A randomized controlled trial is proposed to study the effect, in a cohort of racially and ethnically diverse group of overweight and obese pregnant women, of an Intensive Lifestyle Intervention (ILI) compared to Usual Care (UC) on gestational weight gain (GWG), infant fatness, and mothers' post-delivery weight retention. Women in the ILI arm will receive intensive counseling during pregnancy and group counseling after delivery regarding behavior, nutrition, and physical activity change. Visits to counselors will be weekly and additional telephone and internet contacts will occur. The mothers' will be assessed at 14 and 36 weeks of pregnancy and at 12 weeks and 52 weeks post-delivery. The measurements will be anthropometry, whole body MRI, EchoMRI, and whole body plethysmography (BodPod). The infants' measurements will be anthropometry, whole body MRI, EchoMRI, and whole body plethysmography (PeaPod) for fatness 12 weeks and 52 weeks. Mothers and children will have cardio-metabolic risk factors measured in plasma. Data will be collected regarding mothers' dietary intake and physical activity (questionnaires and accelerometry) to assist in counseling. Other data to be collected include questionnaires on quality of life, socio-economic status. Careful record will be kept of expenses in providing the ILI, so that cost analysis of the intervention can be calculated. The study is powered on the primary outcome, fatness of the infants at birth. We require 180 participants to attain appropriate power. We will enroll 210 so as to allow for some dropouts along the way. Each mother will be followed during pregnancy and for a year post delivery. Each infant will be followed for a year after birth. We have the ability o continue to follow these participants if further funding is forthcoming, as they are all local to or hospital's catchment area and our own physicians.
If aims are achieved, namely that both children and mothers profit from the intervention, there should be a paradigm shift in how overweight pregnant women are treated. At present, there is a dearth of behavioral advice and intervention relating to GWG and physical activity provided to these women. Positive results from our study would provide evidence for ILI preventative intervention.

Public Health Relevance

The prevalence of overweight and obesity in reproductive age US women is extremely high. These women when pregnant tend to gain higher than the recommended GWG, produce disproportionally fat babies, and retain much of the GWG post-partum. It is unknown whether maintaining GWG within the new lOM guidelines will produce leaner babies who have less risk of becoming obese adults, and will lead to less retention of GWG in women. A trial demonstrating these outcomes could lead to public health recommendations.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project--Cooperative Agreements (U01)
Project #
3U01DK094463-05S1
Application #
9330401
Study Section
Special Emphasis Panel (ZDK1-GRB-N (O1)S)
Program Officer
Evans, Mary
Project Start
2011-09-19
Project End
2017-02-28
Budget Start
2016-03-01
Budget End
2017-02-28
Support Year
5
Fiscal Year
2016
Total Cost
$199,816
Indirect Cost
$45,399
Name
Columbia University (N.Y.)
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
621889815
City
New York
State
NY
Country
United States
Zip Code
10032
Abraham, Manjusha; Collins, Christina A; Flewelling, Scott et al. (2018) Mitochondrial inefficiency in infants born to overweight African-American mothers. Int J Obes (Lond) 42:1306-1316
Gallagher, Dympna; Rosenn, Barak; Toro-Ramos, Tatiana et al. (2018) Greater Neonatal Fat-Free Mass and Similar Fat Mass Following a Randomized Trial to Control Excess Gestational Weight Gain. Obesity (Silver Spring) 26:578-587
Lewkowitz, Adam K; López, Julia D; Stein, Richard I et al. (2018) Effect of a Home-Based Lifestyle Intervention on Breastfeeding Initiation Among Socioeconomically Disadvantaged African American Women with Overweight or Obesity. Breastfeed Med 13:418-425
Sutton, Elizabeth F; Morrison, Christopher D; Stephens, Jacqueline M et al. (2018) Fibroblast growth factor 21, adiposity, and macronutrient balance in a healthy, pregnant population with overweight and obesity. Endocr Res 43:275-283
Peaceman, Alan M; Clifton, Rebecca G; Phelan, Suzanne et al. (2018) Lifestyle Interventions Limit Gestational Weight Gain in Women with Overweight or Obesity: LIFE-Moms Prospective Meta-Analysis. Obesity (Silver Spring) 26:1396-1404
Toro-Ramos, Tatiana; Paley, Charles; Wong, William W et al. (2017) Reliability of the EchoMRI Infants System for Water and Fat Measurements in Newborns. Obesity (Silver Spring) 25:1577-1583
Sutton, Elizabeth F; Cain, Loren E; Vallo, Porsha M et al. (2017) Strategies for Successful Recruitment of Pregnant Patients Into Clinical Trials. Obstet Gynecol 129:554-559
Redman, Leanne M; Gilmore, L Anne; Breaux, Jeffrey et al. (2017) Effectiveness of SmartMoms, a Novel eHealth Intervention for Management of Gestational Weight Gain: Randomized Controlled Pilot Trial. JMIR Mhealth Uhealth 5:e133
Clifton, Rebecca G; Evans, Mary; Cahill, Alison G et al. (2016) Design of lifestyle intervention trials to prevent excessive gestational weight gain in women with overweight or obesity. Obesity (Silver Spring) 24:305-13
Torres, Roxana; Soltero, Sandra; Trak, Maria Angelica et al. (2016) Lifestyle modification intervention for overweight and obese Hispanic pregnant women: development, implementation, lessons learned and future applications. Contemp Clin Trials Commun 3:111-116

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