The growing trend in the U.S. is for pregnant women, especially those who are overweight or obese, to gain more weight than recommended by the Institute of Medicine (IOM) guidelines. Also, concerning are our data showing that pregnant low-income Latinas consume far less fruit and vegetables than the Dietary Guidelines recommendations. Dietary interventions to prevent excessive gestational weight gain have been inconsistent, with few conducted among multiethnic samples and none among only Latinas. Given the constant success of fruit and vegetable (F&V) interventions to decrease energy density and promote weight loss and weight management among non-pregnant women, this feasibility study aims to gather data that will inform the design of a community-based intervention promoting appropriate gestational weight gain through increased F&V consumption among overweight and obese, pregnant, low-income Latinas. The study aims are to: 1) determine the acceptability of different community-based interventions to improve F&V intake (i.e. community health worker model;group support model;clinic-based community outreach model);2) identify expected changes in behavior, self-efficacy, coping mechanisms, and outcomes across the accepted interventions scenarios identified in aim 1;3) identify perceived barriers and perceived benefits towards the success of a F&V intervention;4) assess the acceptability and preferences of a variety of raw and prepared F&Vs among overweight and obese pregnant Latinas;and 5) calculate usual dietary energy density (from food only) and mathematically determine the extent to which specific fruit and/or vegetable intake substitutions improve (i.e. decrease) dietary energy density. To fulfill aim 1, five focus groups (1 with Hispani Health Council Comadrona staff, 4 with pregnant overweight/obese Latinas) will be held to determine the acceptability of different community-based interventions to improve F&V intake. One hundred maternal in-depth interviews will be conducted with overweight/obese pregnant Latinas to fulfill aims 2 and 3. The 4th aim will be achieved by conducting two taste testings to determine F&V preferences and preparation. Computer simulations using data from 24 hour recalls (collected from the same 100 women that conducted the in-depth interview) will achieve aim 5. All interviews and focus groups will be audiotaped, transcribed, translated (as needed) and analyzed using standard qualitative methods. In addition to informing the development of an intervention to promote F&V consumption and subsequently prevent excessive gestational weight gain, study results will also inform health care and WIC providers about cultural F&V practices, preferences, and perspectives to help improve nutrition counseling among low-income overweight/obese pregnant Latinas.
The majority of overweight and obese pregnant low-income Latinas in Hartford, CT gain excessive gestational weight and consume lower than recommended fruits and vegetable servings during pregnancy, clearly showing that two evidence-based guidelines, the 2009 Institute of Medicine weight gain recommendations and the 2010 Dietary Guidelines for Americans, are not being met. Since fruit and vegetable interventions focusing on decreasing energy density are most consistent with weight gain loss and maintenance among non-pregnant women, this feasibility study seeks to gather data that will inform the design of a community-based fruit and vegetable intervention proposal to promote appropriate gestational weight gain through increased fruit and vegetable consumption among overweight and obese, pregnant, low-income Latinas. This proposal is timely as it will help define the best methods for dissemination of these relatively new guidelines to overweight and obese pregnant low-income Latinas to help improve health outcomes among this at-risk population.
|Hromi-Fiedler, Amber; Chapman, Donna; Segura-Pérez, Sofia et al. (2016) Barriers and Facilitators to Improve Fruit and Vegetable Intake Among WIC-Eligible Pregnant Latinas: An Application of the Health Action Process Approach Framework. J Nutr Educ Behav 48:468-477.e1|