A Dynamical Systems Model for Improving Gestational Weight Gain Behavioral Interventions.

Excessive gestational weight gain (GWG) represents a major public health concern. In this paper, we present a dynamical systems model that describes how a behavioral intervention can influence weight gain during pregnancy. The model relies on the integration of a mechanistic energy balance with a dynamical behavioral model. The behavioral model incorporates some well-accepted concepts from psychology: the Theory of Planned Behavior (TPB) and the principle of self-regulation which describes how internal processes within the individual can serve to reinforce the positive outcomes of an intervention. A hypothetical case study is presented to illustrate the basic workings of the model and demonstrate how the proper design of the intervention can counteract natural trends towards declines in healthy eating and reduced physical activity during the course of pregnancy. The model can be used by behavioral scientists to evaluate decision rules for adaptive time-varying behavioral interventions, or as the open-loop model for hybrid model predictive control algorithms acting as decision frameworks for such interventions.

Dynamic energy-balance model predicting gestational weight gain.

BACKGROUND: Gestational weight gains (GWGs) that exceed the 2009 Institute of Medicine recommended ranges increase risk of long-term postpartum weight retention; conversely, GWGs within the recommended ranges are more likely to result in positive maternal and fetal outcomes. Despite this evidence, recent epidemiologic studies have shown that the majority of pregnant women gain outside the target GWG ranges. A mathematical model that predicts GWG and energy intake could provide a clinical tool for setting precise goals during early pregnancy and continuous objective feedback throughout pregnancy. OBJECTIVE: The purpose of this study was to develop and validate a differential equation model for energy balance during pregnancy that predicts GWG that results from changes in energy intakes. DESIGN: A set of prepregnancy BMI-dependent mathematical models that predict GWG were developed by using data from a longitudinal study that measured gestational-changes in fat-free mass, fat mass, total body water, and total energy expenditure in 63 subjects. RESULTS: Mathematical models developed for women with low, normal, and high prepregnancy BMI were shown to fit the original data. In 2 independent studies used for validation, model predictions of fat-free mass, fat mass, and total body water matched actual measurements within 1 kg. CONCLUSIONS: Our energy-balance model provides plausible predictions of GWG that results from changes in energy intakes. Because the model was implemented as a Web-based applet, it can be widely used by pregnant women and their health care providers.