Excessive weight gain during pregnancy, particularly in overweight and obese women, predisposes to adverse perinatal outcomes and has long term effects on maternal and neonatal health. With an inverse relationship between socioeconomic status and obesity, significant health disparities exist between obese and normal weight women. The Institute of Medicine (lOM) recently revised its gestational weight gain recommendations, targeted to pregravid body mass index (BMI), to minimize pregnancy complications. However, these recommendations are based on cross sectional observational studies and neither the ideal method to achieve weight gain goals nor whether perinatal outcome is optimized with active management of weight gain is known. We propose to investigate a behavioral incentive-based intervention to improve compliance with lOM weight gain recommendations during pregnancy in low-income overweight and obese women. We will evaluate if 1) gestational weight gain can be reliably targeted to the lOM recommendations and 2) active weight gain management during pregnancy improves perinatal outcomes. Two study groups will be compared in a prospective randomized trial;1) those receiving standard obstetrical care and 2) those receiving behavioral weight management counseling plus financial incentives for achieving weight gain goals. The main outcome measure will be the percentage of women gaining within the lOM recommendations based on prepregnancy BMI. Secondary outcomes evaluated will include fetal growth and body composition changes, birth weight and the rate of cesarean delivery. We hypothesize that 1) the behavioral intervention with incentives will result in greater compliance to lOM guidelines for gestational weight gain than standard care and 2) targeting weight gain to the lOM guidelines will lead to a reduction in the rates of fetal macrosomia and cesarean delivery. Finally, cost effectiveness of treatment conditions will be examined. This intervention, if efficacious and cost-effective, has the potential to improve compliance with gestational weight gain guidelines, optimize perinatal outcomes, and reduce health disparities.

Public Health Relevance

Approximately two-thirds of the US population is overweight and one-third is obese, with even higher percentages in low income women. Prepregnancy obesity is associated with significant perinatal complications including increased risks of miscarriage, congenital anomalies, gestational diabetes, preeclampsia, thromboembolism, macrosomia, cesarean delivery, and stillbirth. Optimizing gestational weight gain may help to improve outcome in low income overweight and obese gravitas.

Agency
National Institute of Health (NIH)
Institute
National Institute of General Medical Sciences (NIGMS)
Type
Exploratory Grants (P20)
Project #
1P20GM103644-01A1
Application #
8464946
Study Section
Special Emphasis Panel (ZGM1-TWD-B (CB))
Project Start
Project End
Budget Start
2013-09-15
Budget End
2014-07-31
Support Year
1
Fiscal Year
2013
Total Cost
$311,268
Indirect Cost
$107,158
Name
University of Vermont & St Agric College
Department
Type
DUNS #
066811191
City
Burlington
State
VT
Country
United States
Zip Code
05405
Lopez, Alexa A; Redner, Ryan; Kurti, Allison N et al. (2018) Tobacco and nicotine delivery product use in a U.S. national sample of women of reproductive age. Prev Med 117:61-68
Higgins, Tara M; Dougherty, Anne K; Badger, Gary J et al. (2018) Comparing long-acting reversible contraception insertion rates in women with Medicaid vs. private insurance in a clinic with a two-visit protocol. Contraception 97:76-78
Dittus, Kim L; Harvey, Jean R; Bunn, Janice Y et al. (2018) Impact of a behaviorally-based weight loss intervention on parameters of insulin resistance in breast cancer survivors. BMC Cancer 18:351
Hart, Vicki; Trentham-Dietz, Amy; Berkman, Amy et al. (2018) The association between post-diagnosis health behaviors and long-term quality of life in survivors of ductal carcinoma in situ: a population-based longitudinal cohort study. Qual Life Res 27:1237-1247
Riley, Hayden; Headley, Samuel; Lindenauer, Peter K et al. (2018) Patient Perception of How Smoking Status Influences Cardiac Rehabilitation Attendance After an Acute Cardiac Hospitalization. J Cardiopulm Rehabil Prev :
Parker, Maria A; Streck, Joanna M; Bergeria, Cecilia L et al. (2018) Reduced Nicotine Content Cigarettes and Cannabis Use in Vulnerable Populations. Tob Regul Sci 4:84-91
Cohn, Amy M; Johnson, Amanda L; Fryer, Craig S et al. (2018) Marijuana use predicts onset of current little cigar use in a national sample of US young adults. Drug Alcohol Depend 190:235-241
Streck, Joanna M; Ochalek, Taylor A; Badger, Gary J et al. (2018) Interim buprenorphine treatment during delays to comprehensive treatment: Changes in psychiatric symptoms. Exp Clin Psychopharmacol 26:403-409
Taghavi, Taraneh; Arger, Christopher A; Heil, Sarah H et al. (2018) Longitudinal Influence of Pregnancy on Nicotine Metabolic Pathways. J Pharmacol Exp Ther 364:238-245
Kurti, Allison N; Redner, Ryan; Bunn, Janice Y et al. (2018) Examining the relationship between pregnancy and quitting use of tobacco products in a U.S. national sample of women of reproductive age. Prev Med 117:52-60

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