A Transgenerational e-Intervention for Gestational Diabetics and their Offspring

针对妊娠糖尿病患者及其后代的跨代电子干预

• 批准号: 8444786
• 负责人: Wanda K Nicholson
• 金额: $ 22.8万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-01 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8444786
• 关键词: Address; Adherence; Adult; Affect; Behavior Therapy; Birth Weight; Body Weight decreased; Caring; Child; Computers; Coupled; Data; Diabetes Mellitus; Diagnosis; Diagnostic; Eating Behavior; Environmental Wind; Epidemic; Exposure to; Family; Female; Fetus; Foundations; Generations; Gestational Diabetes; Glucose Intolerance; Glycosylated Hemoglobin; Growth; Health; Hyperglycemia; Individual; Infant; Insulin; Insulin Resistance; Intervention; Knowledge; Lactation; Learning; Length; Life; Life Cycle Stages; Measures; Metabolic; Metabolic syndrome; Metabolism; Modeling; Mothers; Neonatal; Newborn Infant; Newly Diagnosed; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Parenting behavior; Participant; Pattern; Personal Satisfaction; Persons; Physical activity; Pilot Projects; Postpartum Depression; Postpartum Period; Predisposition; Pregnancy; Process; Protocols documentation; Reporting; Research; Resistance; Risk; Risk Factors; Self Efficacy; Social support; Surface; Technology; Testing; Visit; Weight; Weight Gain; Woman; Work; base; clinical care; clinical practice; cost; demographics; depressive symptoms; design; diabetes risk; diabetic; effective intervention; experience; fetal; flexibility; high risk; improved; in utero; infant outcome; intervention effect; lifestyle intervention; multi-component intervention; novel; obesity risk; offspring; pregnant; prevent; public health relevance; secondary outcome; theories; treatment as usual; waist circumference; weight loss intervention

DESCRIPTION (provided by applicant): Gestational diabetes, defined as glucose intolerance that first occurs or is first identified in pregnancy, is part of a vicious cycle that contributes o the epidemic of diabetes and obesity across generations. In utero alterations to fetal metabolism due to prolonged glycemic exposure have life-long consequences for the newborn; namely an 8-fold risk of diabetes, obesity and the metabolic syndrome. The expectant mother with gestational diabetes is at greater risk for long- term obesity and overt diabetes. In our pilot study, "Weight Loss Interventions after Delivery" (aka "First WinD"), we tested a postpartum-specific intervention that included face-to-face individual and group sessions. The intervention was successful in achieving weight loss over the study period, but two important issues were raised: 1) attending in-person visits proved challenging for participants, due to the competing demands of parenting and work, and 2) participants verbalized missed opportunities during pregnancy and delivery to learn about the implications of GDM for their own health and the well-being of their infants. Building on our experiences with First WinD, our objective is to develop and pilot-test a novel, theory-driven, multi-modal intervention called e-GDM. E-GDM will address the logistical issues associated with in-person visits by incorporating an alternative delivery model, but may also be an effective way of addressing knowledge gaps of mothers about the downstream consequences of GDM. We propose a transgenerational approach to breaking the cycle of diabetes and obesity in gestational diabetics and their offspring. We propose an intervention that starts during pregnancy and extends seamlessly through the first 6 postpartum months- a critical metabolic period for the mother-child dyad. Our specific aims are to : 1) with input from women with current or recent GDM, develop a theory-driven healthy lifestyle intervention, e-GDM, that is delivered via state of the art computer technologies, coupled with periodic in person group visits; 2) conduct a small pilot RCT of the intervention versus usual care on a) measures of maternal and infant outcomes, b) process outcomes, and 3) conduct a preliminary assessment of intervention effects to calculate effect sizes to design a larger scale trial. Maternal outcomes are A1C, postpartum weight loss (6 months -6 weeks postpartum). Infant outcomes are birth weight and 6 weeks and 6 months weight and length z-scores, and waist circumference. Process outcomes are adherence/participation with protocol, improved eating behaviors and physical activity, postpartum depression symptoms, self-efficacy, social support, acceptability and costs. If effective, our intervention could significanty change how GDM is currently treated in clinical practice.

描述（由申请人提供）：妊娠糖尿病，被定义为首次发生或首先在怀孕中鉴定出的葡萄糖不耐症，是一个恶性循环的一部分，它促成了各个一代的糖尿病和肥胖症的流行。在子宫内对胎儿代谢的改变，由于长期血糖暴露会对新生儿产生终生的后果。即糖尿病，肥胖和代谢综合征的风险8倍。妊娠糖尿病的预期母亲患长期肥胖和明显糖尿病的风险更大。在我们的试点研究中，“交付后的减肥干预措施”（又名“第一风”），我们测试了包括面对面的个人和小组会议在内的产后特定干预措施。干预措施成功地在整个研究期间实现了体重减轻，但是提出了两个重要问题：1）由于育儿和工作的竞争要求，参加面对面的访问对参与者来说是具有挑战性的，以及2）参与者在怀孕期间言语错过的机会，以了解GDM对自己的健康以及对自己的健康的影响。我们的目标是基于我们的第一风经验，是开发和试验一种新型，理论驱动的多模式干预措施，称为E-GDM。 E-GDM将通过合并替代交付模型来解决与面对面访问相关的后勤问题，但也可能是解决母亲关于GDM下游后果的知识差距的有效方法。我们提出了一种跨代方法，以打破妊娠糖尿病患者及其后代中糖尿病和肥胖的周期。我们提出了一项干预措施，该干预措施从怀孕期间开始，并在前6个月的前6个月内无缝延伸 - 母子Dyad的重要代谢时期。我们的具体目的是：1）通过当前或最近的GDM的妇女的意见，开发了一种理论驱动的健康生活方式干预e-GDM，通过最先进的计算机技术来提供，再加上周期性的小组访问； 2）对干预措施进行小型试点RCT，而不是通常的护理a）a）孕产妇和婴儿结果的度量，b）过程结果和3）进行干预效果的初步评估，以计算效应大小以设计大规模试验。孕产妇的结局是A1C，产后体重减轻（产后6个月-6周）。婴儿的结局是出生体重和6周零6个月的体重和z得分长度，腰围。过程结果是遵守/参与方案，改善饮食行为和体育锻炼，产后抑郁症状，自我效能感，社会支持，可接受性和成本。如果有效，我们的干预措施可能会大大改变GDM在临床实践中的治疗方式。