University of Virginia School of Nursing
Maternal obesity complicates nearly a third of American pregnancies, and overweight and obese women are two to three times more likely to gain weight in excess.

An icon of a clipboard to signify scholarship in symptom science. An icon of a stethoscope to signify scholarship in compassionate care. If pregnancy is a moment of joy and wonder, for women already struggling with weight issues, it’s also a moment of profound uncertainty.

In a period in which women are encouraged to eat healthfully, and gain some weight, obese women often struggle to understand just how much to eat and gain, given that their starting weight already places them at higher risk for obstetric complications including hypertension, cesarean birth, stillbirth and miscarriage. Too, babies born to obese women often face a rocky road after birth, with a higher incidence of problems at birth, like spina bifida, cleft lip and palate, and longer-term health problems into child- and adulthood, including an increased risk of diabetes and obesity.

And while the Institute of Medicine has revised its guidelines for gestational weight gain for pregnant women who are obese, research indicates that nearly half of all US women gain in excess of these guidelines, with overweight and obese women being two to three times more likely to gain more than is recommended.UVA Nursing professor Jeanne Alhusen says,

It’s precisely why a new pilot study on mindful eating during pregnancy led by University of Virginia School of Nursing professors Jeanne Alhusen and Anna Maria Siega-Riz aims to “break that cycle obesity exerts on moms and babies.”

“While we ideally want women to establish good eating habits before they become pregnant, for many of us, the moment we realize we’re pregnant is often the same one in which we realize we have to eat better and exercise more,” explains Alhusen, who, with Siega-Riz received a $100,000 grant to conduct the trial. “These women absolutely want what’s best for their babies, and so far, we’re finding that they’re very receptive to and excited about the concepts we’re introducing.”

In all, 60 pregnant obese women (20 at UVA and 40 at INOVA, in Washington, D.C.) who are less than 14 weeks gestation will be enrolled in the study. Half will be randomly selected to receive the novel mindful eating intervention – dubbed MB-PEAPOD, for Mindfulness Based Pregnancy Eating Awareness Promoting Optimal Development – which lasts ten weeks. Already at have begun meeting weekly for instruction in mindful eating and guided meditation with nursing faculty, learning tools and concepts to bring home and practice each day. Their progress will be compared against 10 other obese pregnant women who will not receive the intervention.

Over the program, participants will receive instruction in making sound meal and beverage choices, setting pre-meal intentions, practicing hunger awareness, noting emotional triggers for eating, and conducting daily body scans. They’ll be encouraged to practice mini-meditations before meals, and to develop a more acute sense of fullness, hunger and satisfaction. As their pregnancies progress, they’ll also be encouraged to contemplate the consequences of their eating habits and triggers on their baby’s growth and development. In addition, each participant receives a personalized diet guide (based on the USDA’s MyPlate for Pregnancy for the second and third trimester) with feedback from Siega-Riz, a maternal and child nutrition expert.

Researchers will collect data on weight gain and stress from both the intervention and usual care groups at three junctures: the study’s outset; 34 to 35 weeks gestation; and six weeks after delivery. Data collection will occur and coincide with routine obstetric / gynecological care appointments, and the team will also examine the effect of MB-PEAPOD on inflammatory markers of stress through blood draws.

The study’s aims are three:

•    to examine the effect of the mindful eating intervention on pregnant women’s physical and mental health outcomes, especially related to their gestational weight gain, their quality of life, depressive symptoms, perceived stress and any pregnancy complications they experience
•    to assess the effect of the eating intervention on mothers’ and infants’ health outcomes, including babies’ growth, feeding practices and maternal sensitivity and bonding
•    and finally, to explore the effect of the mindful eating intervention on inflammatory stress markers across pregnancy and in the postpartum period

Already, there is growing evidence that mindfulness has a beneficial effect on prenatal depression, anxiety, stress and self-compassion. Though previous studies have yielded some positive results, Alhusen and Siega-Riz believe that MB-PEAPOD’s structure and its early introduction will be key to their study’s success, before eating and mental health habits during pregnancy are set.

Their hope is that the MB-PEAPOD pilot will provide ample evidence for a larger-scale study down the road.

“We need a paradigm shift in the way we teach women to respond to satiety cues,” says Seiga-Riz, “and illuminating our motivations for overeating. Our sincere hope is that this early introduction to mindful eating will make the difference for moms and babies battling the complexities of obesity.”