title: The impact of group prenatal care on pregnancy and postpartum weight trajectories.
abstract: OBJECTIVE
  The objective of the study was to investigate whether group prenatal care (Centering Pregnancy Plus [CP+]) has an impact on pregnancy weight gain and postpartum weight loss trajectories and to determine whether prenatal depression and distress might moderate these trajectories.
  
  
  METHODS
  This was a secondary analysis of a cluster-randomized trial of CP+ in 14 Community Health Centers and hospitals in New York City. Participants were pregnant women aged 14-21 years (n = 984). Medical record review and 4 structured interviews were conducted: in the second and third trimesters and 6 and 12 months postpartum. Longitudinal mixed modeling was utilized to evaluate the weight change trajectories in the control and intervention groups. Prenatal distress and depression were also assessed to examine their impact on weight change.
  
  
  RESULTS
  There were no significant differences between the intervention and control groups in baseline demographics. Thirty-five percent of the participants were overweight or obese, and more than 50% had excessive weight gain by Institute of Medicine standards. CP+ was associated with improved weight trajectories compared with controls (P < .0001): women at clinical sites randomized to group prenatal care gained less weight during pregnancy and lost more weight postpartum. This effect was sustained among women who were categorized as obese based on prepregnancy body mass index (P < .01). Prenatal depression and distress were significantly associated with higher antepartum weight gain and postpartum weight retention. Women with the highest levels of depression and prenatal distress exhibited the greatest positive impact of group prenatal care on weight trajectories during pregnancy and through 12 months postpartum.
  
  
  CONCLUSIONS
  Group prenatal care has a significant impact on weight gain trajectories in pregnancy and postpartum. The intervention also appeared to mitigate the effects of depression and prenatal distress on antepartum weight gain and postpartum weight retention. Targeted efforts are needed during and after pregnancy to improve weight gain trajectories and overall health.
authors.affiliation: Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT. Electronic address: urania.magriples@yale.edu.
authors.forename: Urania
authors.initials: U
authors.lastname: Magriples
authors.affiliation: University of North Carolina Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.
authors.forename: Marcella H
authors.initials: MH
authors.lastname: Boynton
authors.affiliation: Yale School of Public Health, New Haven, CT.
authors.forename: Trace S
authors.initials: TS
authors.lastname: Kershaw
authors.affiliation: Yale School of Public Health, New Haven, CT.
authors.forename: Jessica
authors.initials: J
authors.lastname: Lewis
authors.affiliation: Centering Healthcare Institute, Silver Spring, MD.
authors.forename: Sharon Schindler
authors.initials: SS
authors.lastname: Rising
authors.affiliation: Clinical Directors Network, New York, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY.
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Tobin
authors.affiliation: Department of Psychiatry, University of California, San Francisco, School of Medicine, San Francisco, CA.
authors.forename: Elissa
authors.initials: E
authors.lastname: Epel
authors.affiliation: Yale School of Public Health, New Haven, CT.
authors.forename: Jeannette R
authors.initials: JR
authors.lastname: Ickovics
mesh_terms: D000293:Adolescent; D003863:Depression / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D009035:Mothers / Q000523:psychology*; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration*; D012944:Social Support; D013315:Stress, Psychological / Q000503:physiopathology; D015430:Weight Gain / Q000502:physiology; D015431:Weight Loss / Q000502:physiology; D055815:Young Adult
keywords: excessive gestational weight gain; group prenatal care; postpartum weight loss