Black and Latinx women have the highest prevalence of obesity. Women entering pregnancy with obesity have an excess risk of gestational diabetes, hypertensive disorders, and acute cardiovascular event during labor and delivery, compared to normal weight women. Because pregnant women are motivated to have a healthy baby, pregnancy provides the ideal “teachable moment” to not only reduce adverse pregnancy outcomes, but ultimately prevent long-term CMD in women and their infants.

Lifestyle interventions addressing obesity in pregnancy have the potential to break the cycle of obesity and cardiometabolic disease (CMD) for Black and Latinx women. However, few lifestyle interventions have been tested among Black or Latinx pregnant women or been implemented in community-based settings, where many high risk pregnant and postpartum women access safety-net services. To address this gap, we will leverage our team's experience designing and testing Healthy for Two (H42), an evidence-based pregnancy/postpartum health coaching intervention that is remotely delivered (phone coaching using motivational interviewing + web-based platform + mobile phone behavioral tracking).

Along with our Maryland home visiting partners, we will adapt and implement Healthy for Two into the home visiting setting, i.e., H42-HV (Healthy for Two-Home Visiting) and tailor the intervention for Latinx and Spanish speaking women, i.e., Sanos los Dos. Early home visiting is an evidence-based public health service strategy found in all 50 states that targets services to high-risk communities to address adverse social determinants of health. Home visitors provide health education, promote positive parenting and early learning, and link families with needed community resources. While home visiting programs don't universally prioritize CMD risk in their services, they are an ideal service-strategy for integration of a healthy lifestyle intervention.

We will use a hybrid type 1 effectiveness-implementation randomized control trial to compare the effectiveness of Healthy for Two – Home Visiting (H42-HV) integrated into home visiting compared with usual home visiting services in reducing postpartum weight retention (difference between pre-pregnancy weight and weight at 6 months postpartum) among 360 pregnant and postpartum women. We will also evaluate the implementation of the intervention to enable and sustain integration into home visiting. Our research approach allows us to not only establish the effectiveness of H42-HV but also understand the factors that enable intervention implementation to inform sustainability, further the pathway from evidence translation into practice, and facilitate greater subsequent public health impact.

Kelly Bower, PhD, MSN/MPH, RN
Principal Investigator
Co-leads all aspects of the study, including design, intervention adaptation, IRB requirements, recruitment, data analysis, and dissemination, Dr. Bower directs all community engagement efforts and the implementation science approach. Serves as the contact PI and is responsible for communication with the funding agency (NIMHD).

Wendy L. Bennett, MD, MPH
Principal Investigator
Co-leads all aspects of the study, including design, intervention adaptation, IRB requirements, recruitment, data analysis, and dissemination, Dr. Bennett directs intervention adaptation, recruitment and retention, and works closely with the biostatistician to oversee data analyses.

Janelle Coughlin, PhD
Co-Investigator
Lead of the Intervention Workgroup
Works closely with Drs. Bennett and Bower to adapt the intervention and conduct training for home visitors and health coaches. Leads intervention workgroup adapting and testing the intervention in home visiting.

Eliana Perrin, MD, MPH
Co-Investigator
Provides consultation on intervention adaptation and delivery as well as infant health considerations.

Sofia Wicker Velez
Bilingual Nutritionist
Bayview Medical Center

Alexandra Solano-Umana
Supervisor
The Lourie Center

Katie Capano
Nurse Midwife
Bayview Medical Center

Eleris Fraticelli
Home Visitor
Montgomery County

Tamira Dunn
Program Director
B'More for Healthy Babies

Laura Ocon
Home Visitor
The Lourie Center

Kathy Carroll
Supervisor
DRUM Healthy Families

Kaitlyn Jolley
Home Visitor
Dorchester County

Sharie Wallech
Home Visitor
Washington County

Julia Hernandez
Home Visitor
The Lourie Center

Shirley Scott
Supervisor
DRUM Healthy Families

Jamal Jenkins
Home Visitor
DRUM Healthy Families