The overall goal of this K23 Career Development Award is to train Dr. Michelle A. Kominiarek, MD for a career as an independent investigator who adapts and integrates evidenced based behavioral interventions for obese low-income minority pregnant women and their providers so that gestational weight gain goals can be met and perinatal outcomes ultimately improved. The literature on interventions during pregnancy for obese women lacks a solid evidence base and most interventions were delivered to non-Hispanic whites and did not involve the prenatal care provider. Dr. Kominiarek is a tenure-track Assistant Professor in the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine who has extensive clinical experience in the management of high-risk pregnancies especially related to obesity in pregnancy. Her previous research has 1) detailed the risks of obesity in pregnancy (i.e., increased cesareans, longer labors) and of excessive gestational weight gain from a large multicenter database and 2) described low-income minority women's understanding of these risks. In the proposed award, Dr. Kominiarek plans to move her research career forward with a group behavioral intervention that is adapted for low-income minority women and their providers. The University of Illinois at Chicago (UIC), a tertiary care center located on Chicago's West side, is well-suited for Dr. Kominiarek's career development and research strategy. The majority of women who receive prenatal care and deliver at UIC are low-income minority women (>80% either non-Hispanic blacks or Hispanics;>70% Medicaid recipients) and 30% are obese.
Research aim ed at reducing health disparities is central to the UIC mission. The resources in the institutional environment include the Institute for Health Research and Policy (a Center of Excellence in Eliminating Disparities), the Center for Clinical and Translational Science (numerous resources for investigators conducting patient-based clinical research) and the UIC School of Public Health. Dr. Kominiarek has developed a multidisciplinary mentorship team that is highly experienced and committed to her career goals with representation from each of these resources. The career goals include: (1) Acquire training in health disparities research so as to design culturally sensitive interventions for low-income minority women, (2) Gain expertise in qualitative analysis and focus group methodology along with quantitative analysis as it relates to intervention design, (3) Achieve expertise in group prenatal care administration, implementation, and research so as to implement an effective intervention in a group setting, (4) To apply this training and expertise to adapt, test, and pilotan evidenced-based group behavioral intervention for obese low-income minority women and their providers so that weight gain recommendations are met. The proposed research strategy can improve on prior research because of the cultural adaptations, the involvement of the prenatal care provider, and the use of a group prenatal care delivery model (Centering Pregnancy).
Two Specific Aims guide the research strategy: (1) To examine and describe providers'perspectives on the delivery of prenatal care to obese, racial/ethnic minority women, including barriers to counseling about obesity and GWG;(2) To use the knowledge gained from pregnant, obese, racial/ethnic minority women and their providers to develop and pilot a group prenatal care intervention that targets women and their providers.
Racial/ethnic minority women have the highest prevalence of obesity in the United States and obesity in pregnancy is linked to obesity in future generations. Research that will improve the morbid outcomes associated with obesity in pregnancy urgently needs to be translated into clinical practice so that the cycle of obesity and its morbidities can e broken. The prenatal period is the optimal time to intervene for weight gain as women have access to health care, an unparalleled motivation to improve health behaviors, and provider- patient interactions are frequent.