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Adaptive, behavioral intervention impact on weight gain, physical activity, energy intake, and motivational determinants: results of a feasibility trial in pregnant women with overweight/obesity

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Abstract

Interventions have modest impact on reducing excessive gestational weight gain (GWG) in pregnant women with overweight/obesity. This two-arm feasibility randomized control trial tested delivery of and compliance with an intervention using adapted dosages to regulate GWG, and examined pre-post change in GWG and secondary outcomes (physical activity: PA, energy intake: EI, theories of planned behavior/self-regulation constructs) compared to a usual care group. Pregnant women with overweight/obesity (N = 31) were randomized to a usual care control group or usual care + intervention group from 8 to 2 weeks gestation and completed the intervention through 36 weeks gestation. Intervention women received weekly evidence-based education/counseling (e.g., GWG, PA, EI) delivered by a registered dietitian in a 60-min face-to-face session. GWG was monitored weekly; women within weight goals continued with education while women exceeding goals received more intensive dosages (e.g., additional hands-on EI/PA sessions). All participants used mHealth tools to complete daily measures of weight (Wi-Fi scale) and PA (activity monitor), weekly evaluation of diet quality (MyFitnessPal app), and weekly/monthly online surveys of motivational determinants/self-regulation. Daily EI was estimated with a validated back-calculation method as a function of maternal weight, PA, and resting metabolic rate. Sixty-five percent of eligible women were randomized; study completion was 87%; 10% partially completed the study and drop-out was 3%. Compliance with using the mHealth tools for intensive data collection ranged from 77 to 97%; intervention women attended > 90% education/counseling sessions, and 68–93% dosage step-up sessions. The intervention group (6.9 kg) had 21% lower GWG than controls (8.8 kg) although this difference was not significant. Exploratory analyses also showed the intervention group had significantly lower EI kcals at post-intervention than controls. A theoretical, adaptive intervention with varied dosages to regulate GWG is feasible to deliver to pregnant women with overweight/obesity.

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Acknowledgements

We would like to acknowledge the assistance of the Healthy Mom Zone team who assisted with participant recruitment and data collection for this study. The project described was supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health through grant 1 R01 HL119245-01 and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1 TR000127 and TR002014. The content is solely responsibility of the authors and does not necessarily represent the official views of the NIH.

Funding

The project described was supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health through grant 1 R01 HL119245-01 and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1 TR000127 and TR002014.

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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Dr. DSD, Dr. JSS, Dr. DER, Dr. AMP, Dr. KSL, Dr. EH, Dr. PG, CS, and AK. The first draft of the manuscript was written by Dr. DSD and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Danielle Symons Downs.

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Downs, D.S., Savage, J.S., Rivera, D.E. et al. Adaptive, behavioral intervention impact on weight gain, physical activity, energy intake, and motivational determinants: results of a feasibility trial in pregnant women with overweight/obesity. J Behav Med 44, 605–621 (2021). https://doi.org/10.1007/s10865-021-00227-9

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