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Arnold School of Public Health

Behavioral intervention helps women reduce weight retention when offered during pregnancy and postpartum

September 13, 2022 | Erin Bluvas,

Arnold School scientists* have shown that their theory-based lifestyle intervention is effective in helping women with elevated weight reduce the amount of gestational weight gain they retain after birth. This research was a part of the Health in Pregnancy Postpartum (HIPP) Study and was published in Obesity. The study was housed in the Arnold School’s CDC-funded Prevention Research Center (PRC).

“Pregnancy and postpartum periods are critical life stages that may predispose women to develop obesity, and this is particularly true for women who are already overweight as they begin their pregnancies,” says epidemiology professor Jihong Liu, who is co-principal investigator for the HIPP study along with exercise science professor and PRC director Sara Wilcox. “Unlike the majority of interventions that focus only on the postpartum period, our approach employs lifestyle behaviors during the pregnancy and postpartum to help women achieve a healthy weight.”

Previous research has established that women who have overweight/obesity prior to pregnancy and those who experience excessive weight gain during pregnancy are less likely to return to pre-pregnancy weight than their counterparts. Further, individuals who have overweight/obesity prior to pregnancy are two to three more times likely to gain excessive weight during pregnancy.

Excessive gestational weight gain puts women at risk for maternal complications and adverse outcomes for infants, such as higher birth weight that persists into childhood, adolescence and young adulthood. Individuals with overweight/obesity are also more likely to experience additional co-morbidities, such as type 2 diabetes and cardiovascular disease, which negatively impact quality of life and mortality rates.

“Nearly three-quarters of African American women and half of non-Hispanic White women of childbearing ages in the United State have overweight or obesity prior to pregnancy, and nearly half of pregnant women exceed gestational weight gain recommendations,” Wilcox says. “With funding from the National Institutes of Health, the HIPP study has allowed us to design and test a novel intervention to help white and African American women with overweight and obesity achieve healthy weight during and after pregnancy.” 

In this randomized control trial, 219 white and African American pregnant women (ages 18-44) were assigned to either the behavioral lifestyle intervention group or the standard care control group. From early pregnancy until six months postpartum, women in the intervention group received in-depth counseling sessions, brief telephone counseling, behavioral podcasts and social media support. These components, which were guided by Social Cognitive Theory and based on the Institute of Medicine’s Gestational Weight Gain Guidelines, focused on healthier dietary practices, increased physical activity and weight self-monitoring.

Blinded research staff collected data on participants’ weight at multiple intervals (i.e., pre-pregnancy, delivery room, six months postpartum, 12 months postpartum). After analyses, the researchers found that the combined pregnancy and postpartum behavioral lifestyle intervention used in the HIPP study was effective at reducing postpartum weight retention.

The success of the intervention was greater than the average effect of previous trials that conducted an intervention solely during pregnancy as well as trials that intervened during both pregnancy and postpartum periods. Further, the intervention resulted in an increased percentage of women who returned to pre-pregnancy weight while reducing the percentage with major weight retentions at six months postpartum.

“These findings suggest the importance of extending lifestyle interventions to the postpartum period,” says Liu. “Future trials are needed to disentangle whether prenatal interventions alone, postpartum interventions alone, or the combination of both is most effective in reducing postpartum weight retention. It would also be helpful to better understand how factors – such as healthy eating or built environments – contribute to successful outcomes in reducing postpartum weight retention. Researchers and clinicians should consider integrating intervention content into existing prenatal visits or community programs in which participants are already receiving care or services.”

*Co-authors include Jihong Liu, Sara Wilcox, Brent Hutto, Brie Turner-McGrievy and Ellen Wingard.

The Health in Pregnancy and Postpartum (HIPP) study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under Award Number R01HD078407. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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