Madres para la Salud (Mothers for Health)

Pregnancy-associated weight gain and failure to lose weight after birth contributes to the development of overweight and obesity in Hispanic women, who have prevalence rates exceeding 70%. Recent evidence shows that obesity is associated with systemic and fat tissue inflammation which can facilitate the development of obesity-related chronic diseases and contributes to the development of postpartum depression. Despite the well-established beneficial effects of exercise on weight, women tend to underparticipate in physical activity during the childbearing years. Further, the mechanisms underpinning the interplay of overweight, obesity, physical activity, and subsequent risk such as inflammatory processes or postpartum depression are not clear. The proposed study seeks to test a social support intervention, "Madres para la Salud" [Mothers for Health], to explore the effectiveness of a culturally specific program using "bouts" of physical activity to effect changes in body fat, fat tissue inflammation, and postpartum depression symptoms in sedentary Hispanic women. This innovative program has the potential to advance our understanding of the relationship between moderate increases in physical activity and specific health outcomes. The study aims are to:1) Examine the effectiveness of the Madres para la Salud for reducing the distal outcomes in: (a) body fat (b) systemic and fat tissue inflammation and (c) PPD symptoms among postpartum Hispanic women compared with an attention control group, at 6 and 12 months, after controlling for dietary intake; 2) Test whether the theoretical mediators, intermediate outcomes, of social support and walking, and environmental factor moderators, affect changes in body fat; systemic and fat tissue inflammation; and PPD symptoms among postpartum Hispanic women at 6 and 12 months, and 3) Determine the relationship between the immediate outcome of walking (minutes walked per week) and change in the distal outcomes of: (a) body fat (b) systemic and fat tissue inflammation and (c) PPD symptoms. A prospective, randomized controlled trial will guide the study. A sample of 140 sedentary Hispanic women, 18-35 years, and between 6 weeks and 6 months following childbirth will be used. Participants will be randomly assigned to the intervention or attention-control group. The intervention group will have weekly walking sessions and support interventions with Promotoras. The attention-control group will receive health newsletters and follow-up phone calls. Data will be gathered at baseline, 3, 6, 9, and 12 months using questionnaires, fat tissue biopsies, blood samples, and a subset sample for DEXA body scans, as well as objective and self-report measures of walking adherence. The interventions effectiveness will be evaluated using a mixed models analysis of variance (ANOVA) comparing the two groups, structural equation modeling (SEM), and evaluating the relationship between walking and body-fat loss. The results will have significance for womens health providers who seek to improve the long-term health of Hispanic women.

The increasing prevalence of obesity in recent decades is troublesome because overweight and obesity substantially increase the risk of chronic diseases such as cardiovascular disease (CVD) and type 2 diabetes. In Hispanic women, the prevalence of overweight and obesity is greater than 70%,1 as is a sedentary lifestyle.2 Although birthrates are falling in most developed countries, the birth rate among U.S. Hispanics has risen dramatically in the last decade,3 and indicates the need for risk reduction efforts in this growing subgroup. Failure to lose pregnancy weight following childbirth contributes to obesity in this subgroup, with subsequent impact on obesity-related risk and illness.4 For many women, the postpartum period is often characterized by a decrease in physical activity (PA) and an increase in the likelihood of postpartum depression (PPD) symptoms. Although PA has well-established beneficial effects on weight management and depression, women tend to under-participate or decrease PA during childbearing years. Further, the mechanisms behind the interplay of overweight, obesity, PA, depression and subsequent risk are not clearly explained.5 The parent grant uses a theory-based social support intervention program, Madres para la Salud [Mothers for Health] to explore the effectiveness of increased PA and a culturally specific intervention using PA bouts to effect changes in specific health parameters in Hispanic women following childbirth. Within the range recommended by the American College of Sports Medicine and the Centers for Disease Control and Prevention, the dose of PA that will reduce body fatness and systemic and fat tissue inflammation in postpartum women has not been determined.6 The effectiveness of accumulation of PA by performing multiple short bouts (10 min. each) throughout the day has been the basis of major guidelines since 1995,6 but has not been sufficiently tested among postpartum women. The parent grant, Madres para la Salud, will advance the understanding of the relationship between moderate increases in PA and consequent body fat loss in sedentary Hispanic women during the postpartum period and explore the relationship between PPD symptoms, PA, and inflammatory processes in body fat tissue. Madres para la Salud will help explain the mechanisms of PA in improving metabolic conditions in a group at particularly high risk, postpartum Hispanic women. The project brings together multi-disciplined investigators using translational research strategies focused on the reduction of health disparities. The study extends the science in the area of relevant theory-driven social support interventions and builds upon evidenced-based recommendations from the Task Force on Community Preventive Services, as well as the report on systematic reviews of community-based interventions. These reports strongly recommended testing social support as a theoretical mechanism to increase PA in community settings (http://www.thecommunityguide.org). Hispanic women may be more responsive to programs that specifically provide needed support and role models for PA.