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The investigators propose to conduct a randomized controlled trial in 200 overweight/obese pregnant women and their offspring. The prenatal intervention will emphasize improving diet and physical activity. The lifestyle intervention will be delivered within an empowerment theoretical framework through a combination of group sessions, individual counseling, and by monitoring compliance to diet and physical activity to further tailor the intervention. The post-partum intervention sessions will include mothers and their offspring and will focus on breastfeeding, improving physical activity and quality of the diet and feeding practices through the first post-partum year. As part of routine prenatal care, participants in both the control and intervention arms will be given health-related advice. Since the majority of participants are expected to be eligible for the Women, Infants and Children (WIC) program, both groups will also receive assistance through WIC as per their routine policies. Our primary outcome is Gestational Weight Gain (GWG). The major secondary outcome of interest is infant BMI z-score at 12 months of age, and the investigators will also be evaluating several metabolic outcomes in mothers and infants.
Full description
Obesity and hyperglycemia in pregnancy are thought to impact fetal growth through over-nutrition and may stress the fetal pancreas because of the increased demand for insulin. Such intrauterine programming events affect birth weight and raise the offspring's risk trajectory for future obesity, type 2 diabetes, cardiovascular disease and premature death. Investigators propose to conduct a randomized controlled trial in 200 overweight or obese pregnant Puerto Rican women (free of diabetes) and their infants, to favorably impact metabolic health in mothers and infants.
Women presenting will be randomized to a lifestyle modification intervention or standard care control group before 16 gestational weeks. The intervention will focus on improving: (1) physical activity levels and (2) diet quality and calorie intake. The lifestyle intervention will be delivered within an empowerment theoretical framework through individualized intervention sessions, intensive group sessions, and by phone calls. The intervention will continue through the first postpartum year and will include the infants. A key objective is to evaluate whether the intervention optimizes infant BMI z-score. We will also evaluate whether the intervention increases the number of women who experience appropriate gestational weight gain, and evaluate several additional aims including relating the interventions with improved insulin sensitivity and beta-cell function in the women, and insulin concentrations adjusted for glucose in their infants.This study will also help us to identify and overcome barriers to develop effective ways of intervening during pregnancy to meaningfully improve cardio-metabolic risk trajectories of future generations.
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Inclusion criteria
Exclusion criteria
Diagnosis of diabetes prior to pregnancy (reported physician diagnosed diabetes other than GDM in previous pregnancy or taking insulin or medications to treat diabetes), or an HbA1c ≥ 6.5 % or other test result (elevated fasting glucose ≥126 mg/dL/7.0 mmol/L or 2 h glucose ≥200 mg/dL/11.1 mmol/L when OGTT is completed) suggestive of pre-pregnancy diabetes. All potential participants will have HbA1c performed prior to randomization.*
Known fetal anomaly *
Planned termination of pregnancy*
History of three or more consecutive first trimester miscarriages*
Past history of anorexia or bulimia by medical history or patient report. Binge eating disorder is not an exclusion*
Current eating disorder diagnosed by EDE-Q questions 2-4 and confirmed after discussion with the participant by study staff*
Actively suicidal defined as a value ≥ 2 on the BDI-II question 9*
Prior or planned (within 1 year of expected delivery) bariatric surgery*
Current use of one or more of the following medications: *
Continued use of weight loss medication including OTC and dietary supplements for weight loss *
Contraindications to aerobic exercise in pregnancy specified in the ACOG Committee Opinion #267, 2002 (reaffirmed 2009) *
Participation in another interventional study that influences weight control*
Enrollment in this trial in a previous pregnancy*
Intention of the participant or of the care provider for the delivery to be outside the LIFE-Moms Consortium hospital*
Participant's unwillingness or inability to commit to a 1 year follow-up of herself or her child, including planning to move away*
Past or current intravenous drug use (visual check for injection marks, recorded methadone use, self-report)
Self-reported HIV infection (confirmed from medical records or baseline test results)
Inability to functionally participate in group sessions and other study requirements on a regular basis during the complete duration of the study, including but not limited to the documented use of the accelerometer for the periods required by the study
Non Spanish speaking
Plan on giving up infant for adoption
'*' Core eligibility criterion for the LIFE-Moms Consortium
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31 participants in 2 patient groups
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Data sourced from clinicaltrials.gov
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