BOSTON – A systems-wide program that integrates clinical and public health services during pregnancy to address behavioral and social risk factors can reduce the prevalence of excess gestational weight gain among women who were overweight at the start of their pregnancy, researchers at Massachusetts General Hospital (MGH) have found.

A new study published in Obstetrics & Gynecology describes how a program known as First 1,000 Days – which provides weight gain tracking, screening, coaching, education and social needs support from early pregnancy through the first 24 months of childhood – enabled mothers who were overweight at the start of pregnancy to reduce their odds of excess weight gain by nearly a third.

“Excess maternal weight gain is a known risk factor for pregnancy complications, postpartum weight retention and childhood obesity in the offspring,” said Tiffany Blake-Lamb, MD, investigator in the Department of Obstetrics and Gynecology at MGH and lead author of the study. “Rather than provide a single intervention, the First 1,000 Days program was designed to promote maternal health and reduce excess maternal weight gain by integrating a variety of health-enhancing interventions within the system of prenatal care received by all women at the participating health centers.”

First 1,000 Days is a new program developed by various stakeholders across clinical and public health sectors. Its goal is to reduce obesity risk factors and the development of obesity by engaging the mother from the first trimester of pregnancy, as well as their partner and child through the first two years of life.

The program reinforces such behavioral imperatives during pregnancy as eating a healthy diet, being physically active, getting plenty of sleep and reducing daily stress by linking mothers to behavioral and social support services. For their study, the researchers designed and implemented the systems-wide interventions at two nearby community health centers serving predominantly low-income, racial and ethnic minority populations.

More than 900 women participated in First 1,000 Days at these twin health centers. In addition to staff training, the program developed a text messaging component that sent two to three messages per week to participants, as well as provided access to a library of more than 50 short informational videos available online in English and Spanish to reinforce the behavioral and socio-contextual goals of the program.

Universal screening was implemented to identify the social needs of participants – including food and housing security and strategies to cope with excess life stress and social isolation – in response to which patient navigators were available to connect those in need to appropriate community resources.

Over the course of the two-and-a-half year study, women who began pregnancy in the overweight category, with a body mass index (BMI) between 25 and 30, showed a nearly 10 percent reduction in prevalence of excess gestational weight gain, the MGH researchers found. Moreover, these women reduced their odds of gaining excess weight by 31 percent.

“It was clear from our research that a systems-level intervention that integrates clinical and public health components of a woman’s prenatal care has the potential to improve population-wide pregnancy outcomes and the long-term health of mothers and their children,” said Elsie Taveras, MD, MPH, chief of the Division of General Academic Pediatrics at MGH and senior investigator of the study.

“We also observed that women who stood to benefit most from the program were those who had the most contact with its touchpoints. These included individual health coaching, which was available to women who were deemed to be at greatest risk of weight gain.”

Similar benefits from program participation, however, were not observed by researchers among women entering pregnancy with clinical obesity – a BMI of 30 and above.

“The fact that we didn’t see a statistically significant impact among women with clinical obesity at the start of their pregnancy suggests that more intensive interventions might be needed, in addition to the systems-level work we implemented,” Blake-Lamb emphasized. “Our overriding goal is to create a program in which interventions are beneficial, sustainable and transferable to other maternal healthcare settings across the country.”

Additional co-authors of the study published in Obstetrics & Gynecology were Alexy Arauz Boudreau, MD, MPH, Milt Kotelchuck, PhD, MPH, and Derri Shtasel from MGH, and Erika Cheng, PhD, MPA, from Indiana University School of Medicine.

The study was supported by funding from The Boston Foundation, the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (NIH), and Massachusetts General Hospital.

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $1 billion and comprises more than 8,500 researchers working across more than 30 institutes, centers and departments. In August 2019 the MGH was once again named #2 in the nation by U.S. News & World Report in its list of "America’s Best Hospitals."