Maternal-Offspring Metabolics:Family Intervention Trial (MOMFIT)

• Gestational Weight Gain (GWG) [ Time Frame: 14-36 weeks ] [ Designated as safety issue: Yes ]
  The primary outcome is GWG as assessed continuously by the difference between the maternal weight measured at the baseline and at the 36 week visit.
  
  

• Gestational Diabetes [ Time Frame: up to 40 weeks ] [ Designated as safety issue: Yes ]
  OGTT will be administered at 24-26wks,as part of routine OB visit. Difference in incidence of Gestational diabetes between study groups will be documented.
  
  
• Diet and metabolomic assessment [ Time Frame: 14-37 wks ] [ Designated as safety issue: Yes ]
  Blood will be collected at Baseline, 24-26weeks,and 35-37weeks. Fasting glucose, lipids, C-reactive protein, vitamin D, leptin, adiponectin will be measured and observed for change.
  
  
• Insulin Resistance [ Time Frame: up to 40 weeks ] [ Designated as safety issue: Yes ]
  Insulin resistance will be measured with the assistance of a computer program which will yield the Homeostatic Model Assessment (HOMA)Score
  
  
• Neonatal Body measurements [ Time Frame: up to 40 weeks ] [ Designated as safety issue: No ]
  The following measures will be assessed at birth: weight, length,head circumference and %body fat as measured by PEAPOD
  
  
• Infant Body measurements [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  These following measurements will be assessed at one year of age for comparison to measurements at birth: weight,length and head circumference
  
  

A Randomized Control Trial is planned among ethnically diverse OW/OB pregnant women ages 18-45 years to be randomly assigned to the MOMFIT Active Intervention Group (AIG) or the Educational Control Group (ECG) plus standard obstetrical care. The DASH diet, along with moderate physical activity and group intervention as utilized in the Diabetes Prevention Program (DPP), will be adapted for pregnant and postpartum women through individual visits to tailor calorie/nutrient/activity goals, plus group coaching sessions and electronic self-monitoring behavior. Evidence based motivational interviewing and state of the art self-monitoring tools involving the Calorie King software will be adapted for pregnant/postpartum women via smartphone or Internet access, along with tailored feedback and encouragement from the Lifestyle Coach. Prevention of excessive GWG and achievement of the Institute Of Medicine (IOM) weight gain goals will be compared between groups, whether ongoing adherence to the lifestyle interventions can be sustained through postpartum intervention. Approximately one third of the participants are expected to be minorities and/or from low income backgrounds. The primary outcome is gestational weight gain from baseline (self-reported prepregnancy weight) to near delivery (36 weeks) compared with IOM goals in both groups and postpartum weight retention between 6 weeks and 12 months postpartum. Additional outcome variables include changes in maternal BMI and adiposity postpartum, blood pressure, blood glucose, insulin, HbA1c, CRP, and lipids, diet quality, and physical activity levels, offspring adiposity and anthropometrics, and glucose and C-peptide in cord blood