Postpartum Weight Loss Intervention Research Articles

Delivering a Postpartum Weight Loss Intervention via Facebook or In-Person Groups: Results From a Randomized Pilot Feasibility Trial.

Postpartum weight retention contributes to weight gain and obesity. Remotely delivered lifestyle interventions may be able to overcome barriers to attending in-person programs during this life phase. This study aimed to conduct a randomized feasibility pilot trial of a 6-month postpartum weight loss intervention delivered via Facebook or in-person groups. Feasibility outcomes were recruitment, sustained participation, contamination, retention, and feasibility of study procedures. Percent weight loss at 6 and 12 months were exploratory outcomes. Women with overweight or obesity who were 8 weeks to 12 months post partum were randomized to receive a 6-month behavioral weight loss intervention based on the Diabetes Prevention Program lifestyle intervention via Facebook or in-person groups. Participants completed assessments at baseline, 6 months, and 12 months. Sustained participation was defined by intervention meeting attendance or visible engagement in the Facebook group. We calculated percent weight change for participants who provided weight at each follow-up. Among individuals not interested in the study, 68.6% (72/105) were not interested in or could not attend in-person meetings and 2.9% (3/105) were not interested in the Facebook condition. Among individuals excluded at screening, 18.5% (36/195) were ineligible owing to reasons related to the in-person condition, 12.3% (24/195) related to the Facebook condition, and 2.6% (5/195) were unwilling to be randomized. Randomized participants (n=62) were a median of 6.1 (IQR 3.1-8.3) months post partum, with a median BMI of 31.7 (IQR 28.2-37.4) kg/m2. Retention was 92% (57/62) at 6 months and 94% (58/62) at 12 months. The majority (21/30, 70%) of Facebook and 31% (10/32) of in-person participants participated in the last intervention module. Half (13/26, 50%) of Facebook and 58% (15/26) of in-person participants would be likely or very likely to participate again if they had another baby, and 54% (14/26) and 70% (19/27), respectively, would be likely or very likely to recommend the program to a friend. In total, 96% (25/26) of Facebook participants reported that it was convenient or very convenient to log into the Facebook group daily compared with 7% (2/27) of in-person participants who said it was convenient or very convenient to attend group meetings each week. Average weight loss was 3.0% (SD 7.2%) in the Facebook condition and 5.4% (SD 6.8%) in the in-person condition at 6 months, and 2.8% (SD 7.4%) in the Facebook condition and 4.8% (SD 7.6%) in the in-person condition at 12 months. Barriers to attending in-person meetings hampered recruitment efforts and intervention participation. Although women found the Facebook group convenient and stayed engaged in the group, weight loss appeared lower. Research is needed to further develop care models for postpartum weight loss that balance accessibility with efficacy. ClinicalTrials.gov, NCT03700736; https://clinicaltrials.gov/ct2/show/NCT03700736.

Delivering a Post-Partum Weight Loss Intervention via Facebook or In-Person Groups: Results from a Randomized Pilot Feasibility Trial

Background Postpartum weight retention contributes to weight gain and obesity. Remote lifestyle interventions may overcome barriers to attending in-person programs during this phase. Objective We aimed to conduct a randomized feasibility pilot trial of a 6-month postpartum weight loss intervention delivered via Facebook or in-person groups. Feasibility outcomes were recruitment, sustained participation, contamination, retention, and feasibility of study procedures; percent weight loss at 6 and 12 months, exploratory outcomes. Methods Women with overweight or obesity who were 8 weeks to 12 months post partum were randomized to receive a 6-month behavioral weight loss intervention based on the Diabetes Prevention Program lifestyle intervention via Facebook or in-person groups. Participants completed assessments at baseline, 6 months, and 12 months. Sustained participation was defined with intervention meeting attendance or visible engagement in the Facebook group. Retention was defined as completing follow-up assessments (providing weight or completing the survey). We calculated the percent weight change for participants who provided weight at each follow-up. Results Among uninterested individuals, 69% (72/105) were not interested in or could not attend in-person meetings and 3% (3/105) were not interested in the Facebook condition. Among individuals excluded at screening, 18% (36/195) were ineligible due to reasons related to the in-person condition, 12% (24/195) related to Facebook and 3% (5/195) were unwilling to be randomized (all preferred Facebook). Randomized participants (n=62) were a median of 6.1 (IQR 3.1-8.3) months post partum with a median BMI of 31.7 (IQR 28.2-37.4) kg/m2. Retention was 92% (57/62) at 6 months and 94% (58/62) at 12 months. Overall, 70% (21/30) of Facebook participants and 31% (10/32) of in-person participants attended the last intervention module. Further, 50% (13/26) of Facebook participants and 58% (15/26) of in-person participants would be likely or very likely to participate again if they had another baby, and 54% (14/26) and 70% (19/27), respectively, would be likely or very likely to recommend the program to a friend. Moreover, 96% (25/26) of Facebook participants reported that it was convenient or very convenient to log into the Facebook group daily versus 7% (2/27) of in-person participants who said it was convenient or very convenient to attend group meetings each week. Contamination was low, and study procedures were feasible. Average weight loss was 3.0% (SD 7.2%) in the Facebook condition and 5.4% (SD 6.8%) in the in-person condition at 6 months and 2.8% (SD 7.4%) and 4.8% (SD 7.6%) at 12 months, respectively. Conclusions Barriers to attending in-person meetings hampered recruitment efforts and intervention participation. While women found web-based groups convenient and stayed engaged in the group, weight loss may be lower. Research is needed to further develop care models for postpartum weight loss that balance accessibility with efficacy. Conflicts of Interest None declared. Trial Registration ClinicalTrials.gov NCT03700736; https://clinicaltrials.gov/ct2/show/NCT03700736

Feasibility of using a peer coach to deliver a behavioral intervention for promoting postpartum weight loss in Black and Latina mothers.

Peer coaching may provide a culturally relevant and potentially scalable approach for delivering postpartum obesity treatment. We aimed to evaluate the feasibility of peer coaching to promote postpartum weight loss among ethnic minority women with obesity. This pilot study was a prospective, parallel-arm, randomized controlled trial. Twenty-two obese, Black or Latina mothers ≤6 months postpartum were recruited from the Philadelphia Special Supplemental Nutrition Education Program for Women, Infants and Children (WIC) and randomly assigned to either: (a) a peer-led weight loss intervention (n = 11) or (b) usual WIC care (n = 11). The intervention provided skills training and problem solving via six calls and two in-person visits with a Black mother trained in behavioral weight control strategies. Text messaging and Facebook served as platforms for self-monitoring, additional content, and interpersonal support. Both arms completed baseline and 14 week follow-up assessments. All participants were retained in the trial. Intervention engagement was high; the majority (55%) responded to at least 50% of the self-monitoring text prompts, and an average of 3.4 peer calls and 1.7 visits were completed. Mean weight loss among intervention participants was -1.4 ± 4.2 kg compared to a mean weight gain of 3.5 ± 6.0 kg in usual WIC care. Most intervention participants strongly agreed that the skills they learned were extremely useful (90%) and that the coach calls were extremely helpful for weight control (80%). Results suggest the feasibility of incorporating peer coaching into a postpartum weight loss intervention for ethnic minority women with obesity. Future research should examine the sustained impact in a larger trial.

1386-P: Long-Term Weight Change after Pregnancy and Type 2 Diabetes Risk in Women with a History of Gestational Diabetes

Women with a history of gestational diabetes (GDM) are at high risk for developing type 2 diabetes, which may be further increased with weight gain after pregnancy. Our objective was to determine associations of long-term weight changes after a GDM pregnancy and type 2 diabetes risk. We used data on a cohort of 139 women with a GDM pregnancy identified though the Kaiser Permanente Northern California (KPNC) GDM registry (1986-2009) who completed a follow-up study visit an average of 16 years later (2011-2013). Type 2 diabetes was identified through the KPNC diabetes registry, self-report during follow-up visit recruitment, or at least one abnormal value on a 75-gram, 2-hour oral glucose tolerance test (2015 ADA criteria) conducted at the follow-up visit. Clinically measured weights extracted from the electronic health record were used to calculate average BMI change per year between delivery and either type 2 diabetes identification date or follow-up visit date. We used modified Poisson regression to estimate relative risks of type 2 diabetes associated with BMI change categories. Twenty-six percent of women lost weight [mean -0.3 BMI units/year, equivalent to -0.8 kg/year for a woman of the average height in our cohort (1.6 m)], 24% maintained their weight (<0.17 BMI units/year, mean 0.10 BMI units/year [0.3 kg/year]), and 50% gained weight (≥0.17 BMI units/year, mean 0.5 BMI units/year [1.3 kg/year]). Overall, 50% of women developed type 2 diabetes. Each additional BMI unit gained was associated with 28% greater risk of type 2 diabetes (95% CI: 0.98, 1.67) adjusting for age at delivery, race/ethnicity, pre-pregnancy BMI, and years since delivery. Women who lost weight had 39% lower risk of developing type 2 diabetes (95% CI: 0.33, 1.12) compared to women who maintained their weight, though estimates were imprecise. Our findings suggest that long-term weight gain after a GDM pregnancy may increase risk of type 2 diabetes, supporting postpartum weight loss intervention efforts. Disclosure S.E. Badon: None. F. Xu: None. C. Quesenberry: None. A. Ferrara: None. M.M. Hedderson: None. Funding National Institutes of Health (R01HD065904)

Perceived Motivators, Barriers and Intervention Strategies Related to Weight Loss After Childbirth Among WIC Participants in Southern California.

To explore perceived motivators and barriers to weight loss after childbirth and ideas for postpartum weight loss interventions among participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Four (2 with English-speaking and 2 with Spanish-speaking participants) focus groups were conducted. A WIC clinic in Southern California. Of 22 participants, the majority were Hispanic/Latina. The mean age of the mothers' infants was 6.18 months. A structured focus group guide was used. Audio-recordings were transcribed verbatim. The Spanish transcriptions were reviewed for discrepancies by a bilingual coinvestigator and translated into English for analysis. Transcriptions of the focus group audio-recordings were organized in ATLAS.ti version 8.0. and analyzed using content analysis. Participants had a mean age of 30.5 and a mean prepregnancy body mass index of 32.4. Motivators for weight loss after childbirth included modeling healthy behavior for children and a fear of developing chronic illness. Barriers to weight loss included lack of knowledge, self-efficacy, time, child care and support, postpartum depression, the 40-day rule, and having a c-section. Intervention ideas included providing accountability and peer support for weight loss, providing nutrition/exercise weight loss strategies, and integrating mobile phone technologies into weight loss programs. Weight loss strategies for postpartum WIC participants should provide knowledge, support, accountability, and preferably integrate technology.

Delivering a Post-Partum Weight Loss Intervention via Facebook or In-Person Groups: Protocol for a Randomized Feasibility Pilot Trial.

BackgroundPostpartum weight retention contributes to long-term weight gain and obesity for many women. Lifestyle interventions with numerous visits are logistically challenging for many postpartum women. Delivering a lifestyle intervention via social media may overcome logistic challenges to participation in in-person weight loss programs.ObjectiveThe objective of this study is to conduct a randomized feasibility pilot trial of a 6-month postpartum weight loss intervention delivered via Facebook or in-person groups with 72 postpartum women with overweight or obesity.MethodsWomen with overweight or obesity who are 8 weeks to 12 months postpartum (N=72) will be recruited from the Hartford, Connecticut community. Eligible participants must also own an iPhone or Android smartphone and be an active Facebook user. Participants will receive a 6-month postpartum weight loss intervention based on the Diabetes Prevention Program lifestyle intervention and adapted for postpartum women. Participants will be randomized to receive the intervention via a private Facebook group or in-person group meetings. Assessments will occur at baseline, weekly during the intervention, at 6 months (at the end of the intervention), and at 12 months. Primary feasibility outcomes are recruitment, sustained participation, contamination, retention, and feasibility of assessment procedures including measurement of costs to deliver and receive the intervention. We will describe 6- and 12-month weight loss as an exploratory outcome.ResultsRecruitment began in September 2018. The first wave of the intervention began in February 2019, and the second wave of the intervention is expected to begin in fall 2019. We anticipate completing follow-up assessments in fall 2020, and results will be analyzed at that time.ConclusionsResults will inform the design of a large randomized controlled trial to assess whether delivering a postpartum weight loss intervention via Facebook is noninferior for weight loss and more cost-effective than delivering the intervention via traditional in-person groups.International Registered Report Identifier (IRRID)DERR1-10.2196/15530

Feasibility and Acceptability of Delivering a Postpartum Weight Loss Intervention via Facebook: A Pilot Study

ObjectiveTo evaluate the feasibility and acceptability of a Facebook-delivered postpartum weight loss intervention. MethodsOverweight and obese postpartum women received a 12-week weight loss intervention via Facebook. Feasibility outcomes were recruitment, retention, engagement, and acceptability. Weight loss was an exploratory outcome. ResultsParticipants (n = 19) were 3.5 (SD 2.2) months postpartum with a baseline body mass index of 30.1 (SD 4.2) kg/m2. Retention was 95%. Forty-two percent of participants visibly engaged on the last day of the intervention, and 100% in the last 4 weeks; 88% were likely or very likely to participate again and 82% were likely or very likely to recommend the program to a postpartum friend. Average 12-week weight loss was 4.8% (SD 4.2%); 58% lost ≥5%. Conclusions and ImplicationsFindings suggested that this Facebook-delivered intervention is feasible and acceptable and supports research to test efficacy for weight loss. Research is needed to determine how best to engage participants in social network–delivered weight loss interventions.

Two-year follow-up of a postpartum weight loss intervention: Results from a randomized controlled trial.

We recently reported that a 12-week diet intervention among postpartum women produced a weight loss of 12% after 1year, compared to 5% in controls. Here, we present 2-year results after 1year of unsupervised follow-up. In total, 110 women with a self-reported body mass index of ≥27kg/m2 at 6-15-week postpartum were randomized to diet group (D-group) or control group (C-group). D-group received a 12-week diet intervention by a dietitian followed by monthly e-mails up to the 1-year follow-up. C-group received a brochure on healthy eating. No contact was provided from 1 to 2years to either group. Eighty-nine women (81%) completed the 2-year follow-up. Median (1st; 3rd quartile) weight change from 0 to 2years was -6.9 (-11.0; -2.2) kg in D-group and -4.3 (-8.7; -0.2) kg in C-group. There was no group by time interaction at 2years (p=.082); however, when women with a new pregnancy between 1 and 2years were excluded, the interaction became significant (-8.2 vs. -4.6kg, p=.038). From 1 to 2years, women in D- and C-group gained 2.5±5.0kg and 1.1±4.4kg, respectively (p=.186). Women who gained weight from 1 to 2years reported a decrease in self-weighing frequency compared to women who maintained or lost weight (p=.008). Both groups achieved clinically relevant 2-year weight loss, but the significant between-group-difference observed at 1year was not maintained at 2years in the main analysis. However, when women with a new pregnancy between 1 and 2years were excluded, a significant weight loss effect was observed also at 2years.

Fresh Start, a postpartum weight loss intervention for diverse low-income women: design and methods for a randomized clinical trial.

BackgroundOverweight and obesity are prevalent among young women and are greater among minority and low-income women. The postpartum period is critical in women’s weight trajectories as many women do not lose their pregnancy weight, and others lose some and then plateau or experience weight gain. Excess weight puts women at greater risk of chronic disease and thus weight loss in the postpartum period may be key to the long-term health of young women. This paper describes the design and methods of a randomized clinical trial of Fresh Start, an innovative narrative-based group intervention aimed at promoting postpartum weight loss among low-income, diverse women.Methods/designStudy participants were recruited from the five sites of the Women, Infants and Children (WIC) program in central Massachusetts. Participants were English-speaking, age ≥ 18 years, 6 weeks to 6 months postpartum, with a body mass index (BMI) ≥ 27 kg/m2. The Fresh Start postpartum weight loss intervention, adapted from the Diabetes Prevention Program (DPP) in collaboration with WIC staff and clients, consisted of an 8-week group-based curriculum followed by nine monthly telephone calls. It included a narrative component (i.e., storytelling), group discussions, print materials and access to exercise facilities. The study is a two-arm randomized controlled trial. The control condition included print materials and access to exercise facilities. In-person assessments were conducted at baseline and at 6 and 12 months following the eight-week intervention phase.DiscussionThe Fresh Start intervention translated key elements of an evidence-based weight loss protocol into a format that is hypothesized to be relevant, acceptable and effective for the target audience of low-SES postpartum women. This novel intervention was developed in collaboration with WIC to be sustainable within the context of its clinics, which reach approximately 9 million individuals per year across the U.S. via 10,000 clinics.Trial registrationclinicaltrials.gov NCT02176915. Registered 25 June 2014.

Internet Use and Access Among Pregnant Women via Computer and Mobile Phone: Implications for Delivery of Perinatal Care.

BackgroundThe use of Internet-based behavioral programs may be an efficient, flexible method to enhance prenatal care and improve pregnancy outcomes. There are few data about access to, and use of, the Internet via computers and mobile phones among pregnant women.ObjectiveWe describe pregnant women’s access to, and use of, computers, mobile phones, and computer technologies (eg, Internet, blogs, chat rooms) in a southern United States population. We describe the willingness of pregnant women to participate in Internet-supported weight-loss interventions delivered via computers or mobile phones.MethodsWe conducted a cross-sectional survey among 100 pregnant women at a tertiary referral center ultrasound clinic in the southeast United States. Data were analyzed using Stata version 10 (StataCorp) and R (R Core Team 2013). Means and frequency procedures were used to describe demographic characteristics, access to computers and mobile phones, and use of specific Internet modalities. Chi-square testing was used to determine whether there were differences in technology access and Internet modality use according to age, race/ethnicity, income, or children in the home. The Fisher’s exact test was used to describe preferences to participate in Internet-based postpartum weight-loss interventions via computer versus mobile phone. Logistic regression was used to determine demographic characteristics associated with these preferences.ResultsThe study sample was 61.0% white, 26.0% black, 6.0% Hispanic, and 7.0% Asian with a mean age of 31.0 (SD 5.1). Most participants had access to a computer (89/100, 89.0%) or mobile phone (88/100, 88.0%) for at least 8 hours per week. Access remained high (>74%) across age groups, racial/ethnic groups, income levels, and number of children in the home. Internet/Web (94/100, 94.0%), email (90/100, 90.0%), and Facebook (50/100, 50.0%) were the most commonly used Internet technologies. Women aged less than 30 years were more likely to report use of Twitter and chat rooms compared to women 30 years of age or older. Of the participants, 82.0% (82/100) were fairly willing or very willing to participate in postpartum lifestyle intervention. Of the participants, 83.0% (83/100) were fairly willing or very willing to participate in an Internet intervention delivered via computer, while only 49.0% (49/100) were fairly willing or very willing to do so via mobile phone technology. Older women and women with children tended to be less likely to desire a mobile phone-based program.ConclusionsThere is broad access and use of computer and mobile phone technology among southern US pregnant women with varied demographic characteristics. Pregnant women are willing to participate in Internet-supported perinatal interventions. Our findings can inform the development of computer- and mobile phone-based approaches for the delivery of clinical and educational interventions.

Impact of Parity on Obesity: A Cross-Sectional Study in Iranian Women

Objective: The aim of the present study was to analyze whether or not parity influenced the prevalence of obesity in both pre- and postmenopausal women. Subjects and Methods: A cross-sectional study was conducted on characteristics of urban women regarding parity. A total of 1,620 women aged 45-63 years were selected using cluster sampling. A face-to-face household interview was conducted by trained, skillful personnel. A risk factor questionnaire was used to obtain information on reproductive history and sociodemographic factors. Statistical associations between parity and obesity using logistic regression were then investigated. Results: The mean BMI was 29.1 ± 5.1, and 96.8% of the sample population were parous, with a median of 4 births. Of the total women enrolled, 216 (13.3%) had <3 parities, while 1,404 (86.7%) had ≥3 parities. The prevalence of obesity (BMI ≥30) was 38.3%, diagnosed at a mean age of 51.4 ± 5.2 years. After adjustment for a range of potential confounders (age, marital status, employment, education, smoking status, abortion history, savings situation and menopausal status), women with ≥3 parities were at higher risk of being obese (OR 1.74, 95% CI 1.24-2.45; p = 0.001). Conclusion: A positive association was observed between the number of parities and obesity. The findings of this study suggest that the BMI is associated with high parity in Babolian women. Health policymakers should work with health providers to develop appropriate postpartum weight loss interventions.

Using technology to promote postpartum weight loss in urban, low-income mothers: a pilot randomized controlled trial.

To examine the feasibility, acceptability, and initial efficacy of a technology-based weight loss intervention for urban, low-income mothers. Eighteen obese, ethnic minority, socioeconomically disadvantaged mothers in the first year after childbirth were randomly assigned to either: 1) technology-based intervention, which included empirically supported behavior-change strategies, daily skills, and self-monitoring text messages with personalized feedback, biweekly counseling calls from a health coach, and access to a Facebook support group, or 2) usual-care control. After 14 weeks of treatment, the technology-based intervention participants had significantly greater weight loss (-2.9 ± 3.6 kg) than usual care (0.5 ± 2.3 kg; adjusted mean difference: -3.2 kg, 95% confidence interval -6.2 to -0.1 kg, P = .04). One-third of intervention participants (3 of 9) and no control participants lost > 5% of their initial body weight at follow up. Results suggest the potential for using technology to deliver a postpartum weight loss intervention among low-income racial/ethnic minorities.

Mama sana … usted sana: lessons learned from a postpartum weight loss intervention for Hispanic women with infants six months or less.

The purpose of this feasibility study was to assist limited English proficiency women predominately from Mexico (N = 24) to lose weight postpartum and establish effect sizes to power a randomized controlled pilot study. At 3 months, a small (0.20) effect size was noted in the experimental group compared to the control group in exercise, stress, and both the subscales of the eating self-efficacy scales. There was a medium (0.50) effect size noted in the experimental group compared to the control group in body mass index (BMI), nutrition, and exercise self-efficacy. There was a large (0.80) effect size noted in the experimental group compared to the control group in subscapular skinfolds and health responsibility.

Association Between Parity and Obesity in Mexican and Mexican–American Women: Findings from the Ella Binational Breast Cancer Study

Obesity at diagnosis of breast cancer is associated with higher all-cause mortality and treatment-associated toxicities. We evaluated the association between parity and obesity in the Ella study, a population of Mexican and Mexican-American breast cancer patients with high parity. Obesity outcomes included body mass index (BMI)≥30kg/m(2), waist circumference (WC)≥35 in (88cm), and waist-to-hip-ratio (WHR)≥0.85. Prevalence of obesity ([BMI]≥30kg/m(2)) was 38.9%. For WC, the multivariate odds ratio (OR) (95% confidence interval [CI]) for having WC≥35 inches in women with≥4 pregnancies relative to those with 1-2 pregnancies was 1.59 (1.01-2.47). Higher parity (≥4 pregnancies) was non-significantly associated with high BMI (OR=1.10; 95% CI 0.73-1.67). No positive association was observed for WHR. Our results suggest WC is independently associated with high parity in Hispanic women and may be an optimal target for post-partum weight loss interventions.

Predictors of breastfeeding in overweight and obese women: data from Active Mothers Postpartum (AMP).

Excess maternal weight has been negatively associated with breastfeeding. We examined correlates of breastfeeding initiation and intensity in a racially diverse sample of overweight and obese women. This paper presents a secondary analysis of data from 450 women enrolled in a postpartum weight loss intervention (Active Mothers Postpartum [AMP]). Sociodemographic measures and body mass index (BMI), collected at 6weeks postpartum, were examined for associations with breastfeeding initiation and lactation score (a measure combining duration and exclusivity of breastfeeding until 12months postpartum). Data were collected September 2004-April 2007. In multivariable analyses, BMI was negatively associated with both initiation of breastfeeding (OR: .96; CI: .92-.99) and lactation score (β -0.22; P=0.01). Education and infant gestational age were additional correlates of initiation, while race, working full-time, smoking, parity, and gestational age were additional correlates of lactation score. Some racial differences in these correlates were noted, but were not statistically significant. Belief that breastfeeding could aid postpartum weight loss was initially high, but unrelated to breastfeeding initiation or intensity. Maintenance of this belief over time, however, was associated with lower lactation scores. BMI was negatively correlated with breastfeeding initiation and intensity. Among overweight and obese women, unrealistic expectations regarding the effect of breastfeeding on weight loss may negatively impact breastfeeding duration. In general, overweight and obese women may need additional encouragement to initiate breastfeeding and to continue breastfeeding during the infant's first year.

Managing Excessive Weight Gain During Pregnancy and the Postpartum Period

Childbearing is a period in the life cycle during which some women may gain weight, become overweight, or become obese. Despite guidelines issued in 1990 for gestational weight gain, many women exceed them. Women who are overweight before pregnancy are most vulnerable to excessive gestational weight gain. Prenatal interventions to prevent excessive gain have had mixed results. During the postpartum period, 14% to 20% of women may retain weight from pregnancy, which elevates risk of later health problems. Although postpartum weight loss interventions have been shown to have efficacy, these have been tested primarily with White women. Continued efforts are needed in practice and research to develop effective approaches for managing weight during pregnancy and postpartum, especially for low-income and ethnic minority women.