Glucose intolerance during pregnancy: assessing the feasibility of lifestyle intervention in an under-served population Public
Marcinkevage, Jessica Ann (2013)
Published
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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