1
|
Horn CE, Seely EW, Levkoff SE, Isley BC, Nicklas JM. Postpartum women's experiences in a randomized controlled trial of a web-based lifestyle intervention following Gestational Diabetes: a qualitative study. J Matern Fetal Neonatal Med 2023; 36:2194012. [PMID: 36977603 DOI: 10.1080/14767058.2023.2194012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is associated with an increased maternal risk for the development of type 2 diabetes (T2DM). We previously demonstrated in a randomized trial that a web-based postpartum lifestyle intervention program, Balance After Baby, increased weight loss among postpartum women with recent pregnancies complicated by GDM. The aim of this analysis is to identify the impact of the intervention on study participants as assessed by exit interviews after completion of the 12 month study. METHODS We conducted structured exit interviews created with a concurrent-contextual design with subjects randomized to the intervention group at the conclusion of their participation (∼12 months) in the Balance After Baby study, with the objectives of 1) understanding the impact of the intervention on participants and their family members, 2) identifying which program components were most and least helpful, and 3) identifying the perceived best timing for diabetes prevention interventions in postpartum women with recent GDM. RESULTS Seventy-nine percent (26/33) of eligible intervention participants participated in interviews. Participants noted changes in diet and physical activity as a result of the intervention. Several components of the intervention, particularly the online modules and support from the lifestyle coach, were perceived by intervention participants to have had a positive effect on personal and familial lifestyle change, while other components were less utilized, including the community forum, YMCA memberships, and pedometers. Nearly all participants felt that the timing in the intervention study, beginning about 6 weeks postpartum, was ideal. DISCUSSION Results of this study identify the importance of individualized coaching, impact on family members, and demonstrate that postpartum women feel ready to make changes by 6 weeks postpartum. Findings from this study will help inform the development of future technologically-based lifestyle interventions for postpartum women with recent GDM.
Collapse
Affiliation(s)
- Christine E Horn
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Ellen W Seely
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sue E Levkoff
- College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Breanna C Isley
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jacinda M Nicklas
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
2
|
Wachman EM, Wang A, Isley BC, Boateng J, Beierle JA, Hansbury A, Shrestha H, Bryant C, Zhang H. Placental OPRM1 DNA methylation and associations with neonatal opioid withdrawal syndrome, a pilot study. Explor Med 2021; 1:124-135. [PMID: 33763662 PMCID: PMC7985727 DOI: 10.37349/emed.2020.00009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Aims: Epigenetic variation of DNA methylation of the mu-opioid receptor gene (OPRM1) has been identified in the blood and saliva of individuals with opioid use disorder (OUD) and infants with neonatal opioid withdrawal syndrome (NOWS). It is unknown whether epigenetic variation in OPRM1 exists within placental tissue in women with OUD and whether it is associated with NOWS outcomes. In this pilot study, the authors aimed to 1) examine the association between placental OPRM1 DNA methylation levels and NOWS outcomes, and 2) compare OPRM1 methylation levels in opioid-exposed versus non-exposed control placentas. Methods: Placental tissue was collected from eligible opioid (n = 64) and control (n = 29) women after delivery. Placental DNA was isolated and methylation levels at six cytosine-phosphate-guanine (CpG) sites within the OPRM1 promoter were quantified. Methylation levels were evaluated for associations with infant NOWS outcome measures: need for pharmacologic treatment, length of hospital stay (LOS), morphine treatment days, and treatment with two medications. Regression models were created and adjusted for clinical co-variates. Methylation levels between opioid and controls placentas were also compared. Results: The primary opioid exposures were methadone and buprenorphine. Forty-nine (76.6%) of the opioid-exposed infants required pharmacologic treatment, 10 (15.6%) two medications, and average LOS for all opioid-exposed infants was 16.5 (standard deviation 9.7) days. There were no significant associations between OPRM1 DNA methylation levels in the six CpG sites and any NOWS outcome measures. No significant differences were found in methylation levels between the opioid and control samples. Conclusions: No significant associations were found between OPRM1 placental DNA methylation levels and NOWS severity in this pilot cohort. In addition, no significant differences were seen in OPRM1 methylation in opioid versus control placentas. Future association studies examining methylation levels on a genome-wide level are warranted.
Collapse
Affiliation(s)
- Elisha M Wachman
- Department of Pediatrics, Boston Medical Center, Boston, MA 02119, USA
| | - Alice Wang
- Department of Pediatrics, Boston Medical Center, Boston, MA 02119, USA
| | - Breanna C Isley
- Department of Pediatrics, Boston Medical Center, Boston, MA 02119, USA
| | - Jeffery Boateng
- Boston University School of Public Health, Boston, MA 02118, USA
| | - Jacob A Beierle
- Laboratory of Addiction Genetics, Department of Pharmacology and Experimental Therapeutics and Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
| | - Aaron Hansbury
- Boston University School of Public Health, Boston, MA 02118, USA
| | - Hira Shrestha
- Department of Pediatrics, Boston Medical Center, Boston, MA 02119, USA
| | - Camron Bryant
- Laboratory of Addiction Genetics, Department of Pharmacology and Experimental Therapeutics and Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
| | - Huiping Zhang
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
| |
Collapse
|
3
|
Wachman EM, Houghton M, Melvin P, Isley BC, Murzycki J, Singh R, Minear S, MacMillan KDL, Banville D, Walker A, Mitchell T, Galimi-Hayes R, Jorgensen S, Gomes DR, Hodgins F, Whalen BL, Diop H, Gupta M. A quality improvement initiative to implement the eat, sleep, console neonatal opioid withdrawal syndrome care tool in Massachusetts' PNQIN collaborative. J Perinatol 2020; 40:1560-1569. [PMID: 32678314 DOI: 10.1038/s41372-020-0733-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/17/2020] [Accepted: 07/07/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To support hospitals in the Massachusetts PNQIN collaborative with adoption of the ESC Neonatal Opioid Withdrawal Syndrome (NOWS) Care Tool© and assess NOWS hospitalization outcomes. STUDY DESIGN Statewide QI study where 11 hospitals adopted the ESC NOWS Care Tool©. Outcomes of pharmacotherapy and length of hospital stay (LOS) and were compared in Pre- and Post-ESC implementation cohorts. Statistical Process Control (SPC) charts were used to examine changes over time. RESULTS The Post-ESC group had lower rates of pharmacotherapy (OR 0.35, 95% CI 0.26, 0.46) with shorter LOS (RR 0.79, 95% CI 0.76, 0.82). The 30-day NOWS readmission rate was 1.2% in the Pre- and 0.4% in the Post-ESC cohort. SPC charts indicate a shift in pharmacotherapy from 54.8 to 35.0% and LOS from 14.2 to 10.9 days Post-ESC. CONCLUSIONS The ESC NOWS Care Tool was successfully implemented across a state collaborative with improvement in NOWS outcomes without short-term adverse effects.
Collapse
Affiliation(s)
- Elisha M Wachman
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA.
| | - Mary Houghton
- Newborn Medicine, Beth Israel Deaconness Medical Center, Boston, MA, USA
| | - Patrice Melvin
- Center for Applied Pediatric Quality Analytics, Children's Hospital Boston, Boston, MA, USA
| | - Breanna C Isley
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | | | - Rachana Singh
- Department of Pediatrics, Baystate Children's Hospital, Springfield, MA, USA
| | - Susan Minear
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | | | | | - Amy Walker
- Cooley Dickinson Hospital, Northampton, MA, USA
| | - Teresa Mitchell
- Department of Pediatrics, Mercy Medical Center, Springfield, MA, USA
| | | | - Selena Jorgensen
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Daphne Remy Gomes
- Department of Neonatology, Boston Children's Hospital, Boston, MA, USA
| | - Fran Hodgins
- Massachusetts Health Policy Commission, Boston, MA, USA
| | - Bonny L Whalen
- Department of Pediatrics, Children's Hospital at Dartmouth-Hitchcock, Lebanon, NH, USA
| | - Hafsatou Diop
- Massachusetts Department of Public Health, Boston, MA, USA
| | - Munish Gupta
- Newborn Medicine, Beth Israel Deaconness Medical Center, Boston, MA, USA
| |
Collapse
|