Gestational weight management in underserved mothers in the US.

Authors

Emily W Flanagan, Kaja Falkenhain, Robbie A Beyl, Abby D Altazan, S Ariel Richard, Hannah E Cabre, Chelsea L Kracht, Joshua R Sparks, Maryam Kebbe, L Anne Gilmore, Daniel S Hsia, John W Apolzan, Leanne M Redman

Published in

American journal of preventive medicine. Pages 108542. Aug 08, 2026. Epub Aug 08, 2026.

Abstract

Underserved pregnant individuals experience high risk for weight gain outside clinical guidelines and adverse perinatal outcomes. The Women, Infants, and Children (WIC) federal program assists underserved pregnant individuals with supplemental nutrition. WIC is positioned to disseminate interventions promoting recommended gestational weight gain, increasing access to efficacious programs and complementing clinical care.
Pregnant WIC participants were randomly assigned (2019-2023) to a co-developed multicomponent e-health intervention for gestational weight gain management or usual care between 10 and 16 weeks gestation. The primary outcome (analyzed 2025) was gestational weight gain guideline attainment. Secondary weight outcomes included study-observed weight gain, weekly weight gain, deviation from guidelines, fat mass gain, and change in energy balance behaviors. Adverse perinatal outcomes were exploratory.
Pregnant participants (n=351; 57% non-Hispanic Black) were enrolled (179 Intervention; 172 Usual Care) across 31 WIC clinics. The incidence of guideline attainment was not different between groups (both groups 17%; adjusted odds ratio, 1.05; 95% CI, 0.55 to 2.01; P=0.89). Study-observed weight gain (adjusted mean difference, -1.4 kg; 95% CI, -2.8 to -0.1; P=0.04), rate of weight gain (-0.07 kg/wk; 95% CI, -0.13 to -0.01; P=0.02), deviation from guidelines (-0.05 kg/wk; 95% CI, -0.10 to -0.00; P=0.03), and fat mass gain (-1.3 kg; 95% CI, -2.1 to -0.6; P<0.001) were lower in the Intervention Group compared to Usual Care. Change in energy intake was lower in the Intervention Group (306 kcals/day; 95% CI, -500 to -112; P=0.002). There were 43 cases (9% Intervention, 16% Usual Care) of preterm birth and 30 NICU admissions (7% Intervention, 11% Usual Care).
A remotely delivered lifestyle intervention concomitant with WIC care reduced gestational weight and fat mass gain. This approach demonstrates the potential for scalable interventions integrated into existing public health systems to expand access and inform public health strategies targeting maternal health disparities.
Trial registration: This study is registered at www.
gov NCT04028843.

PMID:
42570779
Bibliographic data and abstract were imported from PubMed on 09 Aug 2026.

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