If pregnancy is a moment of joy and wonder, for women already struggling with weight issues, it can also be a period of profound uncertainty.

At a time when 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 National Academy of Medicine has revised its guidelines for gestational weight gain for pregnant women who are obese, research indicates nearly half of all U.S. women gain in excess of these guidelines, with overweight and obese women two to three times more likely to gain more than is recommended.

This is 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,” Alhusen said.

“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,” continued Alhusen, who, with Siega-Riz, received $100,000 from a UVA-INOVA seed grant and a Healthspan Project Award 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 the INOVA Health System in Washington, D.C.) who are less than 14 weeks pregnant 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.

The 10-week program has already begun at UVA Medical Center where a group of 10 local obese pregnant women gather each Tuesday evening for instruction in mindful eating and guided meditation with nursing faculty members, learning tools and concepts to bring home and practice each day. Their progress will be compared against 10 other locals who are receiving treatment as usual.

Over the course of the program, participants in the intervention groups 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 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 control groups at three junctures: the study’s outset, 34 to 35 weeks into gestation and six weeks after delivery. The team will also examine the effect of the new mindfulness eating program 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;
• 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 the mindfulness eating intervention’s structure and early introduction, before eating and mental health habits during pregnancy are set, will be important to their study’s success. They hope their 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 and illuminate our motivations for overeating,” said Seiga-Riz. “Our sincere hope is that this early introduction to mindful eating will make the difference for moms and babies battling the complexities of obesity.”