Abstract
This study examined whether the neighborhood built environment moderated gestational weight gain (GWG) in LIFE-Moms clinical trials. Participants were 790 pregnant women (13.9 weeks’ gestation) with overweight or obesity randomized within four clinical centers to standard care or lifestyle intervention to reduce GWG. Geographic information system (GIS) was used to map the neighborhood built environment. The intervention relative to standard care significantly reduced GWG (coefficient = 0.05; p = 0.005) and this effect remained significant (p < 0.03) after adjusting for built environment variables. An interaction was observed for presence of fast food restaurants (coefficient = −0.007; p = 0.003). Post hoc tests based on a median split showed that the intervention relative to standard care reduced GWG in participants living in neighborhoods with lower fast food density 0.08 [95% CI, 0.03,0.12] kg/week (p = 0.001) but not in those living in areas with higher fast food density (0.02 [−0.04, 0.08] kg/week; p = 0.55). Interaction effects suggested less intervention efficacy among women living in neighborhoods with more grocery/convenience stores (coefficient = −0.005; p = 0.0001), more walkability (coefficient −0.012; p = 0.007) and less crime (coefficient = 0.001; p = 0.007), but post-hoc tests were not significant. No intervention x environment interaction effects were observed for total number of eating establishments or tree canopy. Lifestyle interventions during pregnancy were effective across diverse physical environments. Living in environments with easy access to fast food restaurants may limit efficacy of prenatal lifestyle interventions, but future research is needed to replicate these findings.
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Acknowledgements
Research reported in this publication was supported by the National Institutes of Health through The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK, U01 DK094418, U01 DK094463, U01 DK094416, 5U01 DK094466 (RCU)), The National Heart, Lung, and Blood Institute (NHLBI, U01 HL114344, U01 HL114377), and The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD, U01 HD072834). In addition, the National Center for Complementary and Integrative Health (NCCIH), the NIH Office of Research in Women’s Health (ORWH), the Office of Behavioral and Social Science Research (OBSSR), the NIH Office of Disease Prevention (ODP), the Indian Health Service, the Intramural Research Program of the NIDDK, and the Office of the Director, National Institutes of Health (OD) contributed support. Additional support was received from the NIDDK Obesity Nutrition Research Centers (P30 DK026687, P30 DK072476, P30 DK56341), National Center for Advancing Translational Sciences Clinical and Translational Science Awards (U54 GM104940, U54 MD007587, UL1 RR024992), National Institute on Minority Health and Health Disparities (S21MD001830) and EXODIAB-Excellence of diabetes research in Sweden. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We thank Russel White at the Cal Poly Robert E. Kennedy Library for his invaluable input and technical assistance in compiling the GIS data.
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The authors’ work has been funded by the NIH. Author SP has received compensation from WW, outside the submitted work. LMR’s SmartMoms™ smartphone application evaluated in the trial at Pennington Biomedical Research Center has a pending trademark and is available for licensure. No other potential competing interests were reported. SP reports receiving a grant from WW unrelated to this work. LMR and CKM reported one of the interventions evaluated in the Expecting Success trial at Pennington Biomedical Research Center (the SmartMoms™ smartphone application) is a licensed trademark and is available for licensure.
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Phelan, S., Marquez, F., Redman, L.M. et al. The moderating role of the built environment in prenatal lifestyle interventions. Int J Obes 45, 1357–1361 (2021). https://doi.org/10.1038/s41366-021-00782-w
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DOI: https://doi.org/10.1038/s41366-021-00782-w
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