Project Summary

Maternal unhealthy weight (excess weight gain during and after pregnancy) in the childbearing period results in maternal health inequities. Nutrition and physical activity counseling starting in pregnancy helps achieve maternal healthy weight and improve maternal and newborn infant health outcomes. Barriers to counseling and being able to enact recommendations include lack of access to counseling and lack of availability and affordability of nutritious food, physical activity spaces, and transportation to get to clinical and community resources. The goal of this study is to compare how three different approaches to overcome these barriers and provide nutrition and physical activity counseling improve maternal healthy weight in pregnancy and postpartum. 

Researchers will first compare two different interventions to usual care to see how they improve maternal healthy weight. Second, they will examine whether the two different interventions reduce racial and ethnic disparities in maternal unhealthy weight. Third, they will explore how, why and for whom the interventions may work best. The results will help patients, clinicians, health systems, community groups and health insurance payers decide what types of interventions work best and for whom relative to nutrition and physical activity counseling and how to address barriers to implementing counseling. 

Pregnant patients will be randomly selected to be in one of three study arms. Usual care includes training staff and providers in sensitive communication techniques. In usual care, patients are asked about challenges to food and other factors that influence health. Based on their response to those questions, they may receive help finding community resources. In intervention 1, patients are offered twice monthly grocery delivery, physical activity resources and transportation vouchers to help overcome barriers to healthy nutrition and physical activity as well as support access to clinic and community resources. They also receive information to help set their own goals for their health through texting, email or paper mailings. Intervention 2 is a community-based intervention led by community health workers (CHWs) who will assist patients with enrollment in desired community services and programs and provide health coaching in individual and group settings in-person, by phone, or by video. In group sessions, CHWs will actively lead skills-building sessions and physical activity group sessions. 

Researchers will include 1,500 pregnant patients (500 per arm) being seen for prenatal care at three health systems in New York City. The main outcome is maternal return to pre-pregnancy weight at 12 months postpartum. Secondary outcomes relate to food security, physical activity access, transportation access, maternal weight gain during pregnancy, diabetes during pregnancy, high blood pressure during pregnancy, complications during labor and delivery, mortality, and maternal cardiometabolic health at 12 months postpartum (blood pressure, glucose level). The timeframe to follow-up for the primary outcome is 16 months. 

Patient partners from our health systems, community stakeholders, clinicians and researchers are part of the project team and collaborated from the start of the project planning. External stakeholders will provide input at least one time per year and include health insurance payers, nutrition experts, policy and quality care experts, and community advisory boards. 

The core partnership includes a community principal investigator and research principal investigator with equal say in decisions. The broader award partnership includes researchers, community organizations, clinicians and health systems, public health and policy groups, and other stakeholders across New York City. Two community-based organizations and three distinct health systems are in the broader award partnership: Public Health Solutions, one of the largest nonprofit institutions in New York City; Northern Manhattan Perinatal Partnership, a nationally recognized organization in the areas of maternal and child health; Columbia University Irving Medical Center (Columbia/NYP) and Mailman School of Public Health; New York-Presbyterian Queens, which is joined with Columbia/NYP through the greater New York Presbyterian enterprise; and New York University Langone Health and its affiliates. Patient partners are included in the broader award partnership. In addition to the broader award partnership with patient partners and internal stakeholders across community, clinical and health systems, the study team has engaged with external stakeholders such as payers, nutrition programs, policy experts, quality care experts and community advisory boards for input.

Project Information

Jennifer Woo Baidal, M.D., MPH
Rachel Schwartz, BSN, MPH, MSW
Trustees of Columbia University in the City of New York
$20,999,785 *

Key Dates

72 months *
November 2023

*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.


Award Type
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: November 28, 2023