Dietary Approaches to Stop Hypertension Diet and Activity to Limit Gestational Weight

Maternal Offspring Metabolics Family Intervention Trial, a Technology Enhanced Randomized Trial

Linda Van Horn*, Alan M Peaceman, Mary Jeanne Kwasny, Eileen Vincent, Angela Fought, Jami L Josefson, Bonnie Spring, Lisa M Neff, Niki Gernhofer

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction: Technology-enhanced antenatal diet and lifestyle intervention could prevent excess gestational weight gain and benefit mother and child. Study design: A randomized clinical trial. Setting/participants: Overweight and obese ethnically diverse pregnant women in Chicago, Illinois, were enrolled between October 2012 and December 2015, with antenatal data collection completed by July 2016. Analysis was completed June 2017. Intervention: Participants were randomized when their fetus was gestational age 16 weeks to dietitian-led Dietary Approaches to Stop Hypertension diet and physical activity coaching that was received as three individual and six group counseling sessions by phone and webinar. A commercially available smartphone application was used for self-monitoring diet and physical activity. Telephone, text message prompts, and e-mail reminders encouraged adherence and website viewing. Usual-care, “web-watcher” participants were e-mailed biweekly newsletters and publicly available maternity website links. Main outcome measures: The primary outcome was gestational weight gain measured at baseline, 24 weeks, and 35.0–36.6 weeks. Secondary outcomes included weekly rate of gestational weight gain, newborn anthropometrics, maternal diet quality, physical activity, and blood pressure. Results: Among 281 participants randomized (n=140 in intervention, n=141 in usual care, BMI 25 to <40, and age range 18–40 years), 37% were non-white and 274 completed antenatal data collection (n=139 in the intervention group and n=135 in the usual-care group). Gestational weight gain differed significantly by intervention group (difference, 1.7 kg, p=0.01) and rate of weight gain was 0.4 (SD=0.2) vs 0.5 (SD=0.2) kg/week. No significant differences were noted in birth weight, percentage body fat, or adverse pregnancy outcomes, but more cesarean sections (55 [40%] vs 37 [27%]) occurred among the intervention group. Conclusions: Technology-enhanced Dietary Approaches to Stop Hypertension diet and lifestyle intervention resulted in significantly less total gestational weight gain over 35 weeks with no adverse infant outcomes. Nutrient quality improved without an adverse impact on rate of prematurity. Increased cesarean delivery requires further exploration. The National Academy of Medicine goals were not achieved by the majority of participants. Obesity prevention preconception is needed. Trial registration: This study is registered at www.clinicaltrials.gov NCT01631747.

Original languageEnglish (US)
Pages (from-to)603-614
Number of pages12
JournalAmerican Journal of Preventive Medicine
Volume55
Issue number5
DOIs
StatePublished - Nov 1 2018

Fingerprint

Surrogate Mothers
Weight Gain
Diet
Hypertension
Technology
Weights and Measures
Exercise
Life Style
Mothers
Text Messaging
Nutritionists
Postal Service
Pregnancy Outcome
Telephone
Birth Weight
Cesarean Section
Gestational Age
Adipose Tissue
Counseling
Pregnant Women

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health

Cite this

@article{a9d79528f9a740e0b895b00723b4d438,
title = "Dietary Approaches to Stop Hypertension Diet and Activity to Limit Gestational Weight: Maternal Offspring Metabolics Family Intervention Trial, a Technology Enhanced Randomized Trial",
abstract = "Introduction: Technology-enhanced antenatal diet and lifestyle intervention could prevent excess gestational weight gain and benefit mother and child. Study design: A randomized clinical trial. Setting/participants: Overweight and obese ethnically diverse pregnant women in Chicago, Illinois, were enrolled between October 2012 and December 2015, with antenatal data collection completed by July 2016. Analysis was completed June 2017. Intervention: Participants were randomized when their fetus was gestational age 16 weeks to dietitian-led Dietary Approaches to Stop Hypertension diet and physical activity coaching that was received as three individual and six group counseling sessions by phone and webinar. A commercially available smartphone application was used for self-monitoring diet and physical activity. Telephone, text message prompts, and e-mail reminders encouraged adherence and website viewing. Usual-care, “web-watcher” participants were e-mailed biweekly newsletters and publicly available maternity website links. Main outcome measures: The primary outcome was gestational weight gain measured at baseline, 24 weeks, and 35.0–36.6 weeks. Secondary outcomes included weekly rate of gestational weight gain, newborn anthropometrics, maternal diet quality, physical activity, and blood pressure. Results: Among 281 participants randomized (n=140 in intervention, n=141 in usual care, BMI 25 to <40, and age range 18–40 years), 37{\%} were non-white and 274 completed antenatal data collection (n=139 in the intervention group and n=135 in the usual-care group). Gestational weight gain differed significantly by intervention group (difference, 1.7 kg, p=0.01) and rate of weight gain was 0.4 (SD=0.2) vs 0.5 (SD=0.2) kg/week. No significant differences were noted in birth weight, percentage body fat, or adverse pregnancy outcomes, but more cesarean sections (55 [40{\%}] vs 37 [27{\%}]) occurred among the intervention group. Conclusions: Technology-enhanced Dietary Approaches to Stop Hypertension diet and lifestyle intervention resulted in significantly less total gestational weight gain over 35 weeks with no adverse infant outcomes. Nutrient quality improved without an adverse impact on rate of prematurity. Increased cesarean delivery requires further exploration. The National Academy of Medicine goals were not achieved by the majority of participants. Obesity prevention preconception is needed. Trial registration: This study is registered at www.clinicaltrials.gov NCT01631747.",
author = "{Van Horn}, Linda and Peaceman, {Alan M} and Kwasny, {Mary Jeanne} and Eileen Vincent and Angela Fought and Josefson, {Jami L} and Bonnie Spring and Neff, {Lisa M} and Niki Gernhofer",
year = "2018",
month = "11",
day = "1",
doi = "10.1016/j.amepre.2018.06.015",
language = "English (US)",
volume = "55",
pages = "603--614",
journal = "American Journal of Preventive Medicine",
issn = "0749-3797",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Dietary Approaches to Stop Hypertension Diet and Activity to Limit Gestational Weight

T2 - Maternal Offspring Metabolics Family Intervention Trial, a Technology Enhanced Randomized Trial

AU - Van Horn, Linda

AU - Peaceman, Alan M

AU - Kwasny, Mary Jeanne

AU - Vincent, Eileen

AU - Fought, Angela

AU - Josefson, Jami L

AU - Spring, Bonnie

AU - Neff, Lisa M

AU - Gernhofer, Niki

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Introduction: Technology-enhanced antenatal diet and lifestyle intervention could prevent excess gestational weight gain and benefit mother and child. Study design: A randomized clinical trial. Setting/participants: Overweight and obese ethnically diverse pregnant women in Chicago, Illinois, were enrolled between October 2012 and December 2015, with antenatal data collection completed by July 2016. Analysis was completed June 2017. Intervention: Participants were randomized when their fetus was gestational age 16 weeks to dietitian-led Dietary Approaches to Stop Hypertension diet and physical activity coaching that was received as three individual and six group counseling sessions by phone and webinar. A commercially available smartphone application was used for self-monitoring diet and physical activity. Telephone, text message prompts, and e-mail reminders encouraged adherence and website viewing. Usual-care, “web-watcher” participants were e-mailed biweekly newsletters and publicly available maternity website links. Main outcome measures: The primary outcome was gestational weight gain measured at baseline, 24 weeks, and 35.0–36.6 weeks. Secondary outcomes included weekly rate of gestational weight gain, newborn anthropometrics, maternal diet quality, physical activity, and blood pressure. Results: Among 281 participants randomized (n=140 in intervention, n=141 in usual care, BMI 25 to <40, and age range 18–40 years), 37% were non-white and 274 completed antenatal data collection (n=139 in the intervention group and n=135 in the usual-care group). Gestational weight gain differed significantly by intervention group (difference, 1.7 kg, p=0.01) and rate of weight gain was 0.4 (SD=0.2) vs 0.5 (SD=0.2) kg/week. No significant differences were noted in birth weight, percentage body fat, or adverse pregnancy outcomes, but more cesarean sections (55 [40%] vs 37 [27%]) occurred among the intervention group. Conclusions: Technology-enhanced Dietary Approaches to Stop Hypertension diet and lifestyle intervention resulted in significantly less total gestational weight gain over 35 weeks with no adverse infant outcomes. Nutrient quality improved without an adverse impact on rate of prematurity. Increased cesarean delivery requires further exploration. The National Academy of Medicine goals were not achieved by the majority of participants. Obesity prevention preconception is needed. Trial registration: This study is registered at www.clinicaltrials.gov NCT01631747.

AB - Introduction: Technology-enhanced antenatal diet and lifestyle intervention could prevent excess gestational weight gain and benefit mother and child. Study design: A randomized clinical trial. Setting/participants: Overweight and obese ethnically diverse pregnant women in Chicago, Illinois, were enrolled between October 2012 and December 2015, with antenatal data collection completed by July 2016. Analysis was completed June 2017. Intervention: Participants were randomized when their fetus was gestational age 16 weeks to dietitian-led Dietary Approaches to Stop Hypertension diet and physical activity coaching that was received as three individual and six group counseling sessions by phone and webinar. A commercially available smartphone application was used for self-monitoring diet and physical activity. Telephone, text message prompts, and e-mail reminders encouraged adherence and website viewing. Usual-care, “web-watcher” participants were e-mailed biweekly newsletters and publicly available maternity website links. Main outcome measures: The primary outcome was gestational weight gain measured at baseline, 24 weeks, and 35.0–36.6 weeks. Secondary outcomes included weekly rate of gestational weight gain, newborn anthropometrics, maternal diet quality, physical activity, and blood pressure. Results: Among 281 participants randomized (n=140 in intervention, n=141 in usual care, BMI 25 to <40, and age range 18–40 years), 37% were non-white and 274 completed antenatal data collection (n=139 in the intervention group and n=135 in the usual-care group). Gestational weight gain differed significantly by intervention group (difference, 1.7 kg, p=0.01) and rate of weight gain was 0.4 (SD=0.2) vs 0.5 (SD=0.2) kg/week. No significant differences were noted in birth weight, percentage body fat, or adverse pregnancy outcomes, but more cesarean sections (55 [40%] vs 37 [27%]) occurred among the intervention group. Conclusions: Technology-enhanced Dietary Approaches to Stop Hypertension diet and lifestyle intervention resulted in significantly less total gestational weight gain over 35 weeks with no adverse infant outcomes. Nutrient quality improved without an adverse impact on rate of prematurity. Increased cesarean delivery requires further exploration. The National Academy of Medicine goals were not achieved by the majority of participants. Obesity prevention preconception is needed. Trial registration: This study is registered at www.clinicaltrials.gov NCT01631747.

UR - http://www.scopus.com/inward/record.url?scp=85055076181&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055076181&partnerID=8YFLogxK

U2 - 10.1016/j.amepre.2018.06.015

DO - 10.1016/j.amepre.2018.06.015

M3 - Article

VL - 55

SP - 603

EP - 614

JO - American Journal of Preventive Medicine

JF - American Journal of Preventive Medicine

SN - 0749-3797

IS - 5

ER -