Background Excess gestational weight gain (GWG) in pregnant adolescents is a major public health concern. Excess GWG increases risk of pregnancy complications as well as postpartum and offspring obesity and cardiometabolic disease. Prevention interventions for pregnant adults that target lifestyle modification (i.e., healthy eating/physical activity) show insufficient effectiveness. Pregnant adolescents have distinct social-emotional needs, which may contribute to excess GWG. From an interpersonal theoretical framework, conflict and low social support increase negative emotions, which in turn promote excess GWG through mechanisms such as overeating and physical inactivity. Methods The current manuscript describes the design of a pilot randomized controlled feasibility trial of adolescent interpersonal psychotherapy (IPT) to address social-emotional needs and prevent excess GWG. Up to 50 pregnant, healthy adolescents 13-19y, 12-18 weeks gestation are recruited from an interdisciplinary adolescent maternity hospital clinic and randomized to IPT + usual care or usual care alone. IPT involves 6 individual 60-minute sessions delivered by a trained behavioral health clinician during 12-30 weeks gestation. Sessions include relationship psychoeducation, emotion identification and expression, and teaching/role-playing communication skills. Between sessions, adolescents are instructed to complete a daily journal and to have conversations to work on relationship goals. Outcomes are assessed at baseline, mid-program, post-program, and 3-months postpartum. Primary outcomes are feasibility and acceptability based upon rate of recruitment, session attendance, program acceptability ratings, and follow-up retention. Secondary outcomes are perinatal social functioning, stress, depression, and eating behaviors assessed with validated surveys and interviews; perinatal physical activity and sleep measured via accelerometer; GWG from measured weights; and at 3-months postpartum only, maternal adiposity by dual energy x-ray absorptiometry, maternal insulin sensitivity derived from 2-hour oral glucose tolerance testing, and infant adiposity by air displacement plethysmography. Discussion This pilot trial will address a key gap in extant understanding of excess GWG prevention for a high-risk population of adolescents. If feasible and acceptable, brief psychotherapy to address social-emotional needs should be tested for its effectiveness to address excess GWG and postpartum maternal/infant health. If effective, such an approach has potential to interrupt an adverse, intergenerational cycle of social-emotional distress, obesity, and cardiometabolic disease among young mothers and their offspring. Trial registration ClinicalTrials.gov NCT03086161, retrospectively registered.

中文翻译：

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用于解决青少年社会情感需求和防止妊娠期体重过度增加的简短人际心理治疗的试验性随机对照可行性研究方案。

背景 怀孕少女的妊娠期体重过度增加 (GWG) 是一个主要的公共卫生问题。过量的 GWG 会增加妊娠并发症以及产后和后代肥胖和心脏代谢疾病的风险。针对生活方式改变（即健康饮食/身体活动）的孕妇预防干预显示效果不足。怀孕的青少年有不同的社会情感需求，这可能导致过度的 GWG。从人际理论框架来看，冲突和低社会支持会增加负面情绪，进而通过暴饮暴食和缺乏身体活动等机制促进过度的GWG。方法 目前的手稿描述了青少年人际关系心理治疗 (IPT) 的试点随机对照可行性试验的设计，以解决社会情感需求并防止过度的 GWG。从跨学科的青少年妇产医院诊所招募多达 50 名 13-19 岁、12-18 周妊娠的怀孕健康青少年，并随机分配接受 IPT + 常规护理或单独常规护理。IPT 包括由受过训练的行为健康临床医生在妊娠 12-30 周期间提供的 6 个单独的 60 分钟会话。课程包括关系心理教育、情感识别和表达以及教学/角色扮演沟通技巧。在会话之间，指导青少年完成每日日记并进行对话以实现关系目标。结果在基线、项目中期、程序后和产后 3 个月。主要结果是基于招聘率、会议出席率、项目可接受性评级和后续保留率的可行性和可接受性。次要结果是通过经过验证的调查和访谈评估的围产期社会功能、压力、抑郁和饮食行为；通过加速度计测量围产期身体活动和睡眠；来自测量重量的 GWG；仅在产后 3 个月时，通过双能 X 射线吸收测定法检测产妇肥胖，通过 2 小时口服葡萄糖耐量测试得出产妇胰岛素敏感性，通过空气置换体积描记法检测婴儿肥胖。讨论 该试验性试验将解决对青少年高危人群过度 GWG 预防的现有理解的关键差距。如果可行且可接受，应对社会情感需求的简短心理治疗应测试其解决过度 GWG 和产后母婴健康的有效性。如果有效，这种方法有可能中断年轻母亲及其后代的社会情绪困扰、肥胖和心脏代谢疾病的不利代际循环。试验注册 ClinicalTrials.gov NCT03086161，回顾性注册。