Exercise Psychology Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, PA, 16802, USA.
Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA, USA.
J Behav Med. 2021 Oct;44(5):605-621. doi: 10.1007/s10865-021-00227-9. Epub 2021 May 5.
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.
干预措施对减少超重/肥胖孕妇过度妊娠体重增加（GWG）仅有适度影响。这项双臂可行性随机对照试验测试了一种干预措施的提供和依从性，该干预措施使用适应性剂量来调节 GWG，并比较了常规护理组，检查了 GWG 和次要结果（体力活动：PA，能量摄入：EI，计划行为理论/自我调节结构）的前后变化。从 8 周到 2 周妊娠时，超重/肥胖孕妇（N=31）被随机分配到常规护理对照组或常规护理+干预组，并在 36 周妊娠时完成干预。干预组妇女每周接受一次由注册营养师进行的 60 分钟面对面的基于证据的教育/咨询（例如 GWG、PA、EI）。每周监测 GWG；体重目标内的女性继续接受教育，而体重超标女性则接受更密集的剂量（例如，额外的 EI/PA 现场咨询）。所有参与者都使用移动健康工具来完成每日体重（Wi-Fi 秤）和 PA（活动监测器）测量，每周饮食质量评估（MyFitnessPal 应用程序）以及动机决定因素/自我调节的每周/每月在线调查。每日 EI 通过经过验证的反向计算方法根据母亲体重、PA 和静息代谢率来估算。符合条件的女性中 65%被随机分配；研究完成率为 87%；10%部分完成研究，失访率为 3%。使用移动健康工具进行密集数据收集的依从性范围为 77%至 97%；干预组妇女参加了超过 90%的教育/咨询课程，剂量升级课程的参加率为 68%-93%。干预组（6.9kg）的 GWG 比对照组（8.8kg）低 21%，尽管这一差异没有统计学意义。探索性分析还表明，干预组在干预后 EI kcals 明显低于对照组。一种具有不同剂量的理论上适应性干预措施来调节 GWG 对超重/肥胖孕妇来说是可行的。
