Glucose intolerance during pregnancy: assessing the feasibility of lifestyle intervention in an under-served population Público

Abstract

This dissertation investigates two important factors to consider in the realm of glucose metabolism in women of childbearing age. We first provide an analysis of the underlying disparities by race/ethnicity in glycemic status among U.S. non-pregnant women of childbearing age. We then describe the feasibility of implementing a lifestyle intervention during pregnancy - focused on improved diet and increased physical activity - for the prevention of gestational diabetes mellitus (GDM) in a high-risk, under-served urban population of Atlanta, GA. Our findings illuminate issues affecting these two very important populations, and can provide insight into the design and development of interventions to improve health outcomes not only for women today, but also for future generations.

Table of Contents

Table of Contents

CHAPTER 1. INTRODUCTION.. 1

CHAPTER 2. REVIEW OF THE LITERATURE: GESTATIONAL DIABETES3

Pathophysiology 3

Screening and diagnosis. 5

Epidemiology 7

Known and potential risk factors for GDM.. 8

Identified risk factors: Age, BMI, race/ethnicity and diabetes history. 8

Potential risk factors - lifestyle and GDM10

Treatment of GDM.. 12

Adverse health outcomes. 12

During pregnancy: maternal and fetal outcomes12

Post-delivery: maternal and infant outcomes14

Public Health Significance. 15

Conclusion 15

CHAPTER 3. REVIEW OF THE LITERATURE:17

LIFESTYLE INTERVENTIONS DURING PREGNANCY17

Lifestyle interventions as effective tools for glucose control outside of pregnancy 17

Developing lifestyle interventions for pregnancy. 19

Overweight/ obesity in U.S. women of childbearing age19

Institute of Medicine Guidelines for GWG20

Disparities in GWG.. 21

Lifestyle interventions during pregnancy - previous findings. 21

Safety and efficacy of lifestyle interventions during pregnancy. 24

Potential barriers to lifestyle changes in pregnancy. 25

Barriers of pregnancy lifestyle interventions specific to underserved populations. 26

Conclusion 28

CHAPTER 4: REALIZING THE BURDEN OF DYSGLYCEMIA IN U.S. WOMEN OF CHILDBEARING AGE.. 29

CHAPTER 5: EXPANDED METHODS. 59

Study design and intervention. 59

Study site and population. 59

Randomization and study groups. 61

Data collection. 63

Descriptive data. 63

Primary outcomes. 64

Secondary outcomes. 67

Power calculation and statistical analysis. 70

Qualitative one-on-one structured interviews73

Protection of Human Subjects. 76

Risks to Human Subjects. 76

CHAPTER 6: FEASIBILITY OF A LIFESTYLE INTERVENTION DURING PREGNANCY IN HIGH-RISK, LOW-INCOME URBAN BLACK WOMEN87

Introduction. 87

Materials and Methods. 89

Study population and setting

Study design. 90

Data collection. 92

Methods for improving participant recruitment and retention rates. 94

Power calculation and statistical analysis. 95

Results. 97

Recruitment, enrollment and baseline characteristics97

Retention of participants. 98

Primary outcomes. 99

Discussion. 101

Conclusion. 108

CHAPTER 7: LIFESTYLE INTERVENTION DURING PREGNANCY MAY ALTER GLUCOSE METABOLISM AND IMPROVE BIRTH OUTCOMES IN A HIGH-RISK UNDERSERVED POPULATION:118

RESULTS FROM A PILOT FEASIBILITY TRIAL118

Introduction 118

Materials and methods. 120

Study population and setting

Study design. 121

Data collection. 123

Power calculation and statistical analysis. 126

Results. 127

Primary outcomes. 129

Delivery and birth outcomes. 132

Discussion. 133

Conclusion. 138

CHAPTER 8. QUALITATIVE EVALUATION OF A LIFESTYLE INTERVENTION DURING PREGNANCY FOR LOW-INCOME OVERWEIGHT/OBESE WOMEN.. 149

Introduction 149

Methods 150

Healthy Moms, Happy Babies: A Lifestyle Intervention during Pregnancy. 150

Data collection and preparation152

Analysis. 153

Results. 154

Discussion. 166

Conclusion. 171

CHAPTER 9: SUMMARY AND DISCUSSION172

Summary of findings. 172

Strengths and limitations. 177

Contribution to public health. 179

Lessons learned for future studies. 181

References - Chapters 2, 3 and 5-9

APPENDIX 1. Gestational diabetes mellitus: taking it to heart221

APPENDIX 2. Healthy Moms, Happy Babies Program Curriculum246

APPENDIX 3. Interview guide for qualitative, in-depth interviews. 247

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About this Dissertation

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School	Laney Graduate School
Department	Biological and Biomedical Sciences
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Health Sciences, Nutrition
Palabra Clave	diabetes lifestyle interventions women of childbearing age
Committee Chair / Thesis Advisor	Venkat Narayan, K.M., Emory University
Committee Members	Correa, Adolfo , Emory University Umpierrez, Guillermo, Emory University Sharma, Andrea, Centers for Disease Control and Prevention Hennink, Monique, Emory University Ramakrishnan, Usha, Emory University

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