Project Summary

Arkansas is ranked fourth worst for maternal health outcomes among US states. Pregnant women living in rural and low-income areas have worse maternal outcomes, due in part to more challenging social determinants of health (SDoH), such as higher food insecurity and transportation barriers which constrain access to healthy food. In Arkansas, 49 percent of women experience excessive gestational weight gain (EGWG). EGWG is especially concerning among women who have overweight or obesity pre-pregnancy. Arkansas has the second highest prevalence of obesity among women in the United States with approximately 65 percent of women in Arkansas having overweight or obesity when they become pregnant. 

Women who have overweight or obesity pre-pregnancy are at greater risk of EGWG and its associated complications. A healthy diet during pregnancy promotes healthy weight gain; however, many pregnant women do not have access to healthy foods. This is especially true for low-income, rural, and/or food-insecure women who face financial and transportation barriers. Research that examined the impact of multiple SDoH on EGWG found that food insecurity and the resulting lack of access to a healthy diet had the greatest impact on EGWG, with pregnant women who were food-insecure having three times higher odds of EGWG when controlling for other factors. 

This study will conduct a large, rigorous, multisite randomized control trial (RCT), that compares the effectiveness of two multilevel interventions, Delivering HOPE (Helping Women Optimize Prenatal Equity) and ESoC, on maternal health outcomes. The ESoC intervention includes: 

  • Implementing a standard clinical protocol for nutritional and GWG counseling recommended for all pregnant women
  • Implementing a standard protocol for helping pregnant women sign up for WIC and SNAP at the clinic without going to another location 
  • Implementing a standard protocol providing referrals to safety net food organizations in their community 

The Delivering HOPE intervention includes the same nutritional and GWG counseling, helping participants sign up for WIC and SNAP if they are eligible, and referral to safety net food organizations in their community. In addition, Delivering HOPE will include grocery delivery of healthy foods to participants’ homes. Grocery delivery is well-established and increasingly covered by insurance companies. 

The RCT will answer the research question, “Does grocery delivery of healthy food during pregnancy (Delivering HOPE) reduce the proportion of women who experience EGWG compared to ESoC?” The study team will also implement an innovative mentored training and research experience with six early-career faculty from backgrounds underrepresented in research and conduct a hybrid type 1 implementation study of Delivering HOPE to document barriers and facilitators for implementation and identify feasible strategies to support broad implementation. 

The study’s specific aims are to: 

  • Compare the effectiveness of Delivering HOPE and ESoC among low-income, urban/nonurban (rural), and racially and ethnically diverse participants on EGWG (primary outcome), diet quality (secondary patient-reported/patient-centered outcome), and pregnancy and delivery complications (secondary clinical outcome) 
  • Implement an innovative mentored training and research experience with six early-career faculty from backgrounds underrepresented in research 
  • Conduct a hybrid type 1 implementation study of Delivering HOPE to document barriers and facilitators for implementation and identify feasible strategies to support broad implementation 

Results from this study have great potential to benefit the quality of pregnancy and postpartum care received by women in the United States. Given the importance of early detection and treatment of complications in the pregnancy and postpartum periods for reducing maternal mortality and morbidity, this study fills a critical gap in knowledge for clinical decision making. This study is particularly significant to scientific knowledge and clinical practice because it is translational to diverse populations, including rural and urban geographies, multiple races and ethnicities, and socioeconomic and insurance coverage status. 

The University of Arkansas for Medical Sciences (UAMS) is partnering with the Community Health Centers of Arkansas (CHCA) for this study. CHCA is a community-based organization that includes 11 different Federally Qualified Health Center organizations with more than 150 clinical locations across Arkansas, 121 of which provide maternity care. UAMS is the state’s only academic medical center and is the primary medical/health research organization for the state.

Project Information

Pearl McElfish, M.A., MBA, Ph.D.
Lanita White, PharmD
University of Arkansas for Medical Sciences
$17,499,997 *

Key Dates

60 months *
November 2023
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.

Tags

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