Improving Women’s Preconceptional Health: Long-Term Effects of the Strong Healthy Women Behavior Change Intervention in the Central Pennsylvania Women’s Health Study

Abstract

Purpose To investigate the long-term (6- and 12-month) effects of the Strong Healthy Women intervention on health-related behaviors, weight and body mass index (BMI), and weight gain during pregnancy. Strong Healthy Women is a small-group behavioral intervention for pre- and interconceptional women designed to modify key risk factors for adverse pregnancy outcomes; pretest–posttest findings from a randomized, controlled trial have been previously reported. The following questions are addressed: 1) were significant pretest–posttest changes in health-related behaviors (previously reported) maintained over the 12-month follow-up period; 2) did the intervention impact weight and BMI over the 12-month follow-up period; and 3) did the intervention impact pregnancy weight gain for those who gave birth during the follow-up period? Methods Data are from 6- and 12-month follow-up telephone interviews of women in the original trial of the Strong Healthy Women intervention (n = 362) and from birth records for singleton births (n = 45) during the 12-month follow-up period. Repeated measures regression was used to evaluate intervention effects. Main Findings At the 12-month follow-up, participants in the Strong Healthy Women intervention were significantly more likely than controls to use a daily multivitamin with folic acid and to have lower weight and BMI. The intervention’s effect on reading food labels for nutritional values dropped off between the 6- and 12-month follow-up. Among those who gave birth to singletons during the follow-up period, women who participated in the intervention had lower average pregnancy weight gain compared with controls. Although the intervention effect was no longer significant when controlling for pre-pregnancy obesity, the adjusted means show a trend toward lower weight gain in the intervention group. Conclusion These findings provide important evidence that the Strong Healthy Women behavior change intervention is effective in modifying important risk factors for adverse pregnancy outcomes and may improve an important pregnancy outcome, weight gain during pregnancy. Because the intervention seems to help women manage their weight in the months after the intervention and during pregnancy, it may be an effective obesity prevention strategy for women before, during, and after the transition to motherhood.

Nutritional and Weight Management Behaviors in Low-Income Women Trying to Conceive

“…This increases their risk of prenatal and postnatal weight gain (19) as well as having preeclampsia, caesarean delivery, or a large-for-gestational-age infant (20, 21). Lifestyle interventions targeting women before conception can improve maternal health behaviors and reduce BMI (22–25). Thus, further efforts are needed to promote healthier dietary habits in overweight and obese women before conception.…”

Preventing Obesity Across Generations: Evidence for Early Life Intervention

“…These interventions have had positive effects on body mass index (BMI) and prenatal vitamin intake. Strategies for improving women's preconception health across their life span include ensuring that they have preventive visits (as an opportunity to provide pre-conception care), that interventions address identified risks, that they have interconception and prepregnancy care, and providing public health programs and interventions (e.g., increase awareness of the importance of preconception health, population surveillance, and through public programs that already serve women) ( 59 , 64 , 140 ). Further, policies and interventions focusing on encouraging males and females to achieve and maintain a healthy weight during adolescence and adulthood can be considered both health-promoting for those individuals, as well as preventative against obesity in the next generation.…”

Physical Activity and Pregnancy: Past and Present Evidence and Future Recommendations

“…There is recent evidence from an observational cohort study, the Central Pennsylvania Women’s Health Study, that women meeting PA guidelines during the preconceptional period had reduced odds of excessive pregnancy weight gain (Weisman, Hillemeier, Symons Downs, Chuang, & Dyer, 2010). Also, women participating in a pre- and interconceptional behavioral intervention, Strong Healthy Women, (including a PA component promoting the PA guidelines) that became pregnant after the intervention ended had lower weight and BMI and more appropriate gestational weight gain during pregnancy compared to controls (Symons Downs et al, 2009; Weisman et al, 2011). Although recommendations suggest that women be counseled prior to conception and encouraged to adopt lifestyle changes to minimize the risk of pregnancy issues (Entin & Munhall, 2006), few studies have examined the impact of preconceptional interventions and clinical practice recommendations to promote PA on maternal and infant outcomes.…”