Weight Management in Obese Pregnant Underserved African American Women
Weight Management in Obese Pregnant Underserved African American Women
This project will test a novel lifestyle intervention to help overweight and obese
 socioeconomically disadvantaged African American women achieve healthy weight control during
 and after pregnancy and improve the health of their offspring. The treatment will be given
 through an existing national home visiting program, Parents As Teachers (PAT), which will
 facilitate sustainability and nationwide dissemination, if effective. We hypothesize that
 compared with standard PAT monitoring and counseling (PAT), women randomized to the lifestyle
 intervention program (PAT+) will have a lower percentage who exceed Institute of Medicine
 recommendations for gestational weight gain.
Maternal overweight/obesity and inappropriate gestational weight gain increase both maternal
 and neonatal morbidity and mortality. In addition, offspring of overweight/obese women are at
 increased risk for neurodevelopmental delay, becoming obese, and developing metabolic
 diseases. Women who are socioeconomically disadvantaged (SED), especially from African
 American populations, are particularly susceptible to adverse pregnancy-related outcomes
 because of their high prevalence rates of obesity. Therefore, successful weight management
 during pregnancy in SED, African American women has considerable public health implications.
 We have experience in testing lifestyle interventions among SED nonpregnant women that have
 been implemented and sustained within community organizations such as Parents As Teachers
 (PAT), a national home visiting program that provides parent-child education and services
 free-of-charge to high-needs women, prenatally and post-partum, with up to 25 home visits per
 year until kindergarten. We propose to conduct a 24-month (6-month prenatal and 18-month
 post-partum) randomized, controlled trial in overweight and obese SED African American women
 to evaluate the ability of an innovative lifestyle intervention program (PAT+), delivered by
 PAT parent educators during prenatal and post-partum home visits, to improve maternal and
 neonatal/infant weight, metabolic and health outcomes, relative to the standard PAT program
 (PAT). A programmatic evaluation will determine the applicability of the PAT+ intervention in
 real world settings by measuring programmatic reach, implementation, acceptability, and
 sustainability. If effective, PAT+ can be disseminated through this national organization,
 which currently reaches over 249,000 mothers and 319,000 children participating in 2,173 PAT
 programs across all 50 states.
Inclusion Criteria:

 -  Pregnant, African American, Socioeconomically disadvantaged

 -  Established prenatal care at our clinic before 15-6/7 weeks gestation

 -  Singleton viable pregnancy

 -  Gestational age 9 to 15 weeks

 -  Body Mass Index (BMI) of 25-45 kg/m²

 Exclusion Criteria:

 -  Diagnosis of diabetes prior to pregnancy, or test results suggestive of pre-pregnancy
 diabetes

 -  Current use of certain medications

 -  Contraindications to aerobic exercise in pregnancy

 -  History of contraindicated medical conditions