Study to Compare Ways to Improve Maternal Healthy Weight

As many parents can attest, it’s easy to gain too much weight during and after pregnancy, which can lead to increased risk for maternal and newborn health issues. This is especially common in marginalized communities, where economic, physical, and geographic factors reduce access to health care, nutrition counseling, healthy foods, and exercise.  

“We know that healthy nutrition and physical activity, starting in pregnancy, can promote healthy weight and improve health outcomes for both pregnant people and their babies. But in the perinatal period, following a healthy diet and getting enough exercise is a huge challenge,” says Jennifer Woo Baidal, MD, MPH, the Florence Irving Associate Professor of Pediatrics at Columbia University Vagelos College of Physicians and Surgeons.  

“We need to find more effective ways to reduce inequities that result in racial and ethnic disparities in maternal health outcomes.” 

Woo Baidal and a team of New York City investigators will soon begin testing interventions that could be more effective than usual care. A total of 1,100 pregnant people in New York City will be recruited to join the study, funded by the Patient-Centered Outcomes Research Institute (PCORI). 

Excessive gestational weight gain can lead to various health risks for the mother, including pregnancy-associated hypertension, gestational diabetes, and long-term obesity.  

“There are risks for the baby, too,” says Woo Baidal, an expert in obesity, weight management, and disparities in health care. “People who have overweight during pregnancy are more likely to experience delivery complications and cesarean deliveries and they tend to terminate breastfeeding earlier.” 

Babies born to people who have obesity at the start of pregnancy also have a higher risk of obesity during childhood and adulthood. “Unhealthy maternal weight can set off an intergenerational cycle of obesity,” Woo Baidal says. “Individuals are not to blame for this cycle, rather structural and systemic inequities that have historically limited access to health-promoting resources in communities of color and neighborhoods with lower household income pose significant barriers. That is why it is important to optimize social factors that impact health equity.” 

The study’s primary goal is to determine which of three approaches is best at helping participants reduce postpartum weight retention a year after giving birth. One-third of the study’s participants will receive usual care and will be directed to appropriate community resources, based on their current access to healthy foods, places to exercise, and health services.  

The other participants will receive one of two interventions selected based on iterative research and partnership with patients, community organizations, clinicians, and researchers. The first is designed to lower social barriers to care and healthy environments by providing patients with regular grocery deliveries, physical activity resources, and transportation vouchers to improve access to appropriate services. The second takes a more hands-on approach, deployed by community health workers, to help patients enroll in desired community services and provide individual and group health coaching in a culturally responsive and family-based setting.  

The researchers will assess each intervention’s impact on various health measures during pregnancy and in the postpartum period, including complications during labor and delivery, and the impact on food security, access to physical activity, and access to transportation. Finally, the study will explore how, why, and for whom the interventions may work best—vital information for patients, clinicians, health systems, community groups, and health insurers.  

The study involves a variety of institutions across New York City, including two community partners, Public Health Solutions, one of the largest public health nonprofit organizations that work to support healthy families, thriving communities, and health equity in NYC, and the Northern Manhattan Perinatal Partnership, a nationally recognized organization in the area of maternal and child health. Woo Baidal will work with the study’s other principal investigator, Rachel Schwartz, senior director of maternal child health at Public Health Solutions, to direct the study and analyze the findings.   

Beginning in 2025, participants for the study will be recruited from among patients at Columbia University Irving Medical Center and other health care sites in Lower and Upper Manhattan and Queens.