Use of home-delivered meals to reduce excessive gestational weight gain for high-risk women

使用送餐上门来减少高危女性妊娠期体重过度增加

• 批准号: 10626837
• 负责人: Gareth R Dutton
• 金额: $ 18.56万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10626837
• 关键词: Address; Adherence; Affect; African American; Behavior Therapy; Behavioral; Birth; Cardiovascular Diseases; Child; Clinical effectiveness; Cognitive; Confusion; Control Groups; Cost Savings; Counseling; Data; Diet; Effectiveness; Exploratory/Developmental Grant; Face; Failure; Future; Gestational Diabetes; Guidelines; Habits; Health; Health Food; Healthy Eating; High Risk Woman; Home; Home environment; Hospital Records; Individual; Informal Social Control; Institute of Medicine (U.S.); Insurance Carriers; Insurance Coverage; Intake; Intervention; Kidney Diseases; Low income; Maternal and Child Health; Medical; Metabolic; Metabolism; Minority Women; Mothers; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Overweight; Participant; Patient Outcomes Assessments; Patients; Pilot Projects; Population; Pregnancy; Pregnant Women; Preparation; Privatization; Problem Solving; Protocols documentation; Public Health; Public Policy; Quasi-experiment; Randomized, Controlled Trials; Recommendation; Reporting; Resources; Risk; Self Efficacy; Serious Adverse Event; Stress; Testing; Time; Transportation; Travel; Underserved Population; United States; Weight maintenance regimen; Woman; acceptability and feasibility; behavior change; cooking; cost; cost effective; cost effectiveness; delivered meals; design; ethnic minority; experience; feasibility testing; food insecurity; gestational weight gain; improved; innovation; intervention delivery; novel; nutrition; obesity risk; offspring; perinatal complications; perinatal outcomes; post intervention; postpartum weight; prenatal; prepregnancy; prevent; programs; psychologic; racial minority; recruit; satisfaction; skills; standard care; stressor; success; Address; Adherence; Affect; African American; Behavior Therapy; Behavioral; Birth; Cardiovascular Diseases; Child; Clinical effectiveness; Cognitive; Confusion; Control Groups; Cost Savings; Counseling; Data; Diet; Effectiveness; Exploratory/Developmental Grant; Face; Failure; Future; Gestational Diabetes; Guidelines; Habits; Health; Health Food; Healthy Eating; High Risk Woman; Home; Home environment; Hospital Records; Individual; Informal Social Control; Institute of Medicine (U.S.); Insurance Carriers; Insurance Coverage; Intake; Intervention; Kidney Diseases; Low income; Maternal and Child Health; Medical; Metabolic; Metabolism; Minority Women; Mothers; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Overweight; Participant; Patient Outcomes Assessments; Patients; Pilot Projects; Population; Pregnancy; Pregnant Women; Preparation; Privatization; Problem Solving; Protocols documentation; Public Health; Public Policy; Quasi-experiment; Randomized, Controlled Trials; Recommendation; Reporting; Resources; Risk; Self Efficacy; Serious Adverse Event; Stress; Testing; Time; Transportation; Travel; Underserved Population; United States; Weight maintenance regimen; Woman; acceptability and feasibility; behavior change; cooking; cost; cost effective; cost effectiveness; delivered meals; design; ethnic minority; experience; feasibility testing; food insecurity; gestational weight gain; improved; innovation; intervention delivery; novel; nutrition; obesity risk; offspring; perinatal complications; perinatal outcomes; post intervention; postpartum weight; prenatal; prepregnancy; prevent; programs; psychologic; racial minority; recruit; satisfaction; skills; standard care; stressor; success

PROJECT SUMMARY/ABSTRACT In the United States, more than 50% of women have pre-pregnancy overweight/obesity, and half of women experience gestational weight gain (GWG) in excess of the Institute of Medicine recommendations. Low-income and racial/ethnic minority women are disproportionately affected. Pre-pregnancy overweight and excessive GWG increase the risk for prenatal and perinatal complications. Behavioral interventions aimed at reducing excessive GWG have had limited success, particularly among women with overweight/obesity. Most GWG interventions involve high participant burden and fail to sufficiently address both the psychological (e.g., stress, low self-efficacy) and material (e.g., food insecurity, transportation) barriers and needs of low-income, minority women. One promising and novel alternative approach capable of overcoming many of these barriers is the provision of healthy, home-delivered meals. In non-pregnant populations, meal delivery has been used to help manage various conditions including overweight/obesity, type 2 diabetes, and cardiovascular disease with cost- effective and encouraging results. While the use of meal delivery for managing weight in pregnancy has not been tested, there is evidence that meal replacement shakes and bars are effective for reducing GWG. However, poor compliance to the meal replacement prescription was common. Instead, the use of culturally appropriate, home- delivered meals may be more palatable and offer a unique approach to managing GWG. Importantly, meal delivery for GWG management may be sustainable given the cost-savings demonstrated in other populations and the recent expansion by public and private insurers to cover home-delivered meals. The purpose of the proposed R21 exploratory/developmental grant is to test the feasibility, acceptability, and preliminary efficacy of a meal delivery intervention for managing GWG among predominantly African American and low-income pregnant women with overweight/obesity using a rigorous and efficient quasi-experimental design. In particular, the specific aims of this project are to: 1) explore the feasibility and acceptability of the meal delivery intervention; 2) investigate the preliminary efficacy of the meal delivery intervention on GWG and estimate the effect size of the intervention relative to a non-randomized but weighted standard care control group derived from de-identified hospital records; and 3) investigate pre- to post-intervention changes in patient-reported food insecurity, stress, diet satisfaction, self-efficacy, and diet quality. This project will provide essential data to inform the design of a future large-scale and fully-powered randomized controlled trial on the effectiveness and cost of the meal delivery intervention on GWG adherence and maternal-child health outcomes. Ultimately, results could inform public policy to leverage existing programs (e.g., supplemental nutrition assistance programs) and/or modify insurance coverage to promote sustainability, which would have a meaningful public health impact on maternal-child health.

项目摘要/摘要 在美国，超过50％的妇女患有怀孕前超重/肥胖，一半的妇女 经验妊娠体重增加（GWG）超出了医学研究所的建议。低收入 种族/少数民族妇女受到不成比例的影响。怀孕前超重和过度 GWG增加了产前和围产期并发症的风险。旨在减少的行为干预措施 过度的GWG取得了有限的成功，尤其是在超重/肥胖的女性中。大多数GWG 干预措施涉及较高的参与者负担，并且无法充分解决心理学（例如，压力， 低自我效能感）和材料（例如粮食不安全，运输）障碍和低收入的需求 女性。一种能够克服许多障碍的有前途且新颖的替代方法是 提供健康的家居用餐。在未怀孕的人群中，用餐已被用来帮助 管理各种疾病，包括超重/肥胖，2型糖尿病和心血管疾病，成本 - 有效而令人鼓舞的结果。虽然使用饮食来管理怀孕体重 经过测试，有证据表明，更换餐的奶昔和棒可有效减少GWG。但是，贫穷 遵守膳食替代处方很常见。相反，使用文化适当，家庭 - 提供的餐点可能更可口，并为管理GWG提供了独特的方法。重要的是，用餐 鉴于其他人群中证明的成本节省，GWG管理的交付可能是可持续的 以及最近由公共和私人保险公司扩张，以涵盖家居用餐。目的 拟议的R21探索/发展赠款是测试可行性，可接受性和初步功效 用于管理非裔美国人和低收入的GWG的饮食干预措施 使用严格有效的准实验设计具有超重/肥胖症的孕妇。尤其， 该项目的具体目的是：1）探索饮食干预的可行性和可接受性； 2）调查饮食递送干预GWG的初步疗效，并估计 相对于非随机但加权标准护理对照组的干预措施，该组得出 医院记录； 3）调查患者报告的粮食不安全，压力，压力，压力，压力后的干预前变化 饮食满意度，自我效能感和饮食质量。该项目将提供基本数据，以告知 未来的大规模和完全供电的随机对照试验，供餐的有效性和成本 干预GWG依从性和母子健康成果。最终，结果可以告知公众 利用现有计划（例如补充营养援助计划）和/或修改保险的政策 促进可持续性的覆盖范围，这将对孕产妇健康产生有意义的公共卫生影响。