Intervening during and after pregnancy to prevent weight retention among African American women Personalized Mobile Health Intervention for Health and Weight Loss in Postpartum Women Receiving Women, Infants, and Children Benefit: A Randomized Controlled Pilot Study. Using technology to promote postpartum weight loss in urban, low-income mothers: a pilot randomized controlled trial. Effect of physical activity intervention based on a pedometer on physical activity level and anthropometric measures after childbirth: a randomized controlled trial The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Effectiveness of a 12-month randomized clinical trial to increase physical activity in multiethnic postpartum women: results from Hawaii's Nā Mikimiki Project. Pregnancy: a "teachable moment" for weight control and obesity prevention. Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss: The IDEA Randomized Clinical Trial. Use of MyPyramid Menu Planner for Moms in a weight-loss intervention during lactation. Home-based active video games to promote weight loss during the postpartum period. Effect of an Internet-Based Program on Weight Loss for Low-Income Postpartum Women: A Randomized Clinical Trial
Efforts to prevent postpartum weight retention in extant clinical trials of African American women have proven exceedingly challenging . The primary purpose of this pilot study was to determine whether a behavioral intervention implemented in early pregnancy through 6 months postpartum could increase the proportion of African American women who were at or below their early pregnancy weights by 6 months postpartum . We additionally evaluated whether mothers ' postpartum weight loss could be maintained at 12 months postpartum . Participants were 66 socioeconomically disadvantaged African American women ( 36 % overweight , 64 % obese ) r and omly assigned to a behavioral intervention or usual care group . The intervention , implemented from early pregnancy to 6 months postpartum , promoted weight control through : ( 1 ) empirically supported behavior change goals ; ( 2 ) interactive self-monitoring text messages ; ( 3 ) weekly to monthly health coach calls ; and ( 4 ) skills training and support through Facebook . In modified intent-to-treat analyses , participants assigned to the intervention were significantly more likely to be at or below their early pregnancy weights by 6 months postpartum compared to usual care ( 56 % vs. 29 % , p = 0.04 ) . At 12 months postpartum , the maternal weight difference between intervention and usual care groups was not maintained ( 41 % vs. 38 % respectively at or below early pregnancy weights , p = 0.83 ) . Findings suggest that a combined pregnancy and postpartum weight control intervention improves 6 month weight outcomes in socioeconomically disadvantaged African American women with obesity . Longer interventions may be needed to overcome late postpartum weight gain among this high risk group . Clinical trial registration number : Clinical Trials.gov identifier BACKGROUND Prepregnancy maternal obesity and excessive weight gain during pregnancy lead to significant morbidities in mothers and their children . Mothers who never return to their prepregnancy weight begin subsequent pregnancies at a greater weight and have a larger propensity for excess gestational weight gain and postpartum weight retention . METHODS In this pilot study , 40 postpartum women credentialed to receive postpartum women , infants , and children ( WIC ) service were  r and omized to usual care ( " WIC Moms " ) or a personalized health intervention delivered via a SmartPhone ( " E-Moms " ) . Assessment s , including body weight , vital signs , circumferences , and body composition , were completed at week 0 ( 6 - 8 weeks postpartum ) , week 8 , and week 16 . RESULTS Results are presented as change from week 0 at 16 . As per the completers analysis , body weight change was not different between the groups ( WIC Moms vs. E-Moms ; 1.8 ± 0.9 vs. -0.1 ± 0.9 kg ; p = 0.10 ) , neither was the change in percent body fat ( 1.7 ± 0.6 vs. 0.1 % ± 0.6 % ; p = 0.90 ) or waist/hip ratio ( -0.01 ± 0.01 vs. -0.02 ± 0.01 cm ; p = 0.60 ) . However , due to notable variability in intervention adherence as the study progressed , participants were classified post hoc as having low ( < 40 % adherence ) , medium ( 40%-70 % adherence ) , or high adherence ( > 70 % adherence ) . Participants with high intervention adherence ( n = 5 ) had a significant reduction in body weight ( -3.6 ± 1.6 vs. 1.8 ± 0.9 kg ; p = 0.005 ) and percent body fat ( -2.5 ± 1.0 vs. 1.7 % ± 0.6 % ; p = 0.001 ) when compared to WIC Moms . CONCLUSIONS Overall , the E-Moms intervention was not able to decrease postpartum weight retention in women receiving WIC benefits compared to usual care received through the current WIC program . However , there is some evidence to suggest improved adherence to the intervention would improve weight management OBJECTIVE To examine the feasibility , acceptability , and initial efficacy of a  technology-based weight loss intervention for urban , low-income mothers . METHODS Eighteen obese , ethnic minority , socioeconomically disadvantaged mothers in the first year after childbirth were r and omly assigned to either : 1 ) technology-based intervention , which included empirically supported behavior-change strategies , daily skills , and self-monitoring text messages with personalized feedback , biweekly counseling calls from a health coach , and access to a Facebook support group , or 2 ) usual-care control . RESULTS After 14 weeks of treatment , the technology-based intervention participants had significantly greater weight loss ( -2.9 ± 3.6 kg ) than usual care ( 0.5 ± 2.3 kg ; adjusted mean difference : -3.2 kg , 95 % confidence interval -6.2 to -0.1 kg , P = .04 ) . One-third of intervention participants ( 3 of 9 ) and no control participants lost > 5 % of their initial body weight at follow up . CONCLUSIONS AND IMPLICATION S Results suggest the potential for using technology to deliver a postpartum weight loss intervention among low-income racial/ethnic minorities Background Pregnancy and childbirth are associated with weight gain in women , and retention of weight gained during pregnancy can lead to obesity in later life . Diet and physical activity are factors that can influence the loss of retained pregnancy weight after birth . Exercise guidelines exist for pregnancy , but recommendations for exercise after childbirth are virtually nonexistent . The aim of this study was to evaluate the effect of physical activity intervention based on pedometer on physical activity level and anthropometric measures of women after childbirth . Methods We conducted a r and omized controlled trial in which 66 women who had given birth 6 weeks to 6 months prior were r and omly assigned to receive either a 12 week tailored program encouraging increased walking using a pedometer ( intervention group , n = 32 ) or routine postpartum care ( control group , n = 34 ) . During the 12-week study period , each woman in the intervention group wore a  pedometer and recorded her daily step count .  The women were advised to increase their steps by 500 per week until they achieved the first target of 5000 steps per day and then continued to increase it to minimum of 10,000 steps per day by the end of 12th week . Assessed outcomes included anthropometric measures , physical activity level , and energy expenditure per week . Data were analyzed using the paired t-test , independent t-test , Mann-Whitney , chi-square , Wilcoxon , covariance analysis , and the general linear model repeated measures procedure as appropriate . Results After 12 weeks , women in the intervention group had significantly increased their physical activity and energy expenditure per week ( 4394 vs. 1651 calorie , p < 0.001 ) . Significant differences between-group in weight ( P = 0.001 ) , Body Mass Index ( P = 0.001 ) , waist circumference ( P = 0.001 ) , hip circumference ( P = 0.032 ) and waist-hip ratio ( P = 0.02 ) were presented after the intervention . The intervention group significantly increased their mean daily step count over the study period ( from 3249 before , to 9960 after the intervention , p < 0.001 ) . Conclusion A physical activity intervention based on pedometer is an effective means to increase physical activity ; reducing retention of weight gained during pregnancy and can improve anthropometric measures in postpartum women . Trial registration IS RCT N : I RCT Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE Few postpartum ethnic minority women perform leisure-time moderate-to-vigorous physical activity ( MVPA ) . The study tested the effectiveness of a 12-month tailored intervention to increase MVPA in women with infants 2 - 12months old . METHODS From 2008 to 2011 , women ( n=311 ) with infants ( average age=5.7months ) from Honolulu , Hawaii were r and omly assigned to receive tailored telephone calls and access to a mom-centric website ( n=154 ) or access to a st and ard PA website ( n=157 ) . MVPA was measured at baseline , 6 , and 12months using self-report and acclerometers . RESULTS Controlling for covariates , the tailored condition significantly increased self-reported MVPA from an average of 44 to 246min/week compared with 46 to 156min/week for the st and ard condition ( p=0.027 ) . Mothers with≥2 children had significantly greater increases in MVPA in response to the tailored intervention than those with one child  ( p=0.016 ) . Accelerometer-measured MVPA significantly increased over time ( p=0.0001 ) , with no condition differences . There was evidence of reactivity to initially wearing accelerometers ; the tailored intervention significantly increased MVPA among women with low baseline accelerometer MVPA minutes , but not among those with high minutes ( pinteraction=0.053 ) . CONCLUSION A tailored intervention effectively increased MVPA over 12months in multiethnic women with infants , particularly those with more than one child Excessive gestational weight gain has been shown to relate to high-postpartum weight retention and the development of overweight and obesity later in life . Because many women are concerned about the health of their babies during pregnancy and are in frequent contact with their healthcare providers , pregnancy may be an especially powerful " teachable moment " for the promotion of healthy eating and physical activity behaviors among women . Initial research suggests that helping women gain the recommended amount during pregnancy through healthy eating and physical activity could make a major contribution to the prevention of postpartum weight retention . However , more r and omized controlled trials with larger sample sizes are needed to identify the most effective and disseminable intervention . Providers have the potential to prevent high postpartum weight retention and future obesity by monitoring weight gain during pregnancy and giving appropriate advice about recommended amounts of gestational weight gain Importance Effective long-term treatments are needed to address the obesity epidemic . Numerous wearable technologies specific to physical activity and diet are available , but it is unclear if these are effective at improving weight loss . Objective To test the hypothesis that , compared with a st and ard behavioral weight loss intervention ( st and ard intervention ) , a technology-enhanced weight loss intervention ( enhanced intervention ) would result in greater weight loss . Design , Setting , Participants R and omized clinical trial conducted at the University of Pittsburgh and enrolling 471 adult participants between October 2010 and October 2012 , with data collection completed by December 2014 . Interventions Participants were placed on a low-calorie diet , prescribed increases in physical activity , and had group counseling sessions . At 6 months , the interventions added telephone counseling sessions , text message prompts , and access to study material s on a website . At 6 months , participants r and omized to the st and ard intervention group initiated self-monitoring of diet and physical activity using a website , and those r and omized to the enhanced intervention group were provided with a wearable device and accompanying web interface to monitor diet and physical activity . Main Outcomes and Measures The primary outcome of weight was measured over 24 months at 6-month intervals , and the primary hypothesis tested the change in weight between 2 groups at 24 months . Secondary outcomes included body composition , fitness , physical activity , and dietary intake . Results Among the 471 participants r and omized ( body mass index [ BMI ] , 25 to < 40 ; age range , 18 - 35 years ; 28.9 % nonwhite , 77.2 % women ) , 470 ( 233 in the st and ard intervention group , 237 in the enhanced intervention group ) initiated the interventions as r and omized , and 74.5 % completed the study . For the enhanced intervention group , mean base line weight was 96.3 kg ( 95 % CI , 94.2 - 98.5 ) and 24-month weight 92.8 kg ( 95 % CI , 90.6- 95.0 ) [ corrected ] . For the st and ard intervention group , mean baseline weight was 95.2 kg ( 95%CI,93.0 - 97.3 ) and 24-month weight was 89.3 kg ( 95%CI , 87.1 - 91.5 ) [ corrected ] . Weight change at 24 months differed significantly by intervention group ( estimated mean weight loss , 3.5 kg [ 95 % CI , 2.6 - 4.5 } in the enhanced intervention group and 5.9 kg [ 95 % CI , 5.0 - 6.8 ] in the st and ard intervention group ; difference , 2.4 kg [ 95 % CI , 1.0 - 3.7 ] ; P = .002 ) . Both groups had significant improvements in body composition , fitness , physical activity , and diet , with no significant difference between groups . Conclusions and Relevance Among young adults with a BMI between 25 and less than 40 , the addition of a wearable technology device to a st and ard behavioral intervention result ed in less weight loss over 24 months . Devices that monitor and provide feedback on physical activity may not offer an advantage over st and ard behavioral weight loss approaches . Trial Registration clinical trials.gov Identifier : NCT01131871 The Internet offers a valuable re source for promotion of healthy eating and Web-based communication between the dietetics practitioner and client . In a 16-week intervention examining the effects of energy restriction ( 500 kcal/day ) and exercise on body composition in overweight/obese lactating women , MyPyramid Menu Planner for Moms  was used to support dietary counseling . R and om assignment occurred at 4 weeks postpartum to either an  Intervention group ( n=14 ) or Minimal Care group ( n=13 ) from 2008 through 2010 . Three 24-hour dietary recalls were obtained using the Nutrition Data System at 4 and 20 weeks postpartum . Individual MyPyramid Menu Planner accounts were created for the Intervention group and used in face-to-face dietary counseling . Repeated measures analysis of variance was used to test for differences between groups for change in dietary intake and weight . Changes in energy , saturated fat , and percent of energy from added sugars were significantly different between Intervention group and Minimal Care group ( -613 [ 521 ] kcal vs -171 [ 435 ] kcal ; P=0.03 ; -14.9 [ 14.0 ] g vs + 0.9 [ 13.4 ] g ; P<0.01 ; and -3.5 % [ 5.3 % ] vs + 2.2 % [ 4.8 % ] ; P<0.01 , respectively ) . The Intervention group significantly increased their whole fruit servings and decreased their total grain and milk servings compared with the Minimal Care group ( P<0.05 ) . The Intervention group lost significantly more weight ( -5.8 [ 3.5 ] kg ) than the Minimal Care group ( -1.6 [ 5.4 ] kg ) ( P=0.03 ) . Although participants must have access to an Internet-based computer and possess basic food knowledge , these results suggest MyPyramid Menu Planner might prove to be an effective dietary counseling support tool for improving dietary intake and promoting weight loss during lactation PURPOSE Weight retention during the postpartum period is critical for the later development of obesity in women . Traditional physical activity is frequently discontinued because of incompatibility with mothers ' agenda ( i.e. , baby care ) . In the present study , active video games ( AVG ) are proposed for postpartum women to improve their body composition . METHODS Thirty-four postpartum women ( body mass index = 24.5 ± 3.4 kg·m ) were r and omized to an AVG group or a control group . Subjects assigned to the AVG group were given a Wii Nintendo console with the game Wii Fit Plus for 40 d. The two groups were tested for weight , body mass index , body fat mass , waist and hip circumferences , and other anthropometric parameters . Physical fitness , energy expenditure , energy intake , and adverse events were also investigated . RESULTS The AVG group lost more weight than the control group ( -2.2 ± 0.9 vs. -0.5 ± 0.7 kg , P < 0.001 ) . They also exhibited more important reductions of BMI , waist and hip circumferences , and body fat ( P < 0.05 ) . During the 40-d period , subjects expended an estimated 4682 ± 2874 kcal just by playing AVG . Daily energy intake was reduced by 206 ± 559 kcal . There were significant positive correlations between playing frequency , total playing time , total energy expenditure during the 40-d period , and decrease in daily energy intake respectively , and weight loss ( P < 0.05 ) . Playing time data suggested no conflict with baby care activities . CONCLUSIONS AVGs could represent an interesting spare physical activity for postpartum women . In the present study , these games promoted physical activity , induced a reduction of energy intake , and subsequently minimized weight retention Importance Postpartum weight retention increases lifetime risk of obesity and related morbidity . Few effective interventions exist for multicultural , low-income women . Objective To test whether an internet-based weight loss program in addition to the Special Supplemental Nutrition Program for Women , Infants , and Children ( WIC program ) for low-income postpartum women could produce greater weight loss than the WIC program alone over 12 months . Design , Setting , and Participants A 12-month , cluster r and omized , assessor-blind , clinical trial enrolling 371 adult postpartum women at 12 clinics in WIC programs from the California central coast between July 2011 and May 2015 with data collection completed in May 2016 . Interventions Clinics were r and omized to the WIC program ( st and ard care group ) or the WIC program plus a 12-month primarily internet-based weight loss program ( intervention group ) , including a website with weekly lessons , web diary , instructional videos , computerized feedback , text messages , and monthly face-to-face groups at the WIC clinics . Main Outcomes and Measures The primary outcome was weight change over 12 months , based on measurements at baseline , 6 months , and 12 months . Secondary outcomes included proportion returning to preconception weight and changes in physical activity and diet . Results Participants included 371 women ( mean age , 28.1 years ; Hispanic , 81.6 % ; mean weight above prepregnancy weight , 7.8 kg ; mean months post partum , 5.2 months ) r and omized to the intervention group ( n = 174 ) or st and ard care group ( n = 197 ) ; 89.2 % of participants completed the study . The intervention group produced greater mean 12-month weight loss compared with the st and ard care group ( 3.2 kg in the intervention group vs 0.9 kg in st and ard care group , P < .001 ; difference , 2.3 kg ( 95 % CI , 1.1 to 3.5 ) . More participants in the intervention group than the st and ard care group returned to preconception weight by 12 months ( 32.8 % in the intervention group vs 18.6 % in the st and ard care group , P < .001 ; difference , 14.2 percentage points [ 95 % CI , 4.7 to 23.5 ] ) . The intervention group and st and ard care group did not significantly differ in 12-month changes in physical activity ( mean [ 95 % CI ] : −7.8 min/d [ −16.1 to 0.4 ] in the intervention group vs −7.2 min/d [ −14.6 to 0.3 ] in the st and ard care group ; difference , −0.7 min/d [ 95 % CI , −42.0 to 10.6 ] , P = .76 ) , calorie intake ( mean [ 95 % CI ] : −298 kcal/d [ −423 to −174 ] in the intervention group vs −144 kcal/d [ −257 to −32 ] in the st and ard care group ; difference , −154 kcal/d [ −325 to 17 ] , P = .06 ) , or incidences of injury ( 16 in the intervention group vs 16 in the st and ard care group ) or low breastmilk supply from baseline to month 6 ( 21 of 61 participants in the intervention group vs 23 of 72 participants in the st and ard care group ) and from month 6 to 12 ( 13 of 32 participants in the intervention group vs 14 of 37 participants in the st and ard care group ) . Conclusions and Relevance Among low-income postpartum women , an internet-based weight loss program in addition to the Special Supplemental Nutrition Program for Women , Infants , and Children ( WIC program ) compared with the WIC program alone result ed in a statistically significant greater weight loss over 12 months . Further research is needed to determine program and cost-effectiveness as part of the WIC program . Trial Registration clinical trials.gov Identifier :
Background Over the past decades , there has been an increase in overweight and obesity in women of childbearing age , as well as the general population .
Overweight and obesity are related to a later , increased risk of type 2 diabetes and cardiovascular diseases .
Increasing weight between pregnancies has a negative impact on the development of the fetus in a subsequent pregnancy .
It is also related to long-term obesity and overweight for the woman .
Accordingly , weight control in women of the childbearing age is important for both women and their offspring .
Information and communication technology ( ICT ) has become an integrated part of many peoples ’ lives , and it has the potential to prevent disease .
In this systematic review , we summarize the evidence from r and omized controlled trials to compare effects of different ICT-based interventions to support postpartum women to achieve weight loss .