More than 45% of women exceed guidelines established by the Institute of Medicine (IOM) for gestational weight gain (GWG). Women who begin pregnancy overweight or obese are more likely to exceed the IOM guidelines than are normal weight women. Excessive (GWG) is associated with negative obstetric outcomes, increases the risk of obesity in offspring and leads to greater postpartum weight retention. Preventing excessive GWG can improve obstetric outcomes and may lead to improvements in the treatment of obesity for women. However, interventions to prevent excessive GWG have not been consistently successful, and there is a need to identify modifiable behaviors related to GWG to support the development of effective interventions to prevent excessive GWG. Loss of control over eating (LOC), or the ingestion of food coupled with a sense of being unable to control the quantity eaten, is strongly associated with weight gain and is modifiable. LOC also is related to depressive symptoms and psychosocial distress which also are associated with weight gain. Thus, the goal of the proposed study is to assess relationships among GWG, LOC and psychosocial distress. Pregnant women (N = 300) who are overweight or obese prior to pregnancy (i.e., pregravid BMI>25) will be recruited from obstetric clinics at a local women's hospital. Women will complete structured, clinical interviews including the Eating Disorder Examination (EDE) and the Structured Clinical Interview for DSM- IV diagnoses (SCID) to document LOC and depressive symptoms at the end of the first trimester of pregnancy. Measures of perceived stress, social support, calorie intake, physical activity, and other factors related to GWG also will collected in first trimester. Assessments of LOC, psychosocial distress, eating and activity will be repeated monthly by telephone between weeks 20 and 36 of pregnancy. To document postpartum weight retention, women will be interviewed again at 6 months postpartum. Weight will be assessed at each in person visit and GWG abstracted from women's medical charts at the end of pregnancy. The proposed research is an extension of previous work conducted by the investigative team, and will provide important data on modifiable mechanisms for excessive GWG. Understanding behavioral mechanisms of excessive GWG is likely to inform interventions to prevent excessive GWG and thereby improve the health of mothers and children.

Public Health Relevance

Gaining too much weight during pregnancy increases the risks of the negative pregnancy outcomes for women and children, and contributes to longer-term weight retention for women. Understanding behavioral and psychological factors that relate to excessive pregnancy weight gain can lead to improved treatments to prevent excessive gestational weight gain and thus will have important implications for the health of women and children.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Kidney, Nutrition, Obesity and Diabetes (KNOD)
Program Officer
Davis, Maurice
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University of Pittsburgh
Schools of Medicine
United States
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Kolko, Rachel P; Salk, Rachel H; Sweeny, Gina M et al. (2018) Mothers' loss of control over eating during pregnancy in relation to their infants' appetitive traits. Appetite 120:1-5
Emery, Rebecca L; Benno, Maria Tina; Salk, Rachel H et al. (2018) Healthcare provider advice on gestational weight gain: uncovering a need for more effective weight counselling. J Obstet Gynaecol :1-6
Emery, Rebecca L; Grace, Jennifer L; Kolko, Rachel P et al. (2017) Adapting the eating disorder examination for use during pregnancy: Preliminary results from a community sample of women with overweight and obesity. Int J Eat Disord 50:597-601
Kolko, Rachel P; Emery, Rebecca L; Marcus, Marsha D et al. (2017) Loss of control over eating before and during early pregnancy among community women with overweight and obesity. Int J Eat Disord 50:582-586
Slane, Jennifer D; Levine, Michele D (2015) Association of Restraint and Disinhibition to Gestational Weight Gain among Pregnant Former Smokers. Womens Health Issues 25:390-5
Marcus, Marsha D; Wildes, Jennifer E (2014) Disordered eating in obese individuals. Curr Opin Psychiatry 27:443-7
Levine, Michele D; Cheng, Yu; Cluss, Patricia A et al. (2013) Prenatal smoking cessation intervention and gestational weight gain. Womens Health Issues 23:e389-93