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Research Project: Improving Nutrition and Physical Activity Related Health Behaviors in Children and Their Environment

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Title: Maternal weight in the postpartum: results from the Delta Healthy Sprouts trial

Author
item Tussing-humphreys, Lisa - University Of Illinois
item Thomson, Jessica
item Hemphill, Nefertiti Oji N - University Of Illinois
item Goodman, Melissa
item Landry, Alicia - University Of Central Arkansas

Submitted to: Maternal Health, Neonatology, and Perinatology
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/23/2017
Publication Date: 12/4/2017
Citation: Tussing-Humphreys, L.M., Thomson, J.L., Hemphill, N.I., Goodman, M.H., Landry, A.S. 2017. Maternal weight in the postpartum: results from the Delta Healthy Sprouts trial. Maternal Health, Neonatology, and Perinatology. 3:20. https://doi.org/10.1186/s40748-017-0058-9.

Interpretive Summary: Pregnancy is a time when a woman intentionally gains weight to support her developing fetus as well as the pregnancy related adaptations occurring in her body. However, 48% of women in the United States gain an excessive amount of weight. This is troubling because excessive gestational weight gain is a risk factor for excessive postnatal weight retention, obesity, and obesity related chronic diseases such as type 2 diabetes. The goal of this study was to determine if women enrolled in a lifestyle enhanced maternal, infant and early childhood home visiting (MIECHV) program had more favorable weight outcomes through 12 months postpartum compared to women randomized to the standard MIECHV program. From September 2013 to May 2016, 54 postpartum women residing in the three rural counties in Mississippi were followed for 12 months. The experimental treatment of the intervention built upon the Parents as Teachers curriculum (control treatment) by adding culturally tailored, maternal weight management and early childhood obesity prevention components. Participants’ body weight was measured at each monthly visit in both the gestational and postnatal periods. Postnatal retention rates were 83% (25/30) and 88% (21/24) for control and experimental groups, respectively. Postnatal weight losses (computed from body weight at the first postnatal visit) were small for both groups – approximately 1 kg at the end of the intervention. Postnatal weight retention (computed from pre-pregnancy body weight) were approximately 4 kg for both groups. The lifestyle enhanced intervention was not associated with more favorable postpartum weight outcomes when compared to the standard MIECHV program in this cohort of African American women. Future studies targeting similar postpartum women should consider designing behavioral lifestyle interventions with a greater emphasis on increasing physical activity, inclusion of simple dietary messages to accommodate women with lower levels of health literacy, and increased frequency of contact with participants.

Technical Abstract: Objective: The primary objective was to determine if women enrolled in a lifestyle enhanced maternal, infant, and early childhood home visiting (MIECHV) program had more favorable weight outcomes through 12 months postpartum compared to women randomized to a standard MIECHV program. Design: Delta Healthy Sprouts was a two-arm, randomized, controlled, comparative impact trial. Participants/setting: Pregnant women at least 18 years of age, less than 19 weeks pregnant with a singleton pregnancy, and residing in three Mississippi counties were recruited between March 2013 and December 2014. Postnatal data was collected between September 2013 and May 2016. Intervention: The intervention was delivered in the participants’ homes by trained parent educators on a monthly basis. The control arm (PAT) received the Parents as Teachers curriculum while the experimental arm (PATE) received a lifestyle enhanced Parents as Teachers curriculum. Main outcome measures: Pre-pregnancy body weight was obtained via self-report. Maternal body weight was measured at baseline (gestational month 4) and at every subsequent monthly visit in the gestational and postnatal periods. Data pertaining to diet, breastfeeding, and physical activity also were obtained. Statistical analysis performed: Linear mixed models, using maximum likelihood estimation, were used to test for significant treatment, time, and treatment by time effects on postnatal weight outcomes. Results: Mean postnatal weight losses were 0.8 and 1.1 kg at postnatal month (PM) 6 and PM 12, respectively, for PAT participants. Mean weight losses for PATE participants were 1.5 and 1.2 kg at PM 6 and PM 12, respectively. Mean weight retention, based on pre-pregnancy weight, were 5.2, 4.0, and 3.6 kg at PM 1, PM 6, and PM 12, respectively, for PAT participants. Mean weight retention for PATE participants were 6.3, 4.5, and 4.0 kg at PM 1, PM 6, and PM 12, respectively. Significant effects were not found for treatment, time, or treatment by time. Conclusions: A lifestyle-enhanced MIECHV intervention was not associated with more favorable postpartum weight outcomes when compared to a standard MIECHV program in a cohort of postpartum women residing in rural Mississippi during the 12 months following the birth of their infant.