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Brown SD, Garcia BL, Ritchie JL, Tsai AL, Millman A, Greenberg M, Quesenberry CP, Ferrara A. Digital health outreach to promote postpartum screening after gestational diabetes: A randomized factorial pilot study. PEC INNOVATION 2024; 4:100256. [PMID: 38282680 PMCID: PMC10818066 DOI: 10.1016/j.pecinn.2024.100256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 12/18/2023] [Accepted: 01/17/2024] [Indexed: 01/30/2024]
Abstract
Objective We examined the acceptability and feasibility of a multi-component digital health outreach intervention to promote uptake of guideline-recommended postpartum screening for type 2 diabetes among patients with gestational diabetes (GDM). Methods We conducted a 24 randomized factorial experiment as part of the Multiphase Optimization Strategy (MOST) preparation phase for developing behavioral interventions. Participants with current or recent GDM in an integrated healthcare system were randomized to receive an outreach message with up to four intervention components, designed to be self-administered in about 10 min and efficiently delivered online via REDCap: a streamlined values affirmation, personalized information on diabetes risk, an interactive motivational interviewing-based component, and an interactive action planning component. Patient-reported acceptability and feasibility outcomes were assessed via survey. Results Among 162 participants, 72% self-identified with a racial/ethnic minority group. Across components, acceptability scores averaged 3.9/5; ≥91% of participants read most or all of the outreach message; ≥89% perceived the amount of information as "about right"; and ≥ 87% completed ≥1 interactive prompt. Conclusion Each intervention component was acceptable to diverse patients and feasible to deliver in a brief, self-directed, online format. Innovation These novel components target unaddressed barriers to patient engagement in guideline-recommended postpartum diabetes screening and adapt theory-based behavior change techniques for large-scale use.
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Affiliation(s)
- Susan D. Brown
- Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Brittany L. Garcia
- Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - Jenna L. Ritchie
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Ai-Lin Tsai
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Andrea Millman
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Mara Greenberg
- Regional Perinatal Service Center, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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Ioannou E, Humphreys H, Homer C, Purvis A. Preventing Type 2 Diabetes after Gestational Diabetes: A Systematic Review Mapping Physical Activity Components using the Socio-Ecological Model. Matern Child Health J 2024; 28:1354-1379. [PMID: 38829517 PMCID: PMC11269493 DOI: 10.1007/s10995-024-03948-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVES Gestational diabetes commonly occurs during pregnancy and increases lifetime risk of type 2 diabetes following pregnancy. Engaging in physical activity postnatally can reduce this subsequent risk. Interventions aiming to increase physical activity after gestational diabetes may not address the wide range of post-pregnancy barriers. A socio-ecological approach highlights the need to include multi-level factors such as social, community and organisational factors. The aim of the review was to map intervention components to prevent type 2 diabetes after gestational diabetes using the socio-ecological model as a framework and investigate how physical activity changes align with different intervention components utilised. METHODS Eligible studies included any study type within 5 years of a gestational diabetes diagnosis and targeted physical activity. A systematic search of MEDLINE, Cochrane Library, Web of Science, CINAHL Complete, and Scopus was conducted in October 2022. Results were categorised based on whether findings demonstrated no increases, non-statistically significant increases or statistically significant increases in physical activity. RESULTS Forty-eight studies were included (37 different interventions). Thirty-eight studies were assessed as "adequate" quality, only two studies were "good" quality, and the remaining were limited quality. Mixed physical activity outcomes were observed across components used at the intrapersonal level, with components across other levels of the socio-ecological model showing more increases in physical activity. Intervention components within the social and organisational levels, for example childcare provision, providing group-based sessions and offering remote delivery, were more often present in interventions with physical activity increases. CONCLUSIONS FOR PRACTICE Future interventions targeting physical activity after gestational diabetes should aim to include social and organisational-level components in their intervention design. This systematic review was registered in PROSPERO (ID: CRD42021272044).
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Affiliation(s)
- Elysa Ioannou
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, UK.
| | - Helen Humphreys
- Centre for Behavioural Science and Applied Psychology (CeBSAP), Sheffield Hallam University, Sheffield, UK
| | - Catherine Homer
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Alison Purvis
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, UK
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Sundarapperuma TD, Katulanda P, Wijesinghe CJ, Hettiarachchi P, Wasalathanthri S. The impact of a culturally adapted lifestyle intervention on the glycaemic profile of mothers with GDM one year after delivery - a community-based, cluster randomized trial in Sri Lanka. BMC Endocr Disord 2024; 24:104. [PMID: 38977979 PMCID: PMC11229281 DOI: 10.1186/s12902-024-01643-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/02/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND A woman with a history of GDM has a high risk of developing type two diabetes (T2DM) in her future life. Lifestyle modifications are known to attenuate the progression of GDM to T2DM. Therefore, the aim of this study was to assess the impact of a simple, cost effective, culturally acceptable lifestyle intervention programme on the trajectory towards T2DM in women with a history of GDM. METHODS This cluster randomized trial was conducted in 100 postpartum women in three selected districts of Sri Lanka. The subjects were divided into intervention (n = 50) and control groups (n = 50) by cluster randomization method. A culturally adapted protocol (comprised of dietary and physical activity modifications) was administered to the intervention group. The glycemic profile was assessed using fasting and 2-hour post-OGTT plasma glucose and HbA1c, and insulin resistance by HOMA-IR at baseline and after one year of intervention. RESULTS The mean age (SD) of the subjects in the intervention and control groups were 33.0 (5.1) and 34.3 (6.5) years respectively. All glycemic and insulin resistance parameters (i.e. Fasting plasma glucose- FPG, 2-hour post-OGTT plasma glucose, HbA1c and HOMA-ir) were comparable (p > 0.05) between the two groups at baseline. FPG, 2 h post OGTT, HbA1c and HOMA-ir values between intervention vs. control (p) at 12 months were 87.3 vs. 123.2 (< 0.01); 106.5 vs. 156.1 (0.01); 5.3 vs. 6.8 (< 0.01) and 0.9 vs. 2.3 (< 0.01) respectively. All glycemic parameters showed a significant reduction in the intervention group at 12 months compared to baseline. In contrast, the control group showed a significant increase in FPG, 2-hour post-OGTT plasma glucose and HbA1c at 12 months compared to baseline. In multiple linear regression model adjusted for age, parity and family history, the control group showed an approximately 33 times risk of developing insulin resistance compared to the intervention group. CONCLUSION The culturally acceptable and individualized lifestyle intervention was able to produce remarkable reductions in glycaemic and insulin resistance parameters among postpartum women with a history of GDM. TRIAL REGISTRATION Ethical clearance was obtained from the Ethics Review Committee of the University of Sri Jayewardenepura, Sri Lanka (ERC 52/14), Sri Lanka Clinical trial registration number Sri Lanka Clinical Trials Registry (SLCTR/2015/021 date 25.09.2015).
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Affiliation(s)
- Thamudi D Sundarapperuma
- Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Galle, 80000, Sri Lanka.
| | - Prasad Katulanda
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, 00800, Sri Lanka
| | - Champa J Wijesinghe
- Department of Community Medicine, Faculty of Medicine, University of Ruhuna, Galle, 80000, Sri Lanka
| | - Priyadarshika Hettiarachchi
- Department of Physiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, 11222, Sri Lanka
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Thompson DA, Haemer MA, Krebs NF, Pereira RI, Moss A, Furniss AL, Bonczynski J, Nicklas JM. A WIC-Based Behavior Change Intervention for Postpartum Women With Overweight and Obesity: A Pilot Feasibility Randomized Trial. Health Promot Pract 2024; 25:677-688. [PMID: 37226873 PMCID: PMC10674029 DOI: 10.1177/15248399231173704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Background. Postpartum weight retention is a risk factor for obesity and is particularly important among Hispanic women who have an increased rate of obesity. Given its broad reach, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program provides an ideal setting to implement community-based interventions for low-income postpartum women. Purpose. To examine the feasibility, acceptability, and preliminary efficacy of a multicomponent intervention delivered by staff within the WIC program designed to promote behavior changes in urban, postpartum women with overweight/obesity. Method. This was a 12-week pilot trial randomizing participants to a health behavior change (Intervention) or control (Observation) group. The Intervention included monthly visits with trained WIC staff providing patient-centered behavior change counseling, with multiple touchpoints between visits promoting self-monitoring and offering health behavior change support. Results. Participants (n = 41), who were mainly Hispanic (n = 37, 90%) and Spanish-speaking (n = 33, 81%), were randomized to the Intervention (n = 19) or Observation (n = 22) group. In the Intervention group, 79% (n = 15) of eligible participants were retained for the study duration. All Intervention participants endorsed that they would participate again. Regarding physical activity, participant readiness to change and self-efficacy improved for Intervention participants. About one-quarter of women in the Intervention group (27%, n = 4) had a 5% weight loss compared with one woman (5%) in the Observation group; this difference was not statistically significant (p = .10). Conclusions. This pilot demonstrated the feasibility and acceptability of delivering a low-intensity behavior change intervention within the WIC setting for postpartum women with overweight/obesity. Findings support the role of WIC in addressing postpartum obesity.
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Affiliation(s)
- Darcy A Thompson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Matthew A Haemer
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Nancy F Krebs
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Rocio I Pereira
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Angela Moss
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Anna L Furniss
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Jacinda M Nicklas
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
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Bodnar LM, Johansson K, Himes KP, Khodyakov D, Abrams B, Parisi SM, Hutcheon JA. Gestational weight gain below recommendations and adverse maternal and child health outcomes for pregnancies with overweight or obesity: a United States cohort study. Am J Clin Nutr 2024:S0002-9165(24)00583-5. [PMID: 38942117 DOI: 10.1016/j.ajcnut.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 06/03/2024] [Accepted: 06/24/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND The current Institute of Medicine (IOM) pregnancy weight gain guidelines were developed using the best available evidence but were limited by substantial knowledge gaps. Some have raised concern that the guidelines for individuals affected by overweight or obesity are too high and contribute to short- and long-term complications for the mother and child. OBJECTIVES To determine the association between pregnancy weight gain below the lower limit of the current IOM recommendations and risk of 10 adverse maternal and child health outcomes among individuals with overweight and obesity. METHODS We used data from a prospective cohort study of United States nulliparae with prepregnancy overweight (n = 955) or obesity (n = 897) followed from the first trimester to 2-7 y postpartum. We used multivariable Poisson regression to relate pregnancy weight gain z-scores with a severity-weighted composite outcome consisting of ≥1 of 10 adverse outcomes (gestational diabetes, preeclampsia, unplanned cesarean delivery, maternal postpartum weight increase >10 kg, maternal postpartum metabolic syndrome, infant death, stillbirth, preterm birth, small-for-gestational age birth, and childhood obesity). RESULTS Pregnancy weight gain z-scores below, within, and above the IOM-recommended ranges occurred in 5%, 13%, and 80% of pregnancies with overweight and 17%, 13%, and 70% of pregnancies with obesity. There was a positive association between pregnancy weight gain z-scores and all adverse maternal outcomes, childhood obesity, and the composite outcome. Pregnancy weight gain z-scores below the lower limit of the recommended ranges (<6.8 kg for overweight, <5 kg for obesity) were not associated with the severity-weighted composite outcome. For example, compared with the lower limit, adjusted rate ratios (95% confidence interval) for z-scores of -2 standard deviations in pregnancies with overweight (equivalent to 3.6 kg at 40 wk) and obesity (-2.8 kg at 40 wk) were 0.99 (95% confidence interval [CI]: 0.91, 1.06) and 0.97 (95% CI: 0.87, 1.07). CONCLUSIONS These findings support arguments to decrease the lower limit of recommended weight gain ranges in these prepregnancy body mass index groups.
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Affiliation(s)
- Lisa M Bodnar
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States; Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States; Magee-Womens Research Institute, Pittsburgh, PA, United States.
| | - Kari Johansson
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Katherine P Himes
- Department of Obstetrics and Gynecology, Dartmouth Hitchcock Medical Center, Hanover, NH, United States
| | | | - Barbara Abrams
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Sara M Parisi
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jennifer A Hutcheon
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
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Dennison RA, Oliver-Williams C, Qi HLJ, Kotecha D, Seed L, Ward RJ, Griffin SJ. The effectiveness of pharmacological and lifestyle interventions to reduce the risk of diabetes and hyperglycaemia following gestational diabetes: A systematic review and meta-analysis. Diabet Med 2024; 41:e15316. [PMID: 38553834 DOI: 10.1111/dme.15316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 01/31/2024] [Accepted: 03/11/2024] [Indexed: 05/12/2024]
Abstract
AIMS To synthesize the available evidence to better understand the effectiveness of interventions to prevent or delay hyperglycaemia and Type 2 diabetes mellitus (T2DM) postnatally in women with current or previous gestational diabetes mellitus (GDM). METHODS We searched five databases up to December 2020 for primary peer-reviewed articles reporting postpartum glycaemic outcomes in women with (previous) GDM following pharmacological or lifestyle intervention. Outcomes were relative risk of T2DM or continuous measures of glycaemia, change or at follow-up. A minimum of two studies evaluating the same intervention-outcome combination were needed to conduct meta-analyses, otherwise studies were described narratively. Meta-regression was used to evaluate whether associations varied by additional variables. We assessed risk of bias using the Critical Appraisal Skills Programme checklist. PROSPERO record CRD42018102380. RESULTS We included 31 studies in the review with a total sample size of 8624 participants, and 26 studies in meta-analyses. Two-thirds of studies followed up participants at 1 year or less. Pharmacological interventions were associated with reduced risk of T2DM (0.80 [95% CI 0.64-1.00], n = 6 studies), as were lifestyle interventions albeit with a smaller effect size (0.88 [95% CI 0.76-1.01], n = 12 studies). Dietary and physical activity interventions were associated with a small reduction in fasting plasma glucose, particularly in longer interventions, but inconsistent effects were seen for other continuous outcomes. CONCLUSIONS Although possibly due to chance, interventions to reduce hyperglycaemia after GDM may be effective. Future research should improve understanding of how interventions affect glucose control and how to optimise interventions for this population.
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Affiliation(s)
- Rebecca A Dennison
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Helen Lin Jia Qi
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Deeya Kotecha
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Lydia Seed
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Rebecca J Ward
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Simon J Griffin
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Tsoi KY, Chan RCM, Zhang C, Tam WH, Ma RCW. A randomized controlled trial to evaluate the effects of an early postnatal lifestyle modification program on diet, adiposity and metabolic outcome in mothers with gestational diabetes mellitus. Int J Gynaecol Obstet 2024. [PMID: 38651286 DOI: 10.1002/ijgo.15521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/01/2024] [Accepted: 03/24/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE The aim of the present study was to evaluate the effectiveness of a 12-month early postnatal lifestyle intervention program in women with gestational diabetes in a recent pregnancy. METHODS This study was a prospective randomized intervention study conducted at a diabetes center in Hong Kong. Chinese women aged 18-45 years, who developed gestational diabetes mellitus (GDM) in their most recent pregnancy, were invited. Eligible women were randomized in 1:1 ratio at baseline (6-12 weeks postpartum), to standard care or lifestyle intervention (diet and physical activity) groups for 12 months. A standardized biochemistry assessment including oral glucose tolerance test, blood lipids, complete blood count, renal and liver functions, were measured at baseline and at 12-month. Anthropometry assessment and lifestyle questionnaire were performed at various timepoints. RESULTS A total of 103 women were randomized at baseline and a total of 79 women (standard care, n = 39, intervention, n = 40) completed the assessment. After the 12-month study period, women in the intervention group had significantly lower energy intake (intervention, -497.6 ± 488.3 kcal; standard, -222.0 ± 390.0 kcal, P < 0.01) compared to the standard care group, and a trend towards greater weight reduction (intervention, -0.93 ± 4.68 kg; standard, -0.01 ± 3.12 kg, P = 0.36). CONCLUSION The lifestyle intervention implemented within 3 months postpartum appeared to promote postpartum weight loss. The early postnatal lifestyle intervention program may provide an opportunity to reduce the long-term risk of diabetes in this high-risk population.
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Affiliation(s)
- Kit Ying Tsoi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Ruth C M Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Cuilin Zhang
- Global Center for Asian Women's Health & Bia-Echo Asia Center for Reproductive Longevity and Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Obstetrics and Gynecology, National University of Singapore, Singapore
| | - Wing Hung Tam
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, The Chinese University of Hong Kong, Hong Kong, China
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Anguzu R, Livergood CM, Hoppe KK, Kulinski J, Fitzgerald GD, Palatnik A. Association between body mass index and chronic hypertension in patients with hypertension disorders of pregnancy one-year postpartum. Pregnancy Hypertens 2024; 35:32-36. [PMID: 38134483 PMCID: PMC10939881 DOI: 10.1016/j.preghy.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 12/04/2023] [Accepted: 12/17/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES To determine the association between body mass index (BMI) and chronic hypertension (CHTN) one-year postpartum following pregnancies complicated by hypertensive disorders of pregnancy (HDP). STUDY DESIGN A retrospective cohort study of patients with HDP (gestational hypertension or preeclampsia) in a single Midwestern academic center from 2014 to 2018. The primary outcome was CHTN at one-year postpartum, defined as systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥ 80 mmHg or taking antihypertensive medication at one-year postpartum. The primary exposure variable was BMI at one-year postpartum, categorized as underweight (<18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25-<30 kg/m2), and obese (≥30 kg/m2) and as continuous BMI variable. Descriptive statistics and adjusted logistic regression analysis were performed. RESULTS Out of 596 patients with HDP included in this analysis, 275 (46.1 %) had CHTN one-year postpartum. Mean one-year postpartum BMI was 27.9 ± 5.2 kg/m2. Prevalence of CHTN at one-year postpartum was higher in obese (38.1 %) and overweight (30.0 %) groups compared to the normal weight group (29.9 %), p < 0.001. In multivariate logistic regression, obesity at one-year postpartum, compared to normal, was associated with 73 % higher likelihood of CHTN following HDP (adjusted OR 1.73, 95 % CI 1.06-2.84). With BMI as a continuous variable, each unit increase in BMI one-year postpartum was associated with 6 % higher likelihood of CHTN (adjusted OR 1.06, 95 % CI 1.02-1.15). CONCLUSIONS Obesity at one-year postpartum following HDP was associated with a higher risk of CHTN compared with normal BMI. Weight is a modifiable risk factor that should be targeted in postpartum interventions to reduce cardiovascular disease following HDP.
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Affiliation(s)
- Ronald Anguzu
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Christine M Livergood
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kara K Hoppe
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin-Madison School of Medicine and Public Health, WI, USA
| | - Jacquelyn Kulinski
- Department of Medicine, Division of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA; Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Garrett D Fitzgerald
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anna Palatnik
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA; Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA
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Lewey J, Beckie TM, Brown HL, Brown SD, Garovic VD, Khan SS, Miller EC, Sharma G, Mehta LS. Opportunities in the Postpartum Period to Reduce Cardiovascular Disease Risk After Adverse Pregnancy Outcomes: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e330-e346. [PMID: 38346104 PMCID: PMC11185178 DOI: 10.1161/cir.0000000000001212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Adverse pregnancy outcomes are common among pregnant individuals and are associated with long-term risk of cardiovascular disease. Individuals with adverse pregnancy outcomes also have an increased incidence of cardiovascular disease risk factors after delivery. Despite this, evidence-based approaches to managing these patients after pregnancy to reduce cardiovascular disease risk are lacking. In this scientific statement, we review the current evidence on interpregnancy and postpartum preventive strategies, blood pressure management, and lifestyle interventions for optimizing cardiovascular disease using the American Heart Association Life's Essential 8 framework. Clinical, health system, and community-level interventions can be used to engage postpartum individuals and to reach populations who experience the highest burden of adverse pregnancy outcomes and cardiovascular disease. Future trials are needed to improve screening of subclinical cardiovascular disease in individuals with a history of adverse pregnancy outcomes, before the onset of symptomatic disease. Interventions in the fourth trimester, defined as the 12 weeks after delivery, have great potential to improve cardiovascular health across the life course.
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Quansah DY, Gilbert L, Arhab A, Gonzalez-Rodriguez E, Hans D, Gross J, Lanzi S, Stuijfzand B, Lacroix A, Horsch A, Puder JJ. Effect of a prepartum and postpartum, complex interdisciplinary lifestyle and psychosocial intervention on metabolic and mental health outcomes in women with gestational diabetes mellitus (the MySweetheart trial): randomised, single centred, blinded, controlled trial. BMJ MEDICINE 2024; 3:e000588. [PMID: 38348309 PMCID: PMC10860000 DOI: 10.1136/bmjmed-2023-000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 01/07/2024] [Indexed: 02/15/2024]
Abstract
Objective To test the effect of a complex, interdisciplinary, lifestyle and psychosocial intervention on metabolic and mental health outcomes in women with gestational diabetes mellitus during pregnancy and in the post partum. Design Single centred, single blinded, randomised, controlled trial (the MySweetheart trial). Setting Lausanne University Hospital, Switzerland, from 2 September 2016 to 25 October 2021. Participants 211 women aged at least 18 years with a diagnosis of gestational diabetes mellitus at 24-32 gestational weeks were randomly assigned (1:1) to the intervention (n=105) or to usual care (n=106). Interventions In addition to a comparator based on active guidelines for prepartum and postpartum usual care, the intervention consisted of four individual lifestyle visits during pregnancy and four interdisciplinary visits in the postpartum group, a peer support group workshop in pregnancy and post partum, and a bimonthly lifestyle coach support through telemedicine. The intervention focused on tailored behavioural and psychosocial strategies to improve diet, physical activity, mental health, social support, and adherence to gestational weight gain during pregnancy and weight retention recommendations. Main outcome measures Primary outcomes were between-group differences in the decrease in maternal weight and depression symptom scores between baseline and one year post partum. Secondary outcomes included changes in total and central body fat, anxiety, wellbeing, glycaemic parameters (homeostatic model assessment for insulin resistance (known as HOMA-IR) and Matsuda indices), aerobic fitness (maximal oxygen uptake), gestational weight gain, and weight retention. Assessors were blinded to primary and secondary outcomes. Results 84 (80%) of 105 women in the intervention and 95 (90%) of 106 in the usual care completed the study. There was not enough evidence of a difference in the decrease in weight (mean difference -0.38 kg (95% confidence interval -2.08 to 1.30)) or depression scores (-0.67 (-1.84 to 0.49)). The intervention led to an increase in fat-free mass (0.02 kg (0.01 to 0.03)). The intervention also decreased gestational weight gain since the first gestational diabetes mellitus visit (-1.20 kg (-2.14 to -0.26)) and weekly weight gain throughout the entire pregnancy (-0.14 kg (-0.25 to -0.03)), and led to a higher proportion of women without weight retention at one year post partum (34.1% (28/82) v 20.8% (20/96), P=0.034). Conclusions Compared with active usual care based on guidelines, there was not enough evidence to conclude that the intervention led to decrease in weight or depression symptoms. However, the intervention decreased gestational weight gain and increased the proportion of women without weight retention. Trial registration Clinicaltrials.gov NCT02890693.
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Affiliation(s)
- Dan Yedu Quansah
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Leah Gilbert
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Amar Arhab
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Elena Gonzalez-Rodriguez
- Interdisciplinary Center of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Didier Hans
- Interdisciplinary Center of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Justine Gross
- Service of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Stefano Lanzi
- Heart and Vessel Department, Division of Angiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Bobby Stuijfzand
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Alain Lacroix
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Lausanne, Switzerland
- Neonatology service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Jardena J Puder
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
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11
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Wagner KA, Whitcomb BW, Marcus B, Pekow P, Rosal MC, Leidy Sievert L, Tucker KL, Manson JE, Chasan-Taber L. The impact of a lifestyle intervention on postpartum weight retention among US Hispanic women with overweight and obesity. Prev Med Rep 2024; 38:102633. [PMID: 38375164 PMCID: PMC10874874 DOI: 10.1016/j.pmedr.2024.102633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/20/2023] [Accepted: 01/26/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction To evaluate the effect of a culturally-modified, motivationally-targeted, individually-tailored lifestyle intervention on postpartum weight retention among Hispanic women with overweight/obesity. Materials and methods Proyecto Mamá was a randomized controlled trial conducted in western Massachusetts (2014-2020). Hispanic women with overweight/obese pre-pregnancy BMI (n = 148) were randomized in early pregnancy to a Lifestyle Intervention (LI) or a Health & Wellness (HW) comparison arm. The LI was based upon theoretical concepts, used a low-cost, high-reach strategy, and focused on healthy exercise and diet with follow-up through 12-months postpartum. The primary outcome of change in weight was calculated as the difference between pre-pregnancy weight and 6-week, 6-month, and 12-month postpartum weight. The secondary outcome was achievement of 5 % weight reduction from pre-pregnancy weight. Retention was 68.2 % in the overall postpartum period and 31.0 % at 12-months. Results In intent-to-treat analyses, compared to the HW arm, there was no difference in postpartum weight retention at 6-weeks (0.0 kg, 95 % CI: -3.4, 3.5), 6-months (-1.8 kg, 95 % CI: -5.6, 2.0), or 12-months (-2.0 kg, 95 % CI: -7.0, 3.1). In a secondary complete case analysis, compared to the HW arm, the LI arm had 5.5 times higher odds of meeting the postpartum weight reduction goal (aOR = 5.5, 95 % CI: 1.7, 17.9) adjusting for pre-pregnancy weight. Conclusions A lifestyle intervention among at-risk Hispanic women with overweight/obesity had no overall impact on postpartum weight, but a beneficial impact among those who completed the trial. Future studies should focus on increasing the feasibility and acceptability of the intervention in this at-risk population.
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Affiliation(s)
- Kathryn A. Wagner
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Brian W. Whitcomb
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Bess Marcus
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
| | - Penelope Pekow
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Milagros C. Rosal
- Division of Preventive and Behavioral Medicine, Department of Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Lynnette Leidy Sievert
- Department of Anthropology, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Katherine L. Tucker
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, United States of America
| | - JoAnn E. Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Lisa Chasan-Taber
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, United States of America
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12
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Foghsgaard S, Vedtofte L, Andersen ES, Bahne E, Andreasen C, Sørensen AL, Forman JL, Mathiesen ER, Svare JA, Clausen TD, Damm P, Holst JJ, Knop FK, Vilsbøll T. Liraglutide treatment for the prevention of glucose tolerance deterioration in women with prior gestational diabetes mellitus: A 52-week randomized controlled clinical trial. Diabetes Obes Metab 2024; 26:201-214. [PMID: 37846555 DOI: 10.1111/dom.15306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/18/2023] [Accepted: 09/18/2023] [Indexed: 10/18/2023]
Abstract
AIM We investigated the effect of 52-week treatment with liraglutide, a glucagon-like peptide 1 receptor agonist, on glucose tolerance and incretin effect in women with previous gestational diabetes mellitus (pGDM). MATERIALS AND METHODS Women with overweight/obesity and pGDM were randomized to once daily subcutaneous liraglutide 1.8 mg or placebo for 52 weeks. Participants underwent oral glucose tolerance test (OGTT) and isoglycaemic intravenous glucose infusion at baseline and at 52 weeks, and an additional OGTT after the drug wash-out. RESULTS In total, 104 women [age: mean ± SD, 38 ± 5 years; fasting plasma glucose (FPG): 5.5 ± 0.4 mmol/L; glycated haemoglobin (HbA1c): 33 ± 4 mmol/mol, bodyweight: 88.2 ± 14.8 kg, body mass index: 31.1 ± 4.3 kg/m2 ] were assigned to liraglutide (n = 49) or placebo (n = 55). Estimated treatment difference (ETD) for area under curve during OGTT was -173 (95% confidence interval -250 to -97) mmol/L × min, p < .0001, but after wash-out the difference disappeared [ETD 58 (-30 to 146) mmol/L × min, p = .536]. Liraglutide reduced FPG [ETD -0.2 (-0.4 to -0.1) mmol/L, p = .018], HbA1c [-2.2 (-3.5 to -0.8) mmol/mol, p = .018] and bodyweight [-3.9 (-6.2 to -1.6) kg, p = .012]. No change in the incretin effect was observed. The number of women with prediabetes was reduced from 64% to 10% with liraglutide vs. 50% with placebo [adjusted odds ratio 0.10 (0.03-0.32), p = .002]. CONCLUSIONS Treatment with liraglutide for 52 weeks improved glucose tolerance, FPG, HbA1c and bodyweight in women with overweight/obesity and pGDM. Progression to prediabetes while on drug was markedly reduced, but after a 1-week drug wash-out, the effect was lost.
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Affiliation(s)
- Signe Foghsgaard
- Clinical Research, Steno Diabetes Center Copenhagen, University of Copenhagen, Herlev, Denmark
- Department of Gynaecology and Obstetrics, Herlev Hospital, University of Copenhagen, Herlev, Denmark
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Louise Vedtofte
- Clinical Research, Steno Diabetes Center Copenhagen, University of Copenhagen, Herlev, Denmark
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Emilie S Andersen
- Clinical Research, Steno Diabetes Center Copenhagen, University of Copenhagen, Herlev, Denmark
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Emilie Bahne
- Clinical Research, Steno Diabetes Center Copenhagen, University of Copenhagen, Herlev, Denmark
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Camilla Andreasen
- Clinical Research, Steno Diabetes Center Copenhagen, University of Copenhagen, Herlev, Denmark
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Anne L Sørensen
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Julie L Forman
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Pregnant Women with Diabetes, Department of Endocrinology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens A Svare
- Department of Gynaecology and Obstetrics, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Tine D Clausen
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter Damm
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens J Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Filip K Knop
- Clinical Research, Steno Diabetes Center Copenhagen, University of Copenhagen, Herlev, Denmark
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tina Vilsbøll
- Clinical Research, Steno Diabetes Center Copenhagen, University of Copenhagen, Herlev, Denmark
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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13
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Ukke GG, Boyle JA, Reja A, Lee WK, Chen M, Ko MSM, Alycia C, Kwon J, Lim S. Lifestyle Interventions to Prevent Type 2 Diabetes in Women with a History of Gestational Diabetes: A Systematic Review and Meta-Analysis through the Lens of Health Equity. Nutrients 2023; 15:4666. [PMID: 37960319 PMCID: PMC10649749 DOI: 10.3390/nu15214666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellites is one of the health problems disproportionally affecting people with low socioeconomic statuses. Gestational diabetes mellites increases the risk of type 2 diabetes by up to ten-fold for women. Lifestyle interventions prevent type 2 diabetes in women with prior gestational diabetes. However, it is unknown if similar effectiveness can be expected for all population subgroups. OBJECTIVE This study aims to assess the prevention of type 2 diabetes in women with prior gestational diabetes using population characteristics according to the PROGRESS (place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, and social capital) criteria. METHODS MEDLINE, CINAHL, EMBASE, PubMed, PsycINFO, Web of Science, and EBM Reviews databases were searched for interventional studies of diet, physical activity, or behavioural interventions published up to 21 February 2023. Random effects subgroup meta-analysis was conducted to evaluate the association of population characteristics and intervention effects. RESULTS All studies were conducted in high-income countries or middle-income countries. Two-thirds of the studies reported on race/ethnicity and education level. Less than one-third reported on place (urban/rural), occupation, and socioeconomic status. None reported on religion or social capital. Studies from high-income countries (MD = -1.46; 95% CI: -2.27, -0.66, I2 = 70.46, p < 0.001) showed a greater reduction in bodyweight compared with the studies conducted in middle-income countries (MD = -0.11; 95% CI: -1.12, 0.89, I2 = 69.31, p < 0.001) (p for subgroup difference = 0.04). CONCLUSION There are significant equity gaps in the evidence for the prevention of type 2 diabetes in women with prior gestational diabetes due to reports on population characteristics being poor. Interventions may be less effective in reducing bodyweight in women from middle-income countries compared to high-income countries. Collecting and analysing data related to equity is needed to understand the effect of lifestyle interventions on type 2 diabetes for different population subgroups.
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Affiliation(s)
- Gebresilasea Gendisha Ukke
- Health Systems and Equity, Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, VIC 3128, Australia; (G.G.U.); (J.A.B.)
| | - Jacqueline A. Boyle
- Health Systems and Equity, Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, VIC 3128, Australia; (G.G.U.); (J.A.B.)
| | - Ahmed Reja
- School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa 9086, Ethiopia;
| | - Wai Kit Lee
- Faculty of Medicine, Nursing and Health Sciences, Monash University, 264 Ferntree Gully Rd, Notting Hill, VIC 3168, Australia; (W.K.L.); (C.A.)
| | - Mingling Chen
- Monash Centre for Health Research and Implementation, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia;
| | - Michelle Shi Min Ko
- MD Programme, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore;
| | - Chelsea Alycia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, 264 Ferntree Gully Rd, Notting Hill, VIC 3168, Australia; (W.K.L.); (C.A.)
| | - Jane Kwon
- Diabetes Victoria, Suite G01/15-31 Pelham St, Carlton, VIC 3053, Australia;
| | - Siew Lim
- Health Systems and Equity, Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, VIC 3128, Australia; (G.G.U.); (J.A.B.)
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14
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Horwitz MEM, Edwards CV, Athavale P, McCloskey L, Cabral HJ, Benjamin EJ, Handley MA. The STAR-MAMA RCT: Bilingual Mobile Health Coaching for Postpartum Weight Loss. Am J Prev Med 2023; 65:596-607. [PMID: 37028566 DOI: 10.1016/j.amepre.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION Gestational diabetes and overweight during pregnancy are associated with future type 2 diabetes. Postpartum weight loss can reduce diabetes risk. However, effective interventions for postpartum weight loss are lacking, in particular for Latina populations, despite their disproportionate burdens of gestational diabetes, overweight, and diabetes. STUDY DESIGN This was a community-based RCT. SETTING/PARTICIPANTS Researchers recruited pregnant individuals with gestational diabetes or BMI>25 kg/m2 from safety-net health care settings and Women, Infants, and Children offices in Northern California in 2014-2018. Of 180 individuals randomized to intervention (n=89) or control (n=91), 78% identified as Latina, 61% were primarily Spanish speaking, and 76% perceived their diabetes risk to be low. INTERVENTION The intervention consisted of a 5-month postpartum telephone-based health coaching intervention delivered in English or Spanish. MAIN OUTCOME MEASURES Data were collected through surveys at enrollment and 9-12 months after delivery and chart review up to 12 months after delivery. The primary outcome, weight change from prepregnancy to 9-12 months after delivery, was compared between the groups, overall and within strata defined a priori according to language (Spanish or English) and diabetes risk perception (none/slight or moderate/high). RESULTS The intent-to-treat estimated intervention effect was +0.7 kg (95% CI= -2.4 kg, +3.8 kg; p=0.67). In stratified analyses, intervention effects remained nonsignificant but varied in direction: effects were favorable among English speakers and those with higher perceived diabetes risk, and unfavorable among Spanish speakers and those with lower perceived risk. Analyses were conducted in 2021-2022. CONCLUSIONS A postpartum health coaching intervention, designed for low-income Latina women at increased risk for diabetes, did not reduce postpartum weight gain. Intervention effects were nonsignificantly more favorable among English speakers versus Spanish speakers, and among those who perceived their diabetes risk to be high versus low. TRIAL REGISTRATION This study is registered at www. CLINICALTRIALS gov NCT02240420.
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Affiliation(s)
- Mara E Murray Horwitz
- Women's Health Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts.
| | - Camille V Edwards
- Section of Hematology/Oncology, Department of Medicine, Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Priyanka Athavale
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, California
| | - Lois McCloskey
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Howard J Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Emelia J Benjamin
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Margaret A Handley
- Department of Epidemiology, School of Medicine, University of California San Francisco, San Francisco, California; Department of Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California; Partnerships for Research in Implementation Science for Equity (PRISE) Center, University of California San Francisco, San Francisco, California
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15
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Fiskå BS, Pay ASD, Staff AC, Sugulle M. Gestational diabetes mellitus, follow-up of future maternal risk of cardiovascular disease and the use of eHealth technologies-a scoping review. Syst Rev 2023; 12:178. [PMID: 37770980 PMCID: PMC10537141 DOI: 10.1186/s13643-023-02343-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/04/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Globally, gestational diabetes mellitus complicates 1 in 6 pregnancies and increases future risk of type 2 diabetes and cardiovascular disease in the affected women. There is a lack of consensus on the optimal follow-up of these women. eHealth is emerging as a health care tool, but its practical utility and advantages over standard care in the follow-up after pregnancy complications remains to be determined. Our aim was to systematically review the existing literature on cardiovascular follow-up after gestational diabetes, the utility of eHealth technology for this purpose, and to identify research gaps. METHODS We performed a systematic scoping review following a published protocol and the Joanna Briggs methodology for studies up until May 2022. Four databases were searched: Ovid MEDLINE, Embase, Maternity and Infant Care, and Cochrane Database of Systematic Reviews. Primary research articles and systematic reviews were included in the final analyses. Two reviewers independently screened abstracts and performed full text assessment. Data was extracted using a data charting form. In all stages of the process, if consensus was not reached, a third reviewer was consulted. The findings from the data charting process provided the basis for summarizing the findings from the included studies. RESULTS The search of the databases generated 2772 hits. After removing duplicates and manually adding a total of 19 studies, reviews, and guidelines, a total of 2769 titles and abstracts were screened, and 97 papers underwent full-text review. In the final analyses, 15 articles and 12 systematic reviews were included, whereas guidelines are presented as supplementary material. No studies were identified that examined follow-up regarding long-term overall cardiovascular risk after gestational diabetes. Various lifestyle interventions were tested for individual cardiovascular risk factors, with diverging effects. eHealth technologies were found acceptable by participants but had no consistent, statistically significant effect on relevant health outcomes. CONCLUSIONS This scoping review of the existing literature revealed neither an established systematic cardiovascular follow-up strategy for women after gestational diabetes nor evidence that eHealth technologies are superior to conventional follow-up. Further research into the utility of eHealth in cardiovascular follow-up after complicated pregnancies should include longer-term follow-up and core cardiovascular outcomes. SYSTEMATIC REVIEW REGISTRATION The protocol for this scoping review was published at Open Science Framework (osf.io/p5hw6).
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Affiliation(s)
- Bendik S Fiskå
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Aase Serine Devold Pay
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Obstetrics and Gynaecology, Bærum Hospital, Vestre Viken Hospital Trust, Bærum, Norway
| | - Anne Cathrine Staff
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Meryam Sugulle
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway.
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
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16
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Marschner S, Mukherjee S, Watts M, Min H, Beale AL, O'Brien J, Juneja A, Tremmel JA, Zaman S. Prevention of Cardiovascular Disease in Women With Pregnancy-Related Risk Factors: A Prospective Women's Heart Clinic Study. J Am Heart Assoc 2023; 12:e030015. [PMID: 37642017 PMCID: PMC10547318 DOI: 10.1161/jaha.123.030015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/20/2023] [Indexed: 08/31/2023]
Abstract
Background Hypertensive disorders of pregnancy, gestational diabetes, and having a small-for-gestational-age baby are known to substantially increase a woman's risk of cardiovascular disease. Despite this, evidence for models of care that mitigate cardiovascular disease risk in women with these pregnancy-related conditions is lacking. Methods and Results A 6-month prospective cohort study assessed the effectiveness of a multidisciplinary Women's Heart Clinic on blood pressure and lipid control in women aged 30 to 55 years with a past pregnancy diagnosis of hypertensive disorders of pregnancy, gestational diabetes, or a small-for-gestational age baby in Melbourne, Australia. The co-primary end points were (1) blood pressure <140/90 mm Hg or <130/80 mm Hg if diabetes and (2) total cholesterol to high-density lipoprotein cholesterol ratio <4.5. The study recruited 156 women with a mean age of 41.0±4.2 years, 3.9±2.9 years from last delivery, 68.6% White, 20.5% South/East Asian, and 80.5% university-educated. The proportion meeting blood pressure target increased (69.2% to 80.5%, P=0.004), with no significant change in lipid targets (80.6% to 83.7%, P=0.182). Systolic blood pressure (-6.9 mm Hg [95% CI, -9.1 to -4.7], P<0.001), body mass index (-0.6 kg/m2 [95% CI, -0.8 to -0.3], P<0.001), low-density lipoprotein cholesterol (-4.2 mg/dL [95% CI, -8.2 to -0.2], P=0.042), and total cholesterol (-4.6 mg/dL [95% CI, -9.1 to -0.2] P=0.042) reduced. Heart-healthy lifestyle significantly improved with increased fish/olive oil (36.5% to 51.0%, P=0.012), decreased fast food consumption (33.8% to 11.0%, P<0.001), and increased physical activity (84.0% to 92.9%, P=0.025). Conclusions Women at high risk for cardiovascular disease due to past pregnancy-related conditions experienced significant improvements in multiple cardiovascular risk factors after attending a Women's Heart Clinic, potentially improving long-term cardiovascular disease outcomes. Registration URL: https://www.anzctr.org.au; Unique identifier: ACTRN12622000646741.
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Affiliation(s)
- Simone Marschner
- Westmead Applied Research Centre, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Swati Mukherjee
- Department of CardiologyCabrini HealthMelbourneAustralia
- Department of CardiologyAlfred HospitalMelbourneAustralia
- Faculty of Medicine, Nursing & Health SciencesMonash UniversityMelbourneAustralia
| | - Monique Watts
- Department of CardiologyAlfred HospitalMelbourneAustralia
- Faculty of Medical EducationUniversity of MelbourneMelbourneAustralia
| | - Haeri Min
- Westmead Applied Research Centre, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Anna L. Beale
- Department of CardiologyAlfred HospitalMelbourneAustralia
| | | | - Aashima Juneja
- Department of MedicineThe Northern HospitalMelbourneAustralia
| | - Jennifer A. Tremmel
- Department of Medicine (Cardiovascular)Stanford University School of MedicineStanfordCA
| | - Sarah Zaman
- Westmead Applied Research Centre, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- School of Clinical Sciences at Monash HealthMonash UniversityMelbourneAustralia
- Department of CardiologyWestmead HospitalSydneyAustralia
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17
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Horn J, Kolberg M, Rangul V, Magnussen EB, Åsvold BO, Henriksen HB, Blomhoff R, Seely EW, Rich-Edwards J. Feasibility of a Postpartum Web- and Phone-Based Lifestyle Program for Women with a History of Preeclampsia or Gestational Diabetes: A Pilot Intervention Study. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:345-357. [PMID: 37485436 PMCID: PMC10357112 DOI: 10.1089/whr.2023.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 07/25/2023]
Abstract
Background Women with a history of preeclampsia (PE) or gestational diabetes mellitus (GDM) are at increased risk of diabetes and cardiovascular disease (CVD) later in life. Increased awareness of pregnancy complications as early warning signs for CVD has called for postpartum primordial prevention strategies. The aim of this study was to evaluate the feasibility of a postpartum web- and phone-based lifestyle program promoting healthy lifestyle behaviors to women after a pregnancy complicated by PE or GDM. Materials and Methods Women with a validated history of PE or GDM were invited to participate in a nonrandomized pilot intervention study 3-12 months after delivery. The intervention was delivered over 6 months. All participants received tailored lifestyle counseling by a registered dietitian and access to information material on healthy lifestyle behaviors on the study's website. After inclusion, participants were invited to three study visits at baseline, 3 months, and 6 months. Feasibility outcomes included assessment of recruitment, retention, and acceptability. Secondary outcomes were changes in lifestyle behaviors and cardiovascular risk factors. Results Of the 207 women invited, 44 were enrolled in the feasibility study and 40 women completed the intervention, corresponding to a recruitment rate of 21% and a retention rate of 91%. At the 3-month study visit, 94.6% of participants reported they had used the website. A total of 41.7% of the participants reported that they had achieved their personal goals during the intervention period. Conclusions This study suggested the feasibility and potential acceptability of a web- and phone-based lifestyle intervention for mothers with recent PE or GDM. Clinical Trial Registration clinicaltrials.gov, www.clinicaltrials.gov, no. NCT03993145.
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Affiliation(s)
- Julie Horn
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Marit Kolberg
- Center for Oral Health Services and Research, Mid-Norway (TkMidt), Trondheim, Norway
| | - Vegar Rangul
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Elisabeth B. Magnussen
- Department of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bjørn Olav Åsvold
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Endocrinology, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hege B. Henriksen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Rune Blomhoff
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Division of Cancer Medicine, Department of Clinic Service, Oslo University Hospital, Oslo, Norway
| | - Ellen W. Seely
- Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Janet Rich-Edwards
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Medicine, Division of Women's Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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18
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Marschner S, Pant A, Henry A, Maple‐Brown LJ, Moran L, Cheung NW, Chow CK, Zaman S. Cardiovascular risk management following gestational diabetes and hypertensive disorders of pregnancy: a narrative review. Med J Aust 2023; 218:484-491. [PMID: 37149790 PMCID: PMC10953444 DOI: 10.5694/mja2.51932] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 05/08/2023]
Affiliation(s)
| | - Anushriya Pant
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
| | - Amanda Henry
- University of New South WalesSydneyNSW
- St George HospitalSydneyNSW
| | - Louise J Maple‐Brown
- Diabetes across the Lifecourse: Northern Australia Partnership, Menzies School of Health ResearchDarwinNT
- Royal Darwin HospitalDarwinNT
| | - Lisa Moran
- Monash Centre for Health Research and ImplementationMonash UniversityMelbourneVIC
- Monash HealthMelbourneVIC
| | - N Wah Cheung
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
| | - Clara K Chow
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
| | - Sarah Zaman
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
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Hauspurg A, Seely EW, Rich-Edwards J, Hayduchok C, Bryan S, Roche AT, Jeyabalan A, Davis EM, Hart R, Shirriel J, Catov J. Postpartum home blood pressure monitoring and lifestyle intervention in overweight and obese individuals the first year after gestational hypertension or pre-eclampsia: A pilot feasibility trial. BJOG 2023; 130:715-726. [PMID: 36655365 PMCID: PMC10880812 DOI: 10.1111/1471-0528.17381] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/30/2022] [Accepted: 10/30/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To test the feasibility of a randomised trial of home blood pressure monitoring paired with a remote lifestyle intervention (Heart Health 4 New Moms) versus home blood pressure monitoring alone versus control in individuals with a hypertensive disorder of pregnancy in the first year postpartum. DESIGN Single-blinded three-arm randomised clinical trial. SETTING Two tertiary care hospitals and a community organisation. POPULATION Postpartum overweight and obese individuals with a hypertensive disorder of pregnancy and without pre-pregnancy hypertension or diabetes. METHODS We assessed the feasibility of recruitment and retention of 150 participants to study completion at 1-year postpartum with randomisation 1:1:1 into each arm. Secondary aims were to test effects of the interventions on weight, blood pressure and self-efficacy. RESULTS Over 23 months, we enrolled 148 of 400 eligible, screened individuals (37%); 28% black or other race and mean pre-pregnancy body mass index (BMI) of 33.4 ± 6.7 kg/m2 . In total, 129 (87%) participants completed the 1-year postpartum study visit. Overall, 22% of participants developed stage 2 hypertension (≥140/90 mmHg or on anti-hypertensive medications) by 1 year postpartum. There were no differences in weight or self-efficacy across the study arms. CONCLUSION In this pilot, randomised trial, we demonstrate feasibility of HBPM paired with a lifestyle intervention in the first year postpartum. We detected high rates of ongoing hypertension, emphasising the need for the development of effective interventions in this population.
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Affiliation(s)
- Alisse Hauspurg
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ellen W. Seely
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Janet Rich-Edwards
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Christina Hayduchok
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Samantha Bryan
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Andrea T. Roche
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Arun Jeyabalan
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Esa M. Davis
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Renee Hart
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Janet Catov
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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20
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Kumari A, Ranjan P, Vikram NK, Kaur D, Balsarkar G, Malhotra A, Puri M, Batra A, Madan J, Tyagi S, Guleria K, Dabral A, Sarkar S, Nigam A, Anwar W, Kamath S, Bhatla N, Kumari SS, Kumar R, Choranur A, Venkataraman S, Kaur T, Rathore AM, Kaloiya GS, Prakash A, Tiwaskar M, Verma A, Singh R, Sharma KA, Baitha U, Tewary K, Misra A, Guleria R. Evidence and consensus-based clinical practice guideline for the management of obesity and overweight in postpartum women: An AIIMS-DST initiative. J Family Med Prim Care 2023; 12:812-855. [PMID: 37448937 PMCID: PMC10336934 DOI: 10.4103/jfmpc.jfmpc_45_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/23/2022] [Accepted: 01/31/2022] [Indexed: 07/18/2023] Open
Affiliation(s)
- Archana Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naval K. Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Divjyot Kaur
- Department of Home Science, University of Delhi, Delhi, India
| | - Geetha Balsarkar
- Department of Obstetrics and Gynaecology, Seth G. S. Medical College, Mumbai, Maharashtra, India
| | - Anita Malhotra
- Department of Home Science, University of Delhi, Delhi, India
| | - Manju Puri
- Director Professor and Head, Department of Obstetrics and Gynaecology, LHMC and SSK Hospital, New Delhi, India
| | - Achla Batra
- President, Association of Obstetricians and Gynaecologists of Delhi (AOGD), New Delhi, India
- Professor, Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Jagmeet Madan
- National President, Indian Dietetic Association, New Delhi, India
| | - Shakun Tyagi
- Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India
| | - Kiran Guleria
- Department of Obstetrics and Gynaecology, University College of Medical Sciences, New Delhi, India
| | - Anjali Dabral
- Professor and Head, Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Siddharth Sarkar
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Aruna Nigam
- Department of Obstetrics and Gynaecology, Hamdard Institute of Medical Sciences & Research, New Delhi, India
| | - Wareesha Anwar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sandhya Kamath
- Former Dean, LT Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
- Former Dean, Seth G. S. Medical College, and KEM Hospital, Mumbai, Maharashtra, India
| | - Neerja Bhatla
- Professor and Head, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - S. Shantha Kumari
- President, The Federation of Obstetric and Gynaecological Societies of India, India
| | - Raman Kumar
- President, Academy of Family Physicians of India, India
- President, World Organization of Family Doctors (WONCA), New Delhi, India
| | | | - Srikumar Venkataraman
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - Tanveer Kaur
- Department of Psychology, University of Delhi, Delhi, India
| | - Asmita Muthal Rathore
- Director Professor and Head, Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India
| | - Gauri Shankar Kaloiya
- Department of Clinical Psychology and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Anupam Prakash
- Department of Medicine, LHMC and SSK Hospital, New Delhi, India
| | | | - Archana Verma
- Vice President, The Federation of Obstetric and Gynaecological Societies of India, India
| | - Rakhi Singh
- The Federation of Obstetric and Gynaecological Societies of India, India
| | - K Aparna Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Upendra Baitha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kamlesh Tewary
- President, Association of the Physicians of India, India
| | - Anoop Misra
- Chairman, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India
- Chairman, National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India
- President, Diabetes Foundation (India) (DFI), New Delhi, India
| | - Randeep Guleria
- Director, All India Institute of Medical Sciences, New Delhi, India
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21
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Chehab RF, Ferrara A, Zheng S, Barupal DK, Ngo AL, Chen L, Fiehn O, Zhu Y. In utero metabolomic signatures of refined grain intake and risk of gestational diabetes: A metabolome-wide association study. Am J Clin Nutr 2023; 117:731-740. [PMID: 36781127 PMCID: PMC10273195 DOI: 10.1016/j.ajcnut.2023.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/06/2023] [Accepted: 02/08/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Epidemiologic evidence has linked refined grain intake to a higher risk of gestational diabetes (GDM), but the biological underpinnings remain unclear. OBJECTIVES We aimed to identify and validate refined grain-related metabolomic biomarkers for GDM risk. METHODS In a metabolome-wide association study of 91 cases with GDM and 180 matched controls without GDM (discovery set) nested in the prospective Pregnancy Environment and Lifestyle Study (PETALS), refined grain intake during preconception and early pregnancy and serum untargeted metabolomics were assessed at gestational weeks 10-13. We identified refined grain-related metabolites using multivariable linear regression and examined their prospective associations with GDM risk using conditional logistic regression. We further examined the predictivity of refined grain-related metabolites selected by least absolute shrinkage and selection operator regression in the discovery set and validation set (a random PETALS subsample of 38 individuals with and 336 without GDM). RESULTS Among 821 annotated serum (87.4% fasting) metabolites, 42 were associated with refined grain intake, of which 17 (70.6% in glycerolipids, glycerophospholipids, and sphingolipids clusters) were associated with subsequent GDM risk (all false discovery rate-adjusted P values <0.05). Adding 7 of 17 metabolites to a conventional risk factor-based prediction model increased the C-statistic for GDM risk in the discovery set from 0.71 (95% CI: 0.64, 0.77) to 0.77 (95% CI: 0.71, 0.83) and in the validation set from 0.77 (95% CI: 0.69, 0.86) to 0.81 (95% CI: 0.74, 0.89), both with P-for-difference <0.05. CONCLUSIONS Clusters of glycerolipids, glycerophospholipids, and sphingolipids may be implicated in the association between refined grain intake and GDM risk, as demonstrated by the significant associations of these metabolites with both refined grains and GDM risk and the incremental predictive value of these metabolites for GDM risk beyond the conventional risk factors. These findings provide evidence on the potential biological underpinnings linking refined grain intake to the risk of GDM and help identify novel disease-related dietary biomarkers to inform diet-related preventive strategies for GDM.
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Affiliation(s)
- Rana F Chehab
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Siwen Zheng
- School of Public Health, University of California, Berkeley, CA
| | - Dinesh K Barupal
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, NY
| | - Amanda L Ngo
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Liwei Chen
- Department of Epidemiology, University of California, Los Angeles, CA
| | - Oliver Fiehn
- West Coast Metabolomics Center, UC Davis Genome Center, University of California, Davis, CA
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA.
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22
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DiTosto JD, Roytman MV, Dolan BM, Khan SS, Niznik CM, Yee LM. Improving Postpartum and Long-Term Health After an Adverse Pregnancy Outcome: Examining Interventions From a Health Equity Perspective. Clin Obstet Gynecol 2023; 66:132-149. [PMID: 36657050 PMCID: PMC9869461 DOI: 10.1097/grf.0000000000000759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Gestational diabetes mellitus and hypertensive disorders in pregnancy are adverse pregnancy outcomes (APOs) that affect 15% of pregnancies in the United States. These APOs have long-term health implications, with greater risks of future cardiovascular and chronic disease later in life. In this manuscript, we review the importance of timely postpartum follow-up and transition to primary care after APOs for future disease prevention. We also discuss interventions to improve postpartum follow-up and long-term health after an APO. In recognizing racial and ethnic disparities in APOs and chronic disease, we review important considerations of these interventions through a health equity lens.
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Affiliation(s)
- Julia D. DiTosto
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Maya V. Roytman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Loyola University Chicago, Chicago, IL
| | - Brigid M. Dolan
- Division of General Internal Medicine, Departments of Medicine and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sadiya S. Khan
- Division of Cardiology, Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Charlotte M. Niznik
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lynn M. Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
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23
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McAuley E, Fleck O, Cassidy L, Kemp BJ, Cupples G, Kelly B, Creighton RM, Graham U, Wallace H, Patterson CC, McCance DR. A pragmatic lifestyle intervention for overweight and obese women with gestational diabetes mellitus (PAIGE2): A parallel arm, multicenter randomized controlled trial study protocol. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1118509. [PMID: 37034478 PMCID: PMC10080069 DOI: 10.3389/fcdhc.2023.1118509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/07/2023] [Indexed: 04/11/2023]
Abstract
Background The global epidemic of type 2 diabetes (T2D) and obesity has been translated into pregnancy, with approximately 18% of women being diagnosed worldwide with Gestational Diabetes Mellitus (GDM). Whilst preventive strategies have proven effective in the non-pregnant context, attrition rates are high and there is an urgent need to develop a customized, pragmatic lifestyle intervention for women both during and after pregnancy. Diet and exercise modification, behavioral support, and Commercial Weight Management Organizations have been strongly recommended to aid postpartum weight reduction for mothers with previous GDM, subsequently reducing their risk of developing obesity and T2D. This study, informed by a previous pilot study, aims to determine the effectiveness of a pragmatic pregnancy and postpartum lifestyle modification program for overweight women with previous GDM (PAIGE2) to reduce body weight at 12 months postpartum. Methods/design This paper summarizes the protocol for the PAIGE2 study, which has been developed based on results from a pilot study (PAIGE). A six center, two parallel arm, 12-month, randomized controlled trial will be conducted across Northern Ireland and the Republic of Ireland (3 centers each), involving 340 women with GDM and body mass index ≥25 kg/m2 recruited during pregnancy. The lifestyle intervention involves a one-hour virtual educational program (to take place at 32-36 weeks gestation). Postpartum, the intervention will include monthly phone calls, weekly motivational text messages, weekly step counts, and referral for three months to a Commercial Weight Management Organization (Slimming World). The control arm will receive usual care as offered by the local maternity hospital. The primary outcome is weight loss at 12 months postpartum. Study visits for anthropometric and clinical measurements, fasting blood samples, questionnaires pertaining to health, wellbeing and physical activity will take place at 6 weeks, 6- and 12-months postpartum. Focus groups will be conducted with intervention mothers' post-intervention to determine the acceptability of the study design including utility of a Commercial Weight Management Organization, feasibility of remote patient contact, family involvement and patient satisfaction. Discussion The PAIGE2 study will address the gaps in previously conducted research and, if positive, has the potential to have major public health implications for the prevention of future GDM and subsequent T2D. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT04579016?term=NCT04579016&draw=2&rank=1, identifier NCT04579016.
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Affiliation(s)
- Emma McAuley
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Olwen Fleck
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Laura Cassidy
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Bridie J. Kemp
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, United Kingdom
| | - Gina Cupples
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Bronagh Kelly
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Rachel M. Creighton
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Una Graham
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Helen Wallace
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Chris C. Patterson
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - David R. McCance
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
- *Correspondence: David R. McCance,
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24
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Madievsky R, Vu A, Cheng F, Chon J, Turk N, Krueger A, Krong J, Maranon R, Liu S, Han CS, Norris KC, Mangione C, Page J, Thomas S, Duru OK, Moin T. A randomized controlled trial of a shared decision making intervention for diabetes prevention for women with a history of gestational diabetes mellitus: The Gestational diabetes Risk Attenuation for New Diabetes (GRAND study). Contemp Clin Trials 2023; 124:107007. [PMID: 36384219 PMCID: PMC10642368 DOI: 10.1016/j.cct.2022.107007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/14/2022] [Accepted: 11/10/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a risk factor for the development of type 2 diabetes. Metformin and lifestyle change through a Diabetes Prevention Program (DPP) are equally effective in preventing diabetes in patients with a GDM history, so women can choose a strategy based on their preferences. This study aims to test whether shared decision making (SDM) can help women with a history of GDM increase adoption of evidence-based strategies and lose weight to lower their risk of incident diabetes in real-world settings. METHODS This pragmatic randomized controlled trial (RCT) will test the effectiveness of SDM for diabetes prevention among 310 overweight/obese women with a history of GDM and prediabetes from two large health care systems (n = 155 from UCLA Health and n = 155 from Intermountain Healthcare). The primary outcome is the proportion of participants who lose ≥5% body weight at 12 months. Secondary outcomes include uptake of DPP and/or metformin and other patient-reported outcomes such as patient activation and health-related quality of life. Rates of GDM in a subsequent pregnancy will be an exploratory outcome. A descriptive analysis of costs related to SDM implementation will also be conducted. CONCLUSION This is the first RCT to examine the effectiveness of SDM on weight loss, lifestyle change and/or metformin use, and other patient-reported outcomes in participants with a GDM history at risk of developing diabetes. TRIAL REGISTRATION ClinicalTrials.gov, NCT03766256. Registered on 6 December 2018.
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Affiliation(s)
- Ruth Madievsky
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Amanda Vu
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Felicia Cheng
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Janet Chon
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Norman Turk
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Ashley Krueger
- Healthcare Delivery Institute, Office of Research, Intermountain Healthcare, 5026 S. State St, Murray, UT 84107, USA.
| | - Jacob Krong
- Healthcare Delivery Institute, Office of Research, Intermountain Healthcare, 5026 S. State St, Murray, UT 84107, USA.
| | - Richard Maranon
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Sandra Liu
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Christina S Han
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, 200 Medical Plaza, Suite 430, Los Angeles, CA 90095, USA.
| | - Keith C Norris
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, David Geffen School of Medicine at UCLA, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Carol Mangione
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, David Geffen School of Medicine at UCLA, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA; Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, USA.
| | - Jessica Page
- Department of Maternal-Fetal Medicine, Intermountain Healthcare. Department of Maternal-Fetal Medicine, University of Utah Health, 8th Ave & C St E, Salt Lake City, UT 84143, USA.
| | - Samuel Thomas
- Department of Internal Medicine, Intermountain Healthcare, 5121 Cottonwood St, Murray, UT 84017, USA.
| | - O Kenrik Duru
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, David Geffen School of Medicine at UCLA, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Tannaz Moin
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA; HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA; Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, UCLA, Los Angeles, CA 90024, USA.
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25
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Parsons J, Forde R, Brackenridge A, Hunt KF, Ismail K, Murrells T, Reid A, Rogers H, Rogers R, Forbes A. The gestational diabetes future diabetes prevention study (GODDESS): A partially randomised feasibility controlled trial. PLoS One 2022; 17:e0273992. [PMID: 36584120 PMCID: PMC9803154 DOI: 10.1371/journal.pone.0273992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/19/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To assess the feasibility of an ante- and post-natal lifestyle intervention for women with gestational diabetes mellitus (GDM) to reduce type 2 diabetes risk. DESIGN A partially randomised patient preference feasibility trial. SETTING Diabetes antenatal clinics in two inner-London hospitals, UK. PARTICIPANTS Pregnant women ≥18 years with a GDM diagnosis and pre-pregnancy body mass index of ≥25kg/m2. INTERVENTION Participants in the intervention group were offered four motivational interview-based sessions (two antenatally and two postnatally, at 3 and 6 months postpartum), a WhatsApp support group, a FitBit and electronic self-help resources. OUTCOME MEASURES Recruitment; retention; intervention dose received; data completion; adaptions; proportion achieving ≥5% weight loss; weight change, blood glucose; blood pressure; diet, physical activity, breastfeeding and depression. Clinical outcomes were measured at baseline and 6 months postpartum. RESULTS 50 participants were recruited from 155 eligible women (32% recruitment rate). Thirty-four were recruited to the intervention group (23 following randomisation (RI-group) and 11 based on preference (PI-group)); and 16 to the control group (13 randomised (RC-group) and 3 preference (PC-group)). Attrition was 44% (n = 22/50). Forty-six percent (n = 6) of the intervention group (25% (n = 2) of the RI-group and 80% (n = 4) of the PI-group) achieved ≥5% weight loss compared to 8% (n = 1) in the control group (95% confidence interval (CI) -0.69 to 0.07). Mean weight change was -2.1kg±9.0 in the intervention group (0kg±5.4 in the RI-group and -5.4kg±13.0 in the PI-group) compared to +4.4kg±4.9 in the control group (RC +4.4kg ±5.3 and PC +4.7kg ±3.1, 95% CI -12.4 to 0.2). CONCLUSIONS Recruitment was feasible, but strategies to improve retention are needed. The findings suggest the intervention can support women with GDM to lose weight. The observed weight loss was primarily in women who preferred the intervention. Therefore, future trials may need to adopt a preference design and consider factors associated with preference. TRIAL REGISTRATION Trial registration: ISRCTN52675820 https://www.isrctn.com/ISRCTN52675820?q=ISRCTN52675820&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search.
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Affiliation(s)
- Judith Parsons
- Care in Long Term Conditions Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
- * E-mail:
| | - Rita Forde
- Care in Long Term Conditions Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | | | - Katharine F. Hunt
- Diabetes & Nutritional Sciences Division, Diabetes Research Group, King’s College London, London, United Kingdom
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, King’s College London, London, United Kingdom
| | - Trevor Murrells
- Methodologies Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | - Anna Reid
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Helen Rogers
- Diabetes & Nutritional Sciences Division, Diabetes Research Group, King’s College London, London, United Kingdom
| | - Rebecca Rogers
- Care in Long Term Conditions Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | - Angus Forbes
- Care in Long Term Conditions Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
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Hu G, Liu H, Leng J, Wang L, Li W, Zhang S, Li W, Liu G, Tian H, Yang S, Yu Z, Yang X, Tuomilehto J. Effects of a Lifestyle Intervention in Young Women with GDM and Subsequent Diabetes. Nutrients 2022; 14:nu14245232. [PMID: 36558389 PMCID: PMC9785424 DOI: 10.3390/nu14245232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to examine whether a 9-month intensive lifestyle intervention could lead to weight loss and improve cardiovascular risk factors among young women with both gestational diabetes mellitus (GDM) and newly diagnosed diabetes. A total of 83 young women, who had GDM and were subsequently diagnosed as type 2 diabetes at an average of 2.6 years after delivery, participated in a 9-month intensive lifestyle intervention and a follow-up survey at 6-9 years postintervention. After the 9-month intervention, these women had a weight loss of 2.90 kg (-4.02% of initial weight), decreased waist circumference (-3.12 cm), body fat (-1.75%), diastolic blood pressure (-3.49 mmHg), fasting glucose (-0.98 mmol/L) and HbA1c (-0.72%). During the 6-9 years postintervention period, they still had lower weight (-3.71 kg; -4.62% of initial weight), decreased waist circumference (-4.56 cm) and body fat (-2.10%), but showed a slight increase in HbA1c (0.22%). The prevalence of using glucose-lowering agents increased from 2.4% at baseline to 34.6% after the 9-month lifestyle intervention, and to 48.4% at 6-9 years postintervention. A 9-month intensive lifestyle intervention can produce beneficial effects on body weight, HbA1c and other cardiovascular risk factors among young women with previous GDM who subsequently developed new diabetes.
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Affiliation(s)
- Gang Hu
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA
- Correspondence: ; Tel.: +225-763-3053; Fax: +225-763-3009
| | - Huikun Liu
- Tianjin Women’s and Children’s Health Center, Tianjin 300071, China
| | - Junhong Leng
- Tianjin Women’s and Children’s Health Center, Tianjin 300071, China
| | - Leishen Wang
- Tianjin Women’s and Children’s Health Center, Tianjin 300071, China
| | - Weiqin Li
- Tianjin Women’s and Children’s Health Center, Tianjin 300071, China
| | - Shuang Zhang
- Tianjin Women’s and Children’s Health Center, Tianjin 300071, China
| | - Wei Li
- Tianjin Women’s and Children’s Health Center, Tianjin 300071, China
| | - Gongshu Liu
- Tianjin Women’s and Children’s Health Center, Tianjin 300071, China
| | - Huiguang Tian
- Tianjin Women’s and Children’s Health Center, Tianjin 300071, China
| | - Shengping Yang
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA
| | - Zhijie Yu
- Population Cancer Research Program, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Xilin Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Jaakko Tuomilehto
- Department of Public Health, University of Helsinki, 00014 Helsinki, Finland
- Population Health Unit, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
- Saudi Diabetes Research Group, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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Barroso CS, Yockey A, Degon E, Poudel PG, Brown SD, Hedderson MM, Moreno-Hunt C, Ehrlich SF. Efficacious lifestyle interventions for appropriate gestational weight gain in women with overweight or obesity set in the health care system: a scoping review. J Matern Fetal Neonatal Med 2022; 35:6411-6424. [PMID: 34034608 PMCID: PMC8613304 DOI: 10.1080/14767058.2021.1914576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/27/2021] [Accepted: 04/06/2021] [Indexed: 12/22/2022]
Abstract
Purpose: Health care systems offer opportunities to scale up interventions for appropriate gestational weight gain (GWG); however, GWG interventions in the health care setting remain largely unavailable to women with overweight or obesity. To inform the translation of efficacious lifestyle interventions to health care delivery systems, this scoping review aimed to systematically identify randomized controlled trials for appropriate GWG in women with overweight or obesity that were set in a health care system.Methods: A scoping review allows for the systematic synthesis of knowledge on an exploratory research question aimed at mapping key concepts (e.g. time, location, source, and evidence) and gaps in a specific area of study. The Colquhoun et al. (2014) framework to conducting scoping reviews was used to develop the research question, identify relevant studies, select studies, extract data, and synthesize data. Specifically, two reviewers searched publication databases for English-language articles published from January 2009 to May 2020 using specific keywords/MeSH terms.Results: Eight peer-reviewed journal articles were identified; six trials were based in Europe and two in the U.S. Only four included lifestyle interventions that were efficacious in reducing GWG. Three trials with efficacious interventions were among women with obesity only and encouraged them to gain at or below the lower limit for total GWG (i.e. ≤5 kg) of the Institute of Medicine (IOM) guidelines. The fourth was among women with overweight or obesity and encouraged women to gain within the IOM guidelines with a telehealth behavioral intervention. Efficacious interventions were initiated in the first half of pregnancy and included frequent contact delivered through multiple modalities (i.e. in-person visits, telephone calls, text messages, email) by trained intervention staff (i.e. dietitian, lifestyle coach, and/or physiotherapist). Only one efficacious intervention trial briefly mentioned theoretical components for health promotion (e.g. self-monitoring); likewise, only one included cost-effectiveness analyses.Conclusions: This review systematically identified randomized controlled trials of efficacious lifestyle interventions (i.e. consisting of diet and physical activity components) for appropriate GWG in women with overweight or obesity that were set in the health care system and delivered by non-clinicians. Translation efforts could draw upon aspects of the efficacious lifestyle interventions described in this review. Future studies should examine theory-based telehealth interventions and cost-effectiveness.
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Affiliation(s)
- Cristina S. Barroso
- Department of Public Health, the University of Tennessee Knoxville, Knoxville, TN, USA
| | - Andrew Yockey
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Emoni Degon
- Department of Public Health, the University of Tennessee Knoxville, Knoxville, TN, USA
| | - Pragya Gautam Poudel
- Department of Public Health, the University of Tennessee Knoxville, Knoxville, TN, USA
| | - Susan D. Brown
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - Carey Moreno-Hunt
- Maternal Fetal Medicine, Kaiser Permanente Roseville Medical Center, Roseville, CA, USA
| | - Samantha F. Ehrlich
- Department of Public Health, the University of Tennessee Knoxville, Knoxville, TN, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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Chen Y, Zhong Q, Luo J, Tang Y, Li M, Lin Q, Willey JA, Chen JL, Whittemore R, Guo J. The 6-Month Efficacy of an Intensive Lifestyle Modification Program on Type 2 Diabetes Risk Among Rural Women with Prior Gestational Diabetes Mellitus: a Cluster Randomized Controlled Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:1156-1168. [PMID: 35773443 PMCID: PMC9489585 DOI: 10.1007/s11121-022-01392-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 12/08/2022]
Abstract
This study aimed to evaluate the efficacy of an intensive lifestyle modification program tailored to rural Chinese women with prior gestational diabetes mellitus compared with usual care. In a cluster randomized controlled trial, 16 towns (clusters) in two distinct rural areas in China were randomly selected (8 towns per district); and 320 women with prior gestational diabetes mellitus were recruited from these towns. With stratification for the two study districts, eight towns (160 women) were randomly assigned to the intervention group of a tailored intensive lifestyle modification program and 8 towns (160 women) to the control group. Process measures were collected on attendance, engagement, fidelity, and satisfaction. Primary efficacy outcomes included glycemic and weight-related outcomes, while secondary efficacy outcomes were behavioral outcomes and type 2 diabetes risk score, which were collected at baseline, 3-month, and 6-month follow-up. Generalized estimation equations were used to analyze the data. High attendance (72% of sessions), engagement (67% of interactive activities and group discussions), fidelity (98%), and satisfaction (92%) with the tailored intensive lifestyle modification program were achieved. There were significant reductions in fasting blood glucose, oral glucose tolerance test 2 h, waist circumference, and type 2 diabetes risk score of participants in the intervention group compared to the control group (p < .05). There was no significant intervention effect on body mass index or behavioral outcomes (p > .05). In this study, we demonstrate the successful efficacy of an Intensive Lifestyle Modification Program in reducing type 2 diabetes risk among younger women with prior gestational diabetes mellitus. This tailored program delivered by local healthcare providers is a promising approach for diabetes prevention in rural China, reducing health disparities in rural communities about diabetes prevention. Registered in the Chinese Clinical Trial Registry (ChiCTR2000037956) on 3rd Jan 2018.
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Affiliation(s)
- Yao Chen
- Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Qinyi Zhong
- Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Jiaxin Luo
- Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Yujia Tang
- Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Mingshu Li
- Xiangya School of Public Health, Central South University, Changsha, 410078, Hinan, China
| | - Qian Lin
- Xiangya School of Public Health, Central South University, Changsha, 410078, Hinan, China
| | - James Allen Willey
- Philip R. Lee Institute for Health Policy Research, University of California, San Francisco, San Francisco, CA, 94118, USA
| | - Jyu-Lin Chen
- School of Nursing, University of California, San Francisco, San Francisco, CA, 94118, USA
| | | | - Jia Guo
- Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, 410013, Hunan, China.
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Choi E, Kazzi B, Varma B, Ortengren AR, Minhas AS, Vaught AJ, Bennett WL, Lewey J, Michos ED. The Fourth Trimester: a Time for Enhancing Transitions in Cardiovascular Care. CURRENT CARDIOVASCULAR RISK REPORTS 2022; 16:219-229. [PMID: 36159207 PMCID: PMC9490714 DOI: 10.1007/s12170-022-00706-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 01/26/2023]
Abstract
Purpose of Review The "fourth trimester" concept, defined as the first 12 weeks after delivery (and beyond), is a critical window of time for clinicians to intervene to optimize women's cardiovascular health after pregnancy. A timely and comprehensive postpartum cardiovascular assessment should be performed in all women following delivery in order to (1) follow up medical conditions present prior to conception, (2) evaluate symptoms and signs of common postpartum complications, and (3) identify risk factors and prevent future adverse cardiovascular outcomes. In this review, we aim to discuss major maternal cardiovascular risk factors such as hypertensive disorders of pregnancy, gestational diabetes mellitus, postpartum weight retention, and postpartum depression, as well as lactation as a potential protective risk modifying factor. Additionally, we will review effectiveness of outpatient interventions to enhance transitions in cardiovascular care during the fourth trimester. Recent Findings A seamless hand-off from obstetric to primary care, and potentially cardiology, is needed for early detection and management of hypertension, weight, glycemic control, stress and mood, and long-term cardiovascular risk. Additionally, the use of telemedicine, blood pressure self-monitoring, remote activity monitoring, and behavioral health coaches are potentially feasible modalities to augment clinic-based care for cardiovascular risk factors and weight management, but additional studies are needed to study their long-term effectiveness. Summary Development of a comprehensive postpartum care plan with careful consideration of each patient's risk profile and access to resources is critical to improve maternal morbidity and mortality, reduce health disparities, and achieve long-term cardiovascular health for women. Supporting postpartum well-being of women during this transition period requires a multidisciplinary approach, especially primary care engagement, and planning should start before delivery.
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Affiliation(s)
- Eunjung Choi
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
| | - Brigitte Kazzi
- Department of Medicine, Johns Hopkins University School of Medicine, MD 21287 Baltimore, USA
| | - Bhavya Varma
- Department of Medicine, Johns Hopkins University School of Medicine, MD 21287 Baltimore, USA
| | | | - Anum S. Minhas
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
| | - Arthur Jason Vaught
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
| | - Wendy L. Bennett
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287 USA
| | - Jennifer Lewey
- Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
- Division of Cardiology, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524-B, Baltimore, MD 21287 USA
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Cheung NW, Thiagalingam A, Smith BJ, Redfern J, Barry T, Mercorelli L, Chow CK. Text messages promoting healthy lifestyle and linked with activity monitors stimulate an immediate increase in physical activity among women after gestational diabetes. Diabetes Res Clin Pract 2022; 190:109991. [PMID: 35835256 DOI: 10.1016/j.diabres.2022.109991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 05/13/2022] [Accepted: 07/08/2022] [Indexed: 11/03/2022]
Abstract
AIMS To evaluate the immediate effect of text messages promoting healthy lifestyle and supporting parenting on physical activity amongst women with recent gestational diabetes (GDM). METHODS Analysis of data from a pilot randomised controlled trial of a healthy lifestyle program for women with recent GDM. Intervention subjects received text messages providing motivation, reminders, information and feedback as well as an activity monitor. This sub-study examined step count in the 4 h after receipt of a text message, compared to the same time of day on other days among intervention subjects. RESULTS Data from 7326 days where step counts were recorded, from 31 women were analysed. The median steps in the 4 h following a text message was 1237 (IQR 18-2240) and it was 1063 (IQR 0-2038) over the same time period on comparison days where there was no message (p < 0.001). The effect was similar whether the messages pertained to physical activity or not. There was no attenuation of the response over 36-38 weeks. CONCLUSIONS Women with recent GDM increase their step count in the hours following positive and supportive text messages. This suggests that text messaging programs can facilitate healthy lifestyle and diabetes prevention in this population.
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Affiliation(s)
- N Wah Cheung
- Department of Diabetes & Endocrinology, Westmead Hospital, Westmead, NSW 2145, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia.
| | - Aravinda Thiagalingam
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia; Department of Cardiology, Westmead Hospital, Westmead, NSW 2145, Australia.
| | - Ben J Smith
- School of Public Health, University of Sydney, NSW 2006, Australia.
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia.
| | - Tony Barry
- Department of Cardiology, Westmead Hospital, Westmead, NSW 2145, Australia.
| | - Louis Mercorelli
- Sydney Informatics Hub, University of Sydney, Darlington, NSW 2008, Australia.
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia; Department of Cardiology, Westmead Hospital, Westmead, NSW 2145, Australia.
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Brown SD, Hedderson MM, Gordon N, Albright CL, Tsai AL, Quesenberry CP, Ferrara A. Reach, acceptability, and perceived success of a telehealth diabetes prevention program among racially and ethnically diverse patients with gestational diabetes: the GEM cluster-randomized trial. Transl Behav Med 2022; 12:793-799. [PMID: 35849139 DOI: 10.1093/tbm/ibac019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Patients with gestational diabetes mellitus and from racial/ethnic minority groups face disproportionate risk for type 2 diabetes. Lifestyle interventions, if accessible and acceptable to diverse patients, could advance diabetes prevention and mitigate racial/ethnic disparities. Here we describe overall and race/ethnicity-specific reach, acceptability, and perceived success from an effective telehealth diabetes prevention lifestyle program for patients with gestational diabetes mellitus, implemented in the Gestational Diabetes Effects on Moms (GEM) cluster-randomized controlled trial. GEM tested a program of 13 telephone sessions and behavior change techniques (BCTs, e.g., goal setting) in a healthcare system. We evaluated participation (completing ≥1 session), acceptability of BCTs, and perceived success reaching program goals. Among 1,087 patients (75.2% from minority groups), 50.3% participated. Participation rates were 61.7% among Black, 56.4% among Hispanic, 55.6% among multiracial/other, 53.0% among White, and 43.7% among Asian/Pacific Islander patients. Evaluation survey respondents (n = 433/547; 79.2%) largely rated BCTs as very helpful (range 40.9%-58.4%) or moderately helpful (27.3%-34.9%). Respondents from minority groups largely rated goal setting for weight management as very or moderately helpful, with fewer minority respondents rating it as only a little/not at all helpful than White respondents (p = .02). Black and White respondents reported more limited success reaching a healthy weight than Asian/Pacific Islander, Hispanic, and multiracial/other women (p = .005). A telehealth diabetes prevention lifestyle program demonstrated reach and acceptability across racial/ethnic groups. While perceived success can be improved among Black and White participants, such programs could promote access to preventive care and help mitigate disparities in diabetes risk.
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Affiliation(s)
- Susan D Brown
- Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Monique M Hedderson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Nancy Gordon
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Cheryl L Albright
- Nancy Atmospera-Walch School of Nursing, University of Hawai'i at Manoa, Honolulu, HI, USA
| | - Ai-Lin Tsai
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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Thomas T, Xu F, Sridhar S, Sedgwick T, Nkemere L, Badon SE, Quesenberry C, Ferrara A, Mandel S, Brown SD, Hedderson M. A Web-Based mHealth Intervention With Telephone Support to Increase Physical Activity Among Pregnant Patients With Overweight or Obesity: Feasibility Randomized Controlled Trial. JMIR Form Res 2022; 6:e33929. [PMID: 35731565 PMCID: PMC9260523 DOI: 10.2196/33929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/29/2022] [Accepted: 04/22/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Pregnant patients with overweight or obesity are at high risk for perinatal complications. Excess gestational weight gain (GWG) further exacerbates this risk. Mobile health (mHealth) lifestyle interventions that leverage technology to facilitate self-monitoring and provide just-in-time feedback may motivate behavior change to reduce excess GWG, reduce intervention costs, and increase scalability by improving access. OBJECTIVE This study aimed to test the acceptability and feasibility of a pilot mHealth lifestyle intervention for pregnant patients with overweight or obesity to promote moderate intensity physical activity (PA), encourage guideline-concordant GWG, and inform the design of a larger pragmatic cluster randomized controlled trial. METHODS We conducted a mixed methods acceptability and feasibility randomized controlled trial among pregnant patients with a prepregnancy BMI of 25 to 40 kg/m2. Patients with singletons at 8 to 15 weeks of gestation who were aged ≥21 years and had Wi-Fi access were recruited via email from 2 clinics within Kaiser Permanente Northern California and randomized to receive usual prenatal care or an mHealth lifestyle intervention. Participants in the intervention arm received wireless scales, access to an intervention website, activity trackers to receive automated feedback on weight gain and activity goals, and monthly calls from a lifestyle coach. Surveys and focus groups with intervention participants assessed intervention satisfaction and ways to improve the intervention. PA outcomes were self-assessed using the Pregnancy Physical Activity Questionnaire, and GWG was assessed using electronic health record data for both arms. RESULTS Overall, 33 patients were randomly assigned to the intervention arm, and 35 patients were randomly assigned to the usual care arm. All participants in the intervention arm weighed themselves at least once a week, compared with 20% (7/35) of the participants in the usual care arm. Participants in the intervention arm wore the activity tracker 6.4 days per week and weighed themselves 5.3 times per week, and 88% (29/33) of them rated the program "good to excellent." Focus groups found that participants desired more nutrition-related support to help them manage GWG and would have preferred an app instead of a website. Participants in the intervention arm had a 23.46 metabolic equivalent of task hours greater change in total PA per week and a 247.2-minute greater change in moderate intensity PA per week in unadjusted models, but these effects were attenuated in adjusted models (change in total PA: 15.55 metabolic equivalent of task hours per week; change in moderate intensity PA: 199.6 minutes per week). We found no difference in total GWG (mean difference 1.14 kg) compared with usual care. CONCLUSIONS The pilot mHealth lifestyle intervention was feasible, highly acceptable, and promoted self-monitoring. Refined interventions are needed to effectively affect PA and GWG among pregnant patients with overweight or obesity. TRIAL REGISTRATION ClinicalTrials.gov NCT03936283; https://clinicaltrials.gov/ct2/show/NCT03936283.
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Affiliation(s)
- Tainayah Thomas
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Fei Xu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Sneha Sridhar
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Tali Sedgwick
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Linda Nkemere
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Sylvia E Badon
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Charles Quesenberry
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Sarah Mandel
- The Permanente Medical Group, San Francisco, CA, United States
| | - Susan D Brown
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
- School of Medicine, University of California, Davis, Sacramento, CA, United States
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States
| | - Monique Hedderson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
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Michalopoulou M, Ferrey AE, Harmer G, Goddard L, Kebbe M, Theodoulou A, Jebb SA, Aveyard P. Effectiveness of Motivational Interviewing in Managing Overweight and Obesity : A Systematic Review and Meta-analysis. Ann Intern Med 2022; 175:838-850. [PMID: 35344379 DOI: 10.7326/m21-3128] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Motivational interviewing (MI) is potentially useful in management of overweight and obesity, but staff training and increased delivery time are barriers, and its effectiveness independent of other behavioral components is unclear. PURPOSE To assess the independent contribution of MI as part of a behavioral weight management program (BWMP) in controlling weight and improving psychological well-being. DATA SOURCES 6 electronic databases and 2 trial registries, searched from database inception through 24 September 2021. STUDY SELECTION Randomized controlled trials in adults or adolescents aimed at weight loss or maintenance and comparing programs incorporating MI versus interventions without MI. DATA EXTRACTION Two reviewers independently screened studies, extracted data, and assessed risk of bias. Outcomes included weight, anxiety, depression, quality of life, and other aspects of psychological well-being. Pooled mean differences or standardized mean differences were obtained using random- and fixed-effects meta-analyses. DATA SYNTHESIS Forty-six studies involving 11 077 participants, predominantly with obesity, were included. At 6 months, BWMPs using MI were more effective than no/minimal intervention (-0.88 [95% CI, -1.27 to -0.48] kg; I 2 = 0%) but were not statistically significantly more effective than lower-intensity (-0.88 [CI, -2.39 to 0.62] kg; I 2 = 55.8%) or similar-intensity (-1.36 [CI, -2.80 to 0.07] kg; I 2 = 18.8%) BWMPs. At 1 year, data were too sparse to pool comparisons with no/minimal intervention, but MI did not produce statistically significantly greater weight change compared with lower-intensity (-1.16 [CI, -2.49 to 0.17] kg; I 2 = 88.7%) or similar-intensity (-0.18 [CI, -2.40 to 2.04] kg; I 2 = 72.7%) BWMPs without MI. Studies with 18-month follow-up were also sparse; MI did not produce statistically significant benefit in any of the comparator categories. There was no evidence of subgroup differences based on study, participant, or intervention characteristics. Too few studies assessed effects on psychological well-being to pool, but data did not suggest that MI was independently effective. LIMITATIONS High statistical heterogeneity among studies, largely unexplained by sensitivity and subgroup analyses; stratification by comparator intensity and follow-up duration resulted in pooling of few studies. CONCLUSION There is no evidence that MI increases effectiveness of BWMPs in controlling weight. Given the intensive training required for its delivery, MI may not be a worthwhile addition to BWMPs. PRIMARY FUNDING SOURCE National Institute for Health Research Biomedical Research Centre. (PROSPERO: CRD42020177259).
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Affiliation(s)
- Moscho Michalopoulou
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom (M.M., A.E.F., S.A.J., P.A.)
| | - Anne E Ferrey
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom (M.M., A.E.F., S.A.J., P.A.)
| | - Georgina Harmer
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, United Kingdom (G.H., L.G., M.K., A.T.)
| | - Lucy Goddard
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, United Kingdom (G.H., L.G., M.K., A.T.)
| | - Maryam Kebbe
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, United Kingdom (G.H., L.G., M.K., A.T.)
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, United Kingdom (G.H., L.G., M.K., A.T.)
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom (M.M., A.E.F., S.A.J., P.A.)
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom (M.M., A.E.F., S.A.J., P.A.)
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Brown SD, Hedderson MM, Zhu Y, Tsai AL, Feng J, Quesenberry CP, Ferrara A. Uptake of guideline-recommended postpartum diabetes screening among diverse women with gestational diabetes: associations with patient factors in an integrated health system in USA. BMJ Open Diabetes Res Care 2022; 10:10/3/e002726. [PMID: 35725017 PMCID: PMC9214412 DOI: 10.1136/bmjdrc-2021-002726] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/20/2022] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Clinical guidelines urge timely postpartum screening for diabetes among women with gestational diabetes mellitus (GDM), yet patient factors associated with screening uptake remain unclear. We aimed to identify patient factors associated with completed postpartum diabetes screening (2-hour oral glucose tolerance test within 4-12 weeks postpartum), as recommended by the American Diabetes Association (ADA). RESEARCH DESIGN AND METHODS Within the context of Gestational Diabetes' Effects on Moms (GEM), a pragmatic cluster randomized trial (2011-2012), we examined survey and electronic health record data to assess clinical and sociodemographic factors associated with uptake of ADA-recommended postpartum screening. Participants included 1642 women (76% racial/ethnic minorities) identified with GDM according to the Carpenter and Coustan criteria in a health system that deploys population-level strategies to promote screening. To contextualize these analyses, screening rates derived from the GEM trial were compared with those in the health system overall using registry data from a concurrent 10-year period (2007-2016, n=21 974). RESULTS Overall 52% (n=857) completed recommended postpartum screening in the analytic sample, comparable to 45.7% (n=10 040) in the registry. Screening in the analytic sample was less likely among women at elevated risk for type 2 diabetes, assessed using items from an ADA risk test (vs non-elevated; adjusted rate ratio (aRR)=0.86 (95% CI 0.75 to 0.98)); perinatal depression (0.88 (0.79 to 0.98)); preterm delivery (0.84 (0.72 to 0.98)); parity ≥2 children (vs 0; 0.80 (0.69 to 0.93)); or less than college education (0.79 (0.72 to 0.86)). Screening was more likely among Chinese Americans (vs White; 1.31 (1.15 to 1.49)); women who attended a routine postpartum visit (5.28 (2.99 to 9.32)); or women who recalled receiving healthcare provider advice about screening (1.31 (1.03 to 1.67)). CONCLUSIONS Guideline-recommended postpartum diabetes screening varied by patient clinical and sociodemographic factors. Findings have implications for developing future strategies to improve postpartum care.
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Affiliation(s)
- Susan D Brown
- Department of Internal Medicine, University of California, Davis, Sacramento, California, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Monique M Hedderson
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Ai-Lin Tsai
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Juanran Feng
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Charles P Quesenberry
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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Lewey J, Murphy S, Zhang D, Putt ME, Elovitz MA, Riis V, Patel MS, Levine LD. Effectiveness of a Text-Based Gamification Intervention to Improve Physical Activity Among Postpartum Individuals With Hypertensive Disorders of Pregnancy: A Randomized Clinical Trial. JAMA Cardiol 2022; 7:591-599. [PMID: 35442393 PMCID: PMC9021982 DOI: 10.1001/jamacardio.2022.0553] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Importance Hypertensive disorders of pregnancy are associated with increased risk of cardiovascular disease, yet few interventions have targeted this population to decrease long-term risk. Objective To determine whether a digital health intervention improves physical activity in postpartum individuals with hypertensive disorders of pregnancy. Design, Setting, and Participants This 12-week randomized clinical trial enrolled postpartum individuals who delivered at the University of Pennsylvania and had a hypertensive disorder of pregnancy between October 2019 and June 2020. Analysis was intention to treat. Interventions All participants received a wearable activity tracker, established a baseline step count, selected a step goal greater than baseline, and were randomly assigned to control or intervention. Participants in the control arm received daily feedback on goal attainment. Participants in the intervention arm were placed on virtual teams and enrolled in a game with points and levels for daily step goal achievement and informed by principles of behavioral economics. Main Outcomes and Measures The primary outcome was change in mean daily step count from baseline to 12-week follow-up. Secondary outcome was proportion of participant-days that step goal was achieved. Results A total of 127 participants were randomized (64 in the control group and 63 in the intervention group) and were enrolled a mean of 7.9 weeks post partum. Participants had a mean (SD) age of 32.3 (5.6) years, 70 (55.1%) were Black, and 52 (41.9%) had Medicaid insurance. The mean (SD) baseline step count was similar in the control and intervention arms (6042 [2270] vs 6175 [1920] steps, respectively). After adjustment for baseline steps and calendar month, participants in the intervention arm had a significantly greater increase in mean daily step steps from baseline compared with the control arm (647 steps; 95% CI, 169-1124 steps; P = .009). Compared with the control arm, participants in the intervention arm achieved their steps goals on a greater proportion of participant-days during the intervention period (0.47 vs 0.38; adjusted difference 0.11; 95% CI, 0.04-0.19; P = .003). Conclusions and Relevance In this study, a digital health intervention using remote monitoring, gamification, and social incentives among postpartum individuals at elevated cardiovascular risk significantly increased physical activity throughout 12 weeks. Trial Registration ClinicalTrials.gov Identifier: NCT03311230.
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Affiliation(s)
- Jennifer Lewey
- Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Samantha Murphy
- Maternal and Child Health Research Program, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Dazheng Zhang
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Mary E. Putt
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Michal A. Elovitz
- Maternal and Child Health Research Program, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Valerie Riis
- Maternal and Child Health Research Program, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | - Lisa D. Levine
- Maternal and Child Health Research Program, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Kumari A, Ranjan P, Vikram NK, Kaur D, Balsalkar G, Malhotra A, Puri M, Batra A, Madan J, Tyagi S, Guleria K, Dabral A, Sarkar S, Nigam A, Anwar W, Kamath S, Bhatla N, Kumari SS, Kumar R, Choranur A, Venkataraman S, Kaur T, Rathore AM, Kaloiya G, Prakash A, Tiwaskar M, Verma A, Singh R, Sharma KA, Baitha U, Tewary K, Misra A, Guleria R. Executive summary of evidence and consensus-based clinical practice guideline for management of obesity and overweight in postpartum women: An AIIMS-DST initiative. Diabetes Metab Syndr 2022; 16:102425. [PMID: 35248972 DOI: 10.1016/j.dsx.2022.102425] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Postpartum obesity is a public health concern. There is a need to counsel women about their postpartum weight management, accounting for various barriers they face. Limited literature in the Indian context underscored the need to develop the clinical practice guideline to be used by healthcare providers in Indian healthcare settings. METHODS The guideline was formulated by following the standardised methodology proposed by the National Health and Medical Research Council. Various steps such as identification of the patient population, assembly of the guideline development groups, identification of the key clinical questions, guideline development methods, grading the quality of evidence and recommendations and guideline translation were carried out to develop and validate the clinical practice recommendations. RESULTS The evidence and consensus-based clinical practice guideline has been developed, providing recommendations for key topics of interest for first-line treatment of obesity (lifestyle-related management). Recommendations focus on screening and initiating discussion with overweight and obese postpartum women as well as those who had normal pre-pregnancy body mass index but have retained excessive weight in the postpartum period. Recommendations highlight the evaluation and management of dietary, physical activity and breastfeeding behaviour. Recommendations also account for behavioural modification techniques to improve adherence to the prescribed weight management advice. Duration and frequency of follow-ups as well as the advice to be disseminated have also been discussed in the recommendations. CONCLUSION The guideline provides clinical practice points that can be used by healthcare providers, postpartum women and policymakers for opportunistic screening and management of postpartum obesity.
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Affiliation(s)
- Archana Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
| | - Naval K Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Divjyot Kaur
- Department of Home Science, University of Delhi, New Delhi, India
| | - Geetha Balsalkar
- Department of Obstetrics and Gynaecology, Seth G. S. Medical College, Mumbai, India
| | - Anita Malhotra
- Food and Nutrition, Department of Home Science, Vice-principal, Lakshmibai College, University of Delhi, New Delhi, India
| | - Manju Puri
- Department of Obstetrics and Gynaecology, LHMC and SSK Hospital, New Delhi, India
| | - Achla Batra
- President, Association of Obstetricians and Gynaecologists of Delhi (AOGD), Professor, Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India
| | | | - Shakun Tyagi
- Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India
| | - Kiran Guleria
- Department of Obstetrics and Gynaecology, University College of Medical Sciences, New Delhi, India
| | - Anjali Dabral
- Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Siddharth Sarkar
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Aruna Nigam
- Department of Obstetrics and Gynaecology, Hamdard Institute of Medical Sciences & Research, New Delhi, India
| | - Wareesha Anwar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sandhya Kamath
- Seth G S Medical College and KEM Hospital, Mumbai, LT Municipal Medical College and General Hospital, Mumbai, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - S Shantha Kumari
- The Federation of Obstetric and Gynaecological Societies of India, India
| | - Raman Kumar
- Academy of Family Physicians of India, India
| | - Ambuja Choranur
- President, Indian Menopause Society, Former Professor and Head, Department of Obstetrics and Gynaecology, Osmania Medical College, Hyderabad, India
| | - Srikumar Venkataraman
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - Tanveer Kaur
- Department of Psychology, University of Delhi, New Delhi, India
| | - Asmita Muthal Rathore
- Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India
| | - Gaurishankar Kaloiya
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Anupam Prakash
- Department of Medicine, LHMC and SSK Hospital, New Delhi, India
| | | | - Archana Verma
- The Federation of Obstetric and Gynaecological Societies of India, India
| | - Rakhi Singh
- Endocrinology Committee, The Federation of Obstetric and Gynaecological Societies of India, India
| | - K Aparna Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Upendra Baitha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kamlesh Tewary
- All India Institute of Medical Sciences, New Delhi, India
| | - Anoop Misra
- Chairman, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chairman, National Diabetes, Obesity and Cholesterol Foundation (N-DOC) and President, Diabetes Foundation (India), New Delhi, India
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Zera CA, Seely EW. Controversies in Gestational Diabetes. TOUCHREVIEWS IN ENDOCRINOLOGY 2022; 17:102-107. [PMID: 35118455 DOI: 10.17925/ee.2021.17.2.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/23/2021] [Indexed: 11/24/2022]
Abstract
Gestational diabetes mellitus (GDM) complicates approximately 7% of pregnancies in the USA. Despite recognition of the benefits of diagnosing and treating GDM, there are several areas of controversy that remain unresolved. There is debate as to whether to screen for GDM with the one-step versus the two-step approach. While the former identifies more pregnancies with potential adverse outcomes, data are lacking as to whether treatment of these pregnancies will improve outcomes, while increasing costs by diagnosing more women. Though it is well established that the diagnosis of even mild GDM, and treatment with lifestyle recommendations and insulin, improves pregnancy outcomes, it is controversial as to which type and regimen of insulin is optimal, and whether oral agents can be used safely and effectively to control glucose levels. Finally, it is recommended that women with GDM get tested for type 2 diabetes within several months of delivery; however, many women do not undergo this testing and alternative approaches are needed. These controversies are discussed with data from both sides of the debate to enable clinicians to make patient-centered decisions until more definitive data are available.
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Affiliation(s)
- Chloe A Zera
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Ellen W Seely
- Harvard Medical School, Boston, MA, USA.,Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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38
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Bennett WL, Coughlin JW, Henderson J, Martin S, Yazdy GM, Drabo EF, Showell NN, McKinney C, Martin L, Dalcin A, Sanders R, Wang NY. Healthy for Two/Healthy for You: Design and methods for a pragmatic randomized clinical trial to limit gestational weight gain and prevent obesity in the prenatal care setting. Contemp Clin Trials 2022; 113:106647. [PMID: 34896296 PMCID: PMC8844210 DOI: 10.1016/j.cct.2021.106647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the effect of Healthy for Two/Healthy for You (H42/H4U), a health coaching program, in prenatal care clinics that serve a racially and economically diverse population, on total gestational weight gain (GWG) (vs. usual care). We hypothesize that compared to usual prenatal care, intervention participants will have lower GWG and lower rates of gestational diabetes mellitus (GDM). METHODS We report the rationale and design of a pragmatic, parallel arm randomized clinical trial with 380 pregnant patients ≤15 weeks gestation with overweight or obesity from one of 6 academic and community-based obstetrics practices, randomized to either H42/H4U or usual prenatal care in a 1:1 ratio. The study duration is early pregnancy to 6 months postpartum. The primary outcome is total GWG, calculated as the difference between first clinic-assessed pregnancy weight and the weight at 37 weeks gestation. Key maternal and infant secondary outcomes include GDM incidence, weight retention at 6 months postpartum, infant weight, maternal health behaviors and wellness. CONCLUSIONS This pragmatic clinical trial embeds a pregnancy health coaching program into prenatal care to allow parallel testing compared to usual prenatal care on the outcome of total GWG. The real-world design provides an approach to enhance its sustainability beyond the trial to ultimately improve maternal/child health outcomes and reduce future obesity. TRIAL REGISTRATION The study was first registered at clinicaltrials.gov on 1/26/21 (NCT04724330).
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Affiliation(s)
- Wendy L Bennett
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Baltimore, MD 21205, USA..
| | | | - Janice Henderson
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, USA
| | - Stephen Martin
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, USA
| | - Golsa M Yazdy
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, USA
| | - Emmanuel F Drabo
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, USA
| | | | - Christine McKinney
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Lindsay Martin
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Arlene Dalcin
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Rachel Sanders
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Baltimore, MD 21205, USA
| | - Nae-Yuh Wang
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 E Monument Street, Baltimore, MD 21205, USA
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O'Reilly SL, Burden C, Campoy C, McAuliffe FM, Teede H, Andresen J, Campbell KJ, Geraghty AA, Harrison CL, Laws R, Norman JE, Maindal HT, Vrangbæk K, Segurado R, Versace VL, Skinner TC. Bump2Baby and Me: protocol for a randomised trial of mHealth coaching for healthy gestational weight gain and improved postnatal outcomes in high-risk women and their children. Trials 2021; 22:963. [PMID: 34963483 PMCID: PMC8713543 DOI: 10.1186/s13063-021-05892-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Gestational diabetes (GDM) impacts 8–18% of pregnancies and greatly increases both maternal and child risk of developing non-communicable diseases such as type 2 diabetes and obesity. Whilst lifestyle interventions in pregnancy and postpartum reduce this risk, a research translation gap remains around delivering implementable interventions with adequate population penetration and participation. Impact Diabetes Bump2Baby is an implementation project of an evidence-based system of care for the prevention of overweight and obesity. Bump2Baby and Me is the multicentre randomised controlled trial investigating the effectiveness of a mHealth coaching programme in pregnancy and postpartum for women at high risk of developing GDM. Methods Eight hundred women will be recruited in early pregnancy from 4 clinical sites within Ireland, the UK, Spain, and Australia. Women will be screened for eligibility using the validated Monash GDM screening tool. Participants will be enrolled from 12 to 24 weeks’ gestation and randomised on a 1:1 basis into the intervention or control arm. Alongside usual care, the intervention involves mHealth coaching via a smartphone application, which uses a combination of synchronous and asynchronous video and text messaging, and allows for personalised support and goal setting with a trained health coach. The control arm receives usual care. All women and their children will be followed from early pregnancy until 12 months postpartum. The primary outcome will be a difference in maternal body mass index (BMI) of 0.8 kg/m2 at 12 months postpartum. Secondary maternal and infant outcomes include the development of GDM, gestational weight gain, pregnancy outcomes, improvements in diet, physical activity, sleep, and neonatal weight and infant growth patterns. The 5-year project is funded by the EU Commission Horizon 2020 and the Australian National Health and Medical Research Council. Ethical approval has been received. Discussion Previous interventions have not moved beyond tightly controlled efficacy trials into routine service delivery. This project aims to provide evidence-based, sustainable support that could be incorporated into usual care for women during pregnancy and postpartum. This study will contribute evidence to inform the early prevention of non-communicable diseases like obesity and diabetes in mothers and the next generation. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12620001240932. Registered on 19 November 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05892-4.
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Affiliation(s)
- Sharleen L O'Reilly
- School of Agriculture and Food Science, University College Dublin, Belfield, Dublin, Ireland.,UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Christy Burden
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Cristina Campoy
- Department of Paediatrics, School of Medicine, University of Granada, Granada, Spain
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Melbourne, Victoria, Australia
| | | | - Karen J Campbell
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University Geelong, Geelong, Victoria, Australia
| | - Aisling A Geraghty
- School of Agriculture and Food Science, University College Dublin, Belfield, Dublin, Ireland.,UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Melbourne, Victoria, Australia
| | - Rachel Laws
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University Geelong, Geelong, Victoria, Australia
| | - Jane E Norman
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Helle T Maindal
- Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, Aarhus, Denmark
| | - Karsten Vrangbæk
- Department of Public Health, Center for Health Economics and Policy, University of Copenhagen, Copenhagen, Denmark
| | - Ricardo Segurado
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Belfield, Dublin, Ireland
| | - Vincent L Versace
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Timothy C Skinner
- Institut for Psykologi, Center for Sundhed of Samfund, Københavns Universitet, Øster Farimagsgade, København K, Denmark.,University Department of Rural Health, La Trobe University, Bendigo, Australia
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Huang S, Magny-Normilus C, McMahon E, Whittemore R. Systematic Review of Lifestyle Interventions for Gestational Diabetes Mellitus in Pregnancy and the Postpartum Period. J Obstet Gynecol Neonatal Nurs 2021; 51:115-125. [PMID: 34843670 DOI: 10.1016/j.jogn.2021.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To examine the characteristics and effectiveness of lifestyle interventions for gestational diabetes mellitus (GDM) in pregnancy and the postpartum period to prevent Type 2 diabetes. DATA SOURCES We conducted searches in seven databases, including Ovid MEDLINE, CINAHL, Ovid Embase, Cochrane Central, Web of Science, Ovid PsycInfo, and ProQuest Dissertations and Theses for articles published from inception to January 2021. STUDY SELECTION We included articles on controlled intervention studies in which researchers evaluated a lifestyle intervention provided during pregnancy and the postpartum period for women with or at risk for GDM that were published in English. DATA EXTRACTION Twelve articles that were reports of seven studies met the inclusion criteria. In some cases, more than one article was selected from the same study. For example, articles reported different outcomes from the same study. We extracted data with the use of a data collection form and compared and synthesized data on study design, purpose, sample, intervention characteristics, recruitment and retention, and outcomes. DATA SYNTHESIS All seven studies focused on weight management and/or healthy lifestyle behaviors (diet and physical activity). Outcomes included glucose regulation, weight, lifestyle behaviors, and knowledge. The interventions varied in duration/dosage, strategies, and modes of delivery. In four studies, researchers reported interventions that had significant effects on improving glucose regulation and/or weight change. Some characteristics from the four effective interventions included goal setting, individualized care, and good retention rates. In the other three studies, limitations included low rates of participant retention, lack of personalized interventions, and limited population diversity or lack of culturally sensitive care. CONCLUSION Lifestyle interventions provided during and after pregnancy to reduce the risk associated with GDM have the potential to improve outcomes. Health care counseling to promote healthy lifestyle behaviors related to the prevention of Type 2 diabetes is needed at different stages of maternity care for women with GDM. Additional high-quality studies are needed to address the limitations of current studies.
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41
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Harris RG, Batterham M, Neale EP, Ferreira I. Impact of missing outcome data in meta-analyses of lifestyle interventions during pregnancy to reduce postpartum weight retention: An overview of systematic reviews with meta-analyses and additional sensitivity analyses. Obes Rev 2021; 22:e13318. [PMID: 34477276 DOI: 10.1111/obr.13318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/20/2021] [Accepted: 06/22/2021] [Indexed: 12/01/2022]
Abstract
High risk of bias associated with missing outcome data (MOD) in meta-analyses (MAs) of the effects of lifestyle interventions during pregnancy on postpartum weight retention (PPWR) casts doubt on whether such interventions can be relied upon as truly effective. This systematic overview of three MAs (19 RCTs), each with high MOD rates in the subset of RCTs included, examined how MOD were addressed in the estimation of summary intervention effects. All MAs reported beneficial and statistically significant intervention effects estimated based on complete case analyses, deemed valid if MOD was missing at random (MAR). Therefore, we conducted sensitivity analyses using pattern mixture models and informative missingness parameters (describing how the outcome in the missing participants may be related to the outcome in the completers), to ascertain the robustness of the estimates to reasonable deviations from the MAR assumption. In plausible scenarios where the response in intervention group participants with versus without MOD was worse (by just 0.5 kg), effect estimates were attenuated in all MAs and no longer statistically significant in two MAs. Statistical significance was retained when all 19 RCTs identified across MAs were examined together in a broader meta-analysis: -0.63 kg (95%CI -0.17, -0.08), but the clinical relevancy of effects of this magnitude remains unclear.
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Affiliation(s)
- Rebecca G Harris
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Marijka Batterham
- School of Mathematics and Applied Statistics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Elizabeth P Neale
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Isabel Ferreira
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Public Health Department, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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42
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Jowell AR, Sarma AA, Gulati M, Michos ED, Vaught AJ, Natarajan P, Powe CE, Honigberg MC. Interventions to Mitigate Risk of Cardiovascular Disease After Adverse Pregnancy Outcomes: A Review. JAMA Cardiol 2021; 7:346-355. [PMID: 34705020 DOI: 10.1001/jamacardio.2021.4391] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance A growing body of evidence suggests that adverse pregnancy outcomes (APOs), including hypertensive disorders of pregnancy, gestational diabetes (GD), preterm birth, and intrauterine growth restriction, are associated with increased risk of cardiometabolic disease and cardiovascular disease (CVD) later in life. Adverse pregnancy outcomes may therefore represent an opportunity to intervene to prevent or delay onset of CVD. The objective of this review was to summarize the current evidence for targeted postpartum interventions and strategies to reduce CVD risk in women with a history of APOs. Observations A search of PubMed and Ovid for English-language randomized clinical trials, cohort studies, descriptive studies, and guidelines published from January 1, 2000, to April 30, 2021, was performed. Four broad categories of interventions were identified: transitional clinics, lifestyle interventions, pharmacotherapy, and patient and clinician education. Observational studies suggest that postpartum transitional clinics identify women who are at elevated risk for CVD and may aid in the transition to longitudinal primary care. Lifestyle interventions to increase physical activity and improve diet quality may help reduce the incidence of type 2 diabetes in women with prior GD; less is known about women with other prior APOs. Metformin hydrochloride may prevent development of type 2 diabetes in women with prior GD. Evidence is lacking in regard to specific pharmacotherapies after other APOs. Cardiovascular guidelines endorse using a history of APOs to refine CVD risk assessment and guide statin prescription for primary prevention in women with intermediate calculated 10-year CVD risk. Research suggests a low level of awareness of the link between APOs and CVD among both patients and clinicians. Conclusions and Relevance These findings suggest that transitional clinics, lifestyle intervention, targeted pharmacotherapy, and clinician and patient education represent promising strategies for improving postpartum maternal cardiometabolic health in women with APOs; further research is needed to develop and rigorously evaluate these interventions. Future efforts should focus on strategies to increase maternal postpartum follow-up, improve accessibility to interventions across diverse racial and cultural groups, expand awareness of sex-specific CVD risk factors, and define evidence-based precision prevention strategies for this high-risk population.
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Affiliation(s)
- Amanda R Jowell
- Currently a medical student at Harvard Medical School, Boston, Massachusetts
| | - Amy A Sarma
- Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston.,Corrigan Women's Heart Health Program, Massachusetts General Hospital, Boston
| | - Martha Gulati
- Division of Cardiology, University of Arizona, Phoenix
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arthur J Vaught
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of Surgical Critical Care, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pradeep Natarajan
- Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston.,Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts.,Cardiovascular Research Center, Massachusetts General Hospital, Boston
| | - Camille E Powe
- Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Diabetes Unit, Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston
| | - Michael C Honigberg
- Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston.,Corrigan Women's Heart Health Program, Massachusetts General Hospital, Boston.,Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts.,Cardiovascular Research Center, Massachusetts General Hospital, Boston
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Marschner S, Chow C, Thiagalingam A, Simmons D, McClean M, Pasupathy D, Smith BJ, Flood V, Padmanabhan S, Melov S, Ching C, Cheung NW. Effectiveness of a customised mobile phone text messaging intervention supported by data from activity monitors for improving lifestyle factors related to the risk of type 2 diabetes among women after gestational diabetes: protocol for a multicentre randomised controlled trial (SMART MUMS with smart phones 2). BMJ Open 2021; 11:e054756. [PMID: 34535488 PMCID: PMC8451310 DOI: 10.1136/bmjopen-2021-054756] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Gestational diabetes (GDM) contributes substantially to the population burden of type 2 diabetes (T2DM), with a high long-term risk of developing T2DM. This study will assess whether a structured lifestyle modification programme for women immediately after a GDM pregnancy, delivered via customised text messages and further individualised using data from activity monitors, improves T2DM risk factors, namely weight, physical activity (PA) and diet. METHODS AND ANALYSIS This multicentre randomised controlled trial will recruit 180 women with GDM attending Westmead, Campbelltown or Blacktown hospital services in Western Sydney. They will be randomised (1:1) on delivery to usual care with activity monitor (active control) or usual care plus activity monitor and customised education, motivation and support delivered via text messaging (intervention). The intervention will be customised based on breastfeeding status, and messages including their step count achievements to encourage PA. Messages on PA and healthy eating will encourage good lifestyle habits. The primary outcome of the study is healthy lifestyle composed of weight, dietary and PA outcomes, to be evaluated at 6 months. The secondary objectives include the primary objective components, body mass index, breastfeeding duration and frequency, postnatal depression, utilisation of the activity monitor, adherence to obtaining an oral glucose tolerance test post partum and the incidence of dysglycaemia at 12 months. Relative risks and their 95% CIs will be presented for the primary objective and the appropriate regression analysis, adjusting for the baseline outcome results, will be done for each outcome. ETHICS AND DISSEMINATION Ethics approval has been received from the Western Sydney Local Health District Human Research Ethics Committee (2019/ETH13240). All patients will provide written informed consent. Study results will be disseminated via the usual channels including peer-reviewed publications and presentations at national and international conferences. TRIAL REGISTRATION NUMBER ACTRN12620000615987; Pre-results.
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Affiliation(s)
- Simone Marschner
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Clara Chow
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Aravinda Thiagalingam
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Penrith South, New South Wales, Australia
- Macarthur Diabetes School, Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Mark McClean
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, New South Wales, Australia
- Department of Diabetes and Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Dharmintra Pasupathy
- Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales, Australia
| | - Ben J Smith
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Victoria Flood
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Suja Padmanabhan
- Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Melov
- Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales, Australia
- Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Cellina Ching
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, New South Wales, Australia
| | - N Wah Cheung
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, New South Wales, Australia
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Palnati M, Marcus BH, Pekow P, Rosal MC, Manson JE, Chasan-Taber L. The Impact of a Lifestyle Intervention on Postpartum Weight Retention Among At-Risk Hispanic Women. Am J Prev Med 2021; 61:44-54. [PMID: 33994252 PMCID: PMC8217276 DOI: 10.1016/j.amepre.2021.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION This study assesses the impact of a culturally modified, motivationally targeted, individually tailored intervention on postpartum weight retention among Hispanic women with abnormal glucose tolerance during pregnancy. METHODS Estudio Parto (Project Aiming to Reduce Type twO diabetes) was an RCT conducted in Western Massachusetts (collected 2013‒2017, analyzed 2018-2020). Hispanic women with blood glucose ≥140 mg/dL (7.77 mmol/L) on routine nonfasting oral glucose challenge test were randomized to a Lifestyle Intervention (n=100) focusing on healthy exercise and diet or to a comparison Health and Wellness Intervention (n=104) with no mention of exercise or diet behavior changes. The primary outcome was change in weight, calculated as the difference between prepregnancy weight and 6-week, 6-month, and 12-month postpartum weight. The secondary outcome was achievement of weight reduction to prepregnancy weight if prepregnancy BMI was normal, or a 5% reduction if prepregnancy BMI was overweight/obese. RESULTS In intent-to-treat analyses, there were no significant differences in weight change pattern between the intervention arms across all follow-up timepoints (β=0.03, 95% CI= -3.38, 3.45). However, at 12 months postpartum, women in the Lifestyle Intervention arm had a statistically significant 2.5-fold higher odds of meeting the secondary weight reduction outcome (OR=2.52, 95% CI=1.09, 5.82) than women in the Health and Wellness arm. Regardless of intervention arm, women who reported higher levels of postpartum sports/exercise had a greater decrease in weight (β= -2.39, 95% CI= -4.66, -0.13, p=0.04) than women reporting lower levels. CONCLUSIONS In this randomized trial among Hispanic women, no significant overall differences in weight change pattern between intervention arms were observed. Higher levels of self-reported physical activity were associated with greater weight loss in both arms.
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Affiliation(s)
- Madhuri Palnati
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Bess H Marcus
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Penelope Pekow
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Milagros C Rosal
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lisa Chasan-Taber
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts.
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Stith BJ, Buls SM, Keim SA, Thung SF, Klebanoff MA, Landon MB, Gabbe SG, Gandhi KK, Oza-Frank R. Moms in motion: weight loss intervention for postpartum mothers after gestational diabetes: a randomized controlled trial. BMC Pregnancy Childbirth 2021; 21:461. [PMID: 34187391 PMCID: PMC8240610 DOI: 10.1186/s12884-021-03886-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background Up to 50 % of women with gestational diabetes mellitus (GDM) will receive a diagnosis of type 2 diabetes mellitus (T2DM) within a decade after pregnancy. While excess postpartum weight retention exacerbates T2DM risk, lifestyle changes and behavior modifications can promote healthy postpartum weight loss and contribute to T2DM prevention efforts. However, some women have difficulty prioritizing self-care during this life stage. Efficacious interventions that women can balance with motherhood to reduce T2DM risk remain a goal. The objective of the Moms in Motion study is to evaluate the efficacy of a simple, novel, activity-boosting intervention using ankle weights worn with daily activities during a 6-month postpartum intervention among women with GDM. We hypothesize that women randomized to the 6-month intensity-modifying intervention will (1) demonstrate greater weight loss and (2) greater improvement in body composition and biomarker profile versus controls. Methods This study will be a parallel two-arm randomized controlled trial (n = 160). Women will be allocated 1:1 to an ankle weight intervention group or a standard-of-care control group. The intervention uses ankle weights (1.1 kg) worn on each ankle during routine daily activities (e.g., cleaning, childcare). Primary outcomes include pre- and post-assessments of weight from Visit 2 to Visit 3. Secondary outcomes include body composition, glycemia (2-h, 75 g oral glucose tolerance test), and fasting insulin. Exploratory outcomes include energy expenditure, diet, and psychosocial well-being. Discussion Beyond the expected significance of this study in its direct health impacts from weight loss, it will contribute to exploring (1) the mechanism(s) by which the intervention is successful (mediating effects of energy expenditure and diet on weight loss) and (2) the effects of the intervention on body composition and biomarkers associated with insulin resistance and metabolic health. Additionally, we expect the findings to be meaningful regarding the intervention’s effectiveness on engaging women with GDM in the postpartum period to reduce T2DM risk. Trial registration The ClinicalTrials.gov Identifier, is NCT03664089. The trial registration date is September 10, 2018. The trial sponsor is Dr. Sarah A. Keim.
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Affiliation(s)
- Briana J Stith
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Samantha M Buls
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Sarah A Keim
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.,Department of Pediatrics, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH, 43210, USA.,Division of Epidemiology, College of Public Health, The Ohio State University, 250 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | - Stephen F Thung
- Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH, 43210, USA
| | - Mark A Klebanoff
- Department of Pediatrics, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH, 43210, USA.,Division of Epidemiology, College of Public Health, The Ohio State University, 250 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA.,Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH, 43210, USA.,Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Mark B Landon
- Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH, 43210, USA
| | - Steven G Gabbe
- Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH, 43210, USA
| | - Kajal K Gandhi
- Department of Pediatric Endocrinology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Reena Oza-Frank
- Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH, 43210, USA. .,Ohio Department of Health, 246 N High Street, Columbus, OH, 43215, USA.
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Ehrlich SF, Maples JM, Barroso CS, Brown KC, Bassett DR, Zite NB, Fortner KB. Using a consumer-based wearable activity tracker for physical activity goal setting and measuring steps in pregnant women with gestational diabetes mellitus: exploring acceptance and validity. BMC Pregnancy Childbirth 2021; 21:420. [PMID: 34103002 PMCID: PMC8188700 DOI: 10.1186/s12884-021-03900-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/19/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Activity monitoring devices may be used to facilitate goal-setting, self-monitoring, and feedback towards a step-based physical activity (PA) goal. This study examined the performance of the wrist-worn Fitbit Charge 3™ (FC3) and sought opinions on walking and stepping-in-place from women with gestational diabetes (GDM). METHODS Participants completed six 2-min metronome-assisted over ground bouts that varied by cadence (67, 84, or 100 steps per minute) and mode (walking or stepping-in-place; N = 15), with the sequence randomized. Steps were estimated by FC3 and measured, in duplicate, by direct observation (hand-tally device, criterion). Equivalence testing by the two one-sided tests (TOST) method assessed agreement within ± 15%. Mean absolute percent error (MAPE) of steps were compared to 10%, the accuracy standard of the Consumer Technology Association (CTA)™. A subset (n = 10) completed a timed, 200-m self-paced walk to assess natural walking pace and cadence. All participants completed semi-structured interviews, which were transcribed and analyzed using descriptive and interpretive coding. RESULTS Mean age was 27.0 years (SD 4.2), prepregnancy BMI 29.4 kg/m2 (8.3), and gestational age 32.8 weeks (SD 2.6). The FC3 was equivalent to hand-tally for bouts of metronome-assisted walking and stepping-in-place at 84 and 100 steps per minute (i.e., P < .05), although walking at 100 steps per minute (P = .01) was no longer equivalent upon adjustment for multiple comparisons (i.e., at P < .007). The FC3 was equivalent to hand-tally during the 200-m walk (i.e., P < .001), in which mean pace was 68.2 m per minute (SD 10.7), or 2.5 miles per hour, and mean cadence 108.5 steps per minute (SD 6.5). For walking at 84 and 100 steps per minute, stepping-in-place at 100 steps per minute, and the 200-m walk, MAPE was within 10%, the accuracy standard of the CTA™. Interviews revealed motivation for PA, that stepping-in-place was an acceptable alternative to walking, and competing responsibilities made it difficult to find time for PA. CONCLUSIONS The FC3 appears to be a valid step counter during the third trimester, particularly when walking or stepping-in-place at or close to women's preferred cadence.
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Affiliation(s)
- Samantha F Ehrlich
- Department of Public Health, The University of Tennessee, Knoxville, 390 HPER, 1914 Andy Holt Ave, Knoxville, TN, 37996, USA.
| | - Jill M Maples
- The University of Tennessee, Graduate School of Medicine, 1924 Alcoa Highway, Knoxville, TN, 37920, USA
| | - Cristina S Barroso
- College of Nursing, The University of Tennessee, Knoxville, 1200 Volunteer Blvd, Knoxville, TN, 37996, USA
| | - Kathleen C Brown
- Department of Public Health, The University of Tennessee, Knoxville, 390 HPER, 1914 Andy Holt Ave, Knoxville, TN, 37996, USA
| | - David R Bassett
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, 1914 Andy Holt Ave, Knoxville, TN, 37996, USA
| | - Nikki B Zite
- The University of Tennessee, Graduate School of Medicine, 1924 Alcoa Highway, Knoxville, TN, 37920, USA
| | - Kimberly B Fortner
- The University of Tennessee, Graduate School of Medicine, 1924 Alcoa Highway, Knoxville, TN, 37920, USA
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Onaade O, Maples JM, Rand B, Fortner KB, Zite NB, Ehrlich SF. Physical activity for blood glucose control in gestational diabetes mellitus: rationale and recommendations for translational behavioral interventions. Clin Diabetes Endocrinol 2021; 7:7. [PMID: 33896420 PMCID: PMC8074463 DOI: 10.1186/s40842-021-00120-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/15/2021] [Indexed: 12/12/2022] Open
Abstract
Gestational Diabetes Mellitus (GDM) is associated with adverse health outcomes during pregnancy and beyond. Previous randomized controlled trials of exercise interventions have demonstrated that exercise, conducted primarily during supervised sessions, improves maternal glycemic control in women with GDM. However, additional research is needed to develop physical activity interventions that are easily implemented in healthcare settings (e.g., recommendations and strategies to increase non-supervised physical activity). This narrative review presents: current physical activity recommendations for pregnancy and women with GDM; the scientific literature to date on physical activity, particularly walking, and blood glucose control in GDM; rationale for physical activity interventions targeting women with GDM that are appropriate for translation to the clinical setting (e.g., lifestyle interventions that include behavioral counseling with a health coach); and the strategies employed by previous, successful lifestyle interventions for pregnant and postpartum women that were based in clinical settings.Most previous exercise interventions for blood glucose control in women with GDM have included supervised exercise sessions, and will thus be difficult to translate to the health care system. However, lifestyle interventions for weight maintenance (i.e., healthy diet and physical activity) set in the health care system and delivered by health coaches have been successfully implemented in pregnant and postpartum populations. Therefore, we suggest that future trials examine lifestyle interventions that promote unsupervised walking with evidence-based behavioral strategies (e.g., goal setting, monitoring, and feedback) and consider incorporating the use of physical activity tracking devices to support these strategies.
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Affiliation(s)
- Oluwafemifola Onaade
- Department of Public Health, The University of Tennessee, 369 HPER, 1914 Andy Holt Ave., TN, 37996, Knoxville, USA.
| | - Jill M Maples
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tennessee, Knoxville, TN, USA
| | - Bethany Rand
- Department of Public Health, The University of Tennessee, 369 HPER, 1914 Andy Holt Ave., TN, 37996, Knoxville, USA
| | - Kimberly B Fortner
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tennessee, Knoxville, TN, USA
| | - Nikki B Zite
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tennessee, Knoxville, TN, USA
| | - Samantha F Ehrlich
- Department of Public Health, The University of Tennessee, 369 HPER, 1914 Andy Holt Ave., TN, 37996, Knoxville, USA
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Phelan S, Jelalian E, Coustan D, Caughey AB, Castorino K, Hagobian T, Muñoz-Christian K, Schaffner A, Shields L, Heaney C, McHugh A, Wing RR. Protocol for a randomized controlled trial of pre-pregnancy lifestyle intervention to reduce recurrence of gestational diabetes: Gestational Diabetes Prevention/Prevención de la Diabetes Gestacional. Trials 2021; 22:256. [PMID: 33827659 PMCID: PMC8024941 DOI: 10.1186/s13063-021-05204-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with several maternal complications in pregnancy, including preeclampsia, preterm labor, need for induction of labor, and cesarean delivery as well as increased long-term risks of type 2 diabetes, metabolic syndrome, and cardiovascular disease. Intrauterine exposure to GDM raises the risk for complications in offspring as well, including stillbirth, macrosomia, and birth trauma, and long-term risk of metabolic disease. One of the strongest risk factors for GDM is the occurrence of GDM in a prior pregnancy. Preliminary data from epidemiologic and bariatric surgery studies suggest that reducing body weight before pregnancy can prevent the development of GDM, but no adequately powered trial has tested the effects of a maternal lifestyle intervention before pregnancy to reduce body weight and prevent GDM recurrence. METHODS The principal aim of the Gestational Diabetes Prevention/Prevención de la Diabetes Gestacional is to determine whether a lifestyle intervention to reduce body weight before pregnancy can reduce GDM recurrence. This two-site trial targets recruitment of 252 women with overweight and obesity who have previous histories of GDM and who plan to have another pregnancy in the next 1-3 years. Women are randomized within site to a comprehensive pre-pregnancy lifestyle intervention to promote weight loss with ongoing treatment until conception or an educational control group. Participants are assessed preconceptionally (at study entry, after 4 months, and at brief quarterly visits until conception), during pregnancy (at 26 weeks' gestation), and at 6 weeks postpartum. The primary outcome is GDM recurrence, and secondary outcomes include fasting glucose, biomarkers of cardiometabolic disease, prenatal and perinatal complications, and changes over time in weight, diet, physical activity, and psychosocial measures. DISCUSSION The Gestational Diabetes Prevention /Prevención de la Diabetes Gestacional is the first randomized controlled trial to evaluate the effects of a lifestyle intervention delivered before pregnancy to prevent GDM recurrence. If found effective, the proposed lifestyle intervention could lay the groundwork for shifting current treatment practices towards the interconception period and provide evidence-based preconception counseling to optimize reproductive outcomes and prevent GDM and associated health risks. TRIAL REGISTRATION ClinicalTrials.gov NCT02763150 . Registered on May 5, 2016.
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Affiliation(s)
- Suzanne Phelan
- Department of Kinesiology & Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, CA USA
| | - Elissa Jelalian
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI USA
| | - Donald Coustan
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI USA
| | - Aaron B. Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | | | - Todd Hagobian
- Department of Kinesiology & Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, CA USA
| | - Karen Muñoz-Christian
- Department of World Languages and Cultures, California Polytechnic State University, San Luis Obispo, CA USA
| | - Andrew Schaffner
- Statistics Department, California Polytechnic State University, San Luis Obispo, CA USA
| | - Laurence Shields
- Dignity Health, Marian Regional Medical Center, Santa Maria, CA USA
| | - Casey Heaney
- Department of Kinesiology & Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, CA USA
| | - Angelica McHugh
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, USA
| | - Rena R. Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, USA
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Halligan J, Whelan ME, Roberts N, Farmer AJ. Reducing weight and BMI following gestational diabetes: a systematic review and meta-analysis of digital and telemedicine interventions. BMJ Open Diabetes Res Care 2021; 9:9/1/e002077. [PMID: 33853849 PMCID: PMC8054068 DOI: 10.1136/bmjdrc-2020-002077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/24/2021] [Accepted: 03/06/2021] [Indexed: 11/04/2022] Open
Abstract
Women with past gestational diabetes mellitus (GDM) are at risk of subsequent type 2 diabetes and adverse cardiovascular events. Digital and telemedicine interventions targeting weight loss and reductions in body mass index (BMI) may help reduce risk for women with GDM. The aim was to compare the effectiveness of digital or telemedicine intervention with usual care. Randomized controlled trials (RCTs) were identified in Embase, Medline, CINAHL, PsycINFO and the Cochrane Library. Included trials recruited women with prior GDM but without pre-existing diabetes, and tested a digital or telemedicine intervention with or without an in-person component. Data extraction was carried out independently by two authors. The search yielded 898 citations. Eighteen articles reporting 15 trials were included, of which 8 tested digital interventions. Reported outcomes included weight, BMI, fasting plasma glucose and waist circumference. None of the included trials reported type 2 diabetes incidence or cardiovascular risk. Data were pooled using a random-effects model. The point estimate favored the intervention but was non-significant for both BMI (-0.90 kg/m2, 95% CI -1.89 to 0.09; p=0.08) and weight (-1.83 kg, 95% CI -4.08 to 0.42, p=0.11). Trials evaluating digital and telemedicine interventions identified clinically relevant, but non-significant improvements in BMI and weight compared with control. No trials assessed type 2 diabetes occurrence as an outcome. More well-designed RCTs with adequate power and long-term follow-up are needed to identify the impact of these interventions on type 2 diabetes occurrence.
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Affiliation(s)
- Julia Halligan
- St Hilda's College, Oxford University, Oxford, Oxfordshire, UK
| | - Maxine E Whelan
- Centre for Intelligent Healthcare, Coventry University, Coventry, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, Oxford University, Oxford, Oxfordshire, UK
| | - Andrew J Farmer
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
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Lim K, Chan SY, Lim SL, Tai BC, Tsai C, Wong SR, Ang SM, Yew TW, Tai ES, Yong EL. A Smartphone App to Restore Optimal Weight (SPAROW) in Women With Recent Gestational Diabetes Mellitus: Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e22147. [PMID: 33724204 PMCID: PMC8088857 DOI: 10.2196/22147] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 12/14/2020] [Accepted: 01/09/2021] [Indexed: 12/23/2022] Open
Abstract
Background Women with a history of gestational diabetes mellitus (GDM) are at an increased risk of developing type 2 diabetes mellitus (T2DM). Lifestyle interventions aimed at postpartum weight loss to reduce T2DM risk have been reported, but poor compliance remains a barrier. Smartphone-based interventions may improve compliance, but data on its use in women with recent GDM are limited. Objective This trial aimed to investigate the efficacy of a smartphone app in restoring optimal weight following delivery in women with GDM, in the setting of a population with high rates of GDM and type 2 diabetes. Methods In this unblinded randomized controlled trial, 200 women with GDM were randomized to receive the intervention or standard care following delivery. The intervention enabled logging of weight, meals, and activity, with web-based interaction with a team comprising dieticians, a physiotherapist, and an occupational therapist. The primary outcome was an achievement of optimal weight (defined as the restoration of first trimester weight if first trimester BMI≤23 kg/m2 or weight loss of at least 5% from first trimester weight if first trimester BMI>23 kg/m2) at 4 months post partum. Secondary outcome measures included absolute weight loss, serum metabolic markers, self-reported nutritional intake, health education, and quality of life via questionnaires and user engagement in the intervention group. Results In total, 40% (38/96) of women in the intervention group achieved optimal weight at 4 months post delivery compared with 32% (28/93) in the control group (P=.27). Compared with the control group, women in the intervention group reported significantly reduced caloric intake at 4 months after delivery (P<.001) and higher health-directed behavior scores (P=.045). The intervention group also reported increased emotional distress scores (P=.01). At 4 months, participant engagement with the intervention was maintained at 60.8% (SD 33.9%). Conclusions Although a statistically significant increase in women achieving healthy weight was not observed, this app remains promising, as women in the intervention group reported improved health behaviors and lower caloric intake. Importantly, the high retention rates suggest that a larger study with a longer follow-up period might confirm the effectiveness of this app for weight management. Trial Registration ClinicalTrials.gov NCT03324737; https://clinicaltrials.gov/ct2/show/NCT03324737 International Registered Report Identifier (IRRID) RR2-10.1186/s12889-019-7691-3
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Affiliation(s)
- Karen Lim
- Department of Obstetrics and Gynecology, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shiao-Yng Chan
- Department of Obstetrics and Gynecology, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Su Lin Lim
- Department of Dietetics, National University Hospital, Singapore, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Cammy Tsai
- Department of Rehabilitation, National University Hospital, Singapore, Singapore
| | - Su Ren Wong
- Department of Rehabilitation, National University Hospital, Singapore, Singapore
| | - Siew Min Ang
- Department of Dietetics, National University Hospital, Singapore, Singapore
| | - Tong Wei Yew
- Department of Medicine, National University Hospital, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Department of Medicine, National University Hospital, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Eu Leong Yong
- Department of Obstetrics and Gynecology, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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