Feasibility and Initial Efficacy Evaluation of a Community-Based Cognitive-Behavioral Lifestyle Intervention to Prevent Excessive Weight Gain During Pregnancy in Latina Women

Maternal and Child Health Journal, Feb 2015

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 targets were met in 3 months: 135 pregnant women (>10 and <28 weeks) were randomly assigned to receive a 12-week intervention (n = 68) or usual care (n = 67). Retention rate was 81 %. On average, women attended 4 of 12 group sessions, and each session had 4 of the 8–10 assigned participants in attendance. Initial efficacy analyses were based on 87 women. Compared to usual care, fewer normal-weight women in the intervention exceeded IOM recommendations (47.1 % usual care vs. 6.7 % intervention; absolute difference 40.4 %; p = .036). Recommendations for recruitment, retention, and delivery are discussed. A community-based cognitive-behavioral lifestyle intervention during pregnancy was feasible in a hard-to-reach, high-risk population of low-income Latina women, and showed efficacy in preventing excessive gestational weight gain. Due to frequently changing work schedules, strategies are needed to either increase attendance at group sessions (e.g., within a group prenatal care format) or to build core skills necessary for behavior change through other modalities.

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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 - 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)


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Sabina B. Gesell, Jeffrey A. Katula, Carmen Strickland, Mara Z. Vitolins. Feasibility and Initial Efficacy Evaluation of a Community-Based Cognitive-Behavioral Lifestyle Intervention to Prevent Excessive Weight Gain During Pregnancy in Latina Women, Maternal and Child Health Journal, 2015, pp. 1842-1852, Volume 19, Issue 8, DOI: 10.1007/s10995-015-1698-x