine , Winston-Salem, NC , USA
4 C. Strickland Family and Community Medicine, Wake Forest School of Medicine , Winston-Salem, NC , USA
About 48 % of US women gain more weight during pregnancy than recommended by the Institute of Medicine (IOM). Excessive gestational weight gain is a major risk factor for obesity in both women and offspring over their lifetimes, and should be avoided. This study was designed to test the feasibility and initial efficacy of a prenatal behavioral intervention in a sample of low-income, predominantly Latina women. The intervention was delivered in groups of 8-10 women in a community recreation center, and structured to reduce the proportion of women who gained weight in excess of IOM guidelines. Recruitment ClinicalTrials.gov Identifier: NCT01279109.
Pregnancy; Gestational weight gain; Maternal health; Obesity; Hispanic Americans
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The Centers for Disease control and prevention (CDC)
estimates that 48 % of United States (US) women gain
more weight during pregnancy than recommended by the
Institute of Medicine (IOM) [1]. The IOM recommends
that underweight women (BMI \ 18.5) gain 2840 lb,
normal-weight women (BMI = 18.524.9) gain 2535 lb,
overweight women (BMI = 25.029.9) gain 1525 lb, and
obese women (BMI [ 30) gain 1120 lb during
pregnancy. Excessive gestational weight gain (GWG) is a major
risk factor for postpartum weight retention, which
contributes to new and persistent maternal obesity [25] and
perpetuates a cycle of maternal-infant health complications
with each subsequent pregnancy. Excessive GWG is
independently associated with neonatal adiposity [6] and
greater body mass index (BMI) in childhood, adolescence,
and early adulthood [710], although the intra-uterine
mechanisms involved are still unclear [11].
In its 2009 report, the IOM focused on the need for
effective, sustainable GWG interventions [2]. To date, such
interventions are typically clinic-based and have had mixed
success [12]. The most recent meta-analysis of
interventions on GWG found a 1.42 kg reduction (95 % confidence
interval 0.95 to 1.89 kg, p \ 0.001) in GWG interventions
versus controls [13], with no significant difference between
intervention and control groups in adherence to IOM
recommendations. Correspondingly, there are scant
evidencebased recommendations for clinical practice in antenatal
care [14], and there remains an urgent need for effective,
sustainable interventions focused on healthy GWG.
Hispanic and AfricanAmerican women are at increased
risk of entering into pregnancy overweight [15] and
gaining additional weight during their childbearing years, both
during and following pregnancies [4, 16, 17]. Hispanic
women also have increased fertility rates [18]. However,
GWG interventions have focused on non-Hispanic White
women, a situation that the IOM found especially
noteworthy [19]. Variations in intervention dose, timing and
method of delivery, quality of study designs [20], and
effects within subgroups of women (based on BMI, age,
ethnicity, parity, underlying medical conditions, and
socioeconomic status) [21] complicate evaluation of previous
GWG interventions.
This study was designed to evaluate feasibility and
initial efficacy of a 12-week GWG intervention among
low-income minority women. We hypothesized that
women who received the intervention would be less likely
to exceed IOM pregnancy weight gain recommendations
than a usual-care control group. Because understanding
how successful interventions achieve outcomes is an
importantyet generally underreportedaspect of designing
more effective programs [22], we also provide
programmatic details about the program.
This project (called Madre Sana, Bebe Sano/Healthy
Mother, Healthy Baby) was conducted in collaboration
with Nashville Parks and Recreation. The study was
approved by an Institutional Review Board and registered at
ClinicalTrials.gov. Recruitment occurred between January
and April 2011. Participants provided written consent in
their language of choice (Spanish or English).
Our goal was to recruit 100 women. We developed referral
systems with community and hospital clinics with
Spanishspeaking obstetricians. Women (...truncated)