The moderating role of the built environment in prenatal lifestyle interventions

• Published in: International Journal of Obesity Vol. 45; no. 6; pp. 1357 - 1361
• Main Authors: Phelan, Suzanne, Marquez, Fred, Redman, Leanne M., Arteaga, Sonia, Clifton, Rebecca, Grice, Brian A., Haire-Joshu, Debra, Martin, Corby K., Myers, Candice A., Pomeroy, Jeremy, Vincent, Eileen, Van Horn, Linda, Peaceman, Alan, Ashby-Thompson, Maxine, Gallagher, Dympna, Pi-Sunyer, Xavier, Boekhoudt, Trisha, Drews, Kimberly, Brown, Greg
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.06.2021; Nature Publishing Group
• Subjects: 692/308/2779/777; 692/700/2817; Adult; Body weight; Body weight gain; Brief Communication; Built environment; Built Environment - statistics & numerical data; Canopies; Clinical trials; Coefficients; Crime; Density; Epidemiology; Fast food; Female; Food; Geographic information systems; Gestation; Gestational Weight Gain - physiology; Health aspects; Health Promotion and Disease Prevention; Humans; Internal Medicine; Intervention; Life Style; Lifestyles; Medicine; Medicine & Public Health; Metabolic Diseases; Obesity; Obesity - epidemiology; Overweight; Overweight - epidemiology; Pregnancy; Pregnancy Complications - epidemiology; Pregnant women; Prevention; Public Health; Remote sensing; Residence Characteristics; Restaurants; Risk factors; Urban environments; Walking - statistics & numerical data; Weight gain; United States
• ISSN: 0307-0565; 1476-5497; 1476-5497
• DOI: 10.1038/s41366-021-00782-w

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.