A telehealth lifestyle intervention to reduce excess gestational weight gain in pregnant women with overweight or obesity (GLOW): a randomised, parallel-group, controlled trial

Ferrara, Assiamira; Hedderson, Monique M.; Brown, Susan D.; Ehrlich, Samantha F.; Tsai, Ai‐Lin; Feng, Jean; Galarce, Maren; Marcovina, Santica M.; Catalano, Patrick M.; Quesenberry, Charles P.

doi:10.1016/s2213-8587(20)30107-8

Cited by 110 publications

(198 citation statements)

References 28 publications

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“…Behavioral interventions delivered via health coaching have successfully been implemented during pregnancy and the postpartum period in the health care delivery system [47][48][49]. A pilot feasibility RCT that tested a Diabetes Prevention Program (DPP) based lifestyle intervention of diet and physical activity for weight management delivered by trained dieticians demonstrated that such a behavioral lifestyle intervention can be successfully implemented in women with GDM [47].…”

Section: Future Research: Interventions Appropriate For the Health Care Delivery Systemmentioning

confidence: 99%

Physical activity for blood glucose control in gestational diabetes mellitus: rationale and recommendations for translational behavioral interventions

Onaade

Maples

Rand

et al. 2021

Clin Diabetes Endocrinol

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Gestational Diabetes Mellitus (GDM) is associated with adverse health outcomes during pregnancy and beyond. Previous randomized controlled trials of exercise interventions have demonstrated that exercise, conducted primarily during supervised sessions, improves maternal glycemic control in women with GDM. However, additional research is needed to develop physical activity interventions that are easily implemented in healthcare settings (e.g., recommendations and strategies to increase non-supervised physical activity). This narrative review presents: current physical activity recommendations for pregnancy and women with GDM; the scientific literature to date on physical activity, particularly walking, and blood glucose control in GDM; rationale for physical activity interventions targeting women with GDM that are appropriate for translation to the clinical setting (e.g., lifestyle interventions that include behavioral counseling with a health coach); and the strategies employed by previous, successful lifestyle interventions for pregnant and postpartum women that were based in clinical settings.Most previous exercise interventions for blood glucose control in women with GDM have included supervised exercise sessions, and will thus be difficult to translate to the health care system. However, lifestyle interventions for weight maintenance (i.e., healthy diet and physical activity) set in the health care system and delivered by health coaches have been successfully implemented in pregnant and postpartum populations. Therefore, we suggest that future trials examine lifestyle interventions that promote unsupervised walking with evidence-based behavioral strategies (e.g., goal setting, monitoring, and feedback) and consider incorporating the use of physical activity tracking devices to support these strategies.

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Section: Future Research: Interventions Appropriate For the Health Care Delivery Systemmentioning

confidence: 99%

Physical activity for blood glucose control in gestational diabetes mellitus: rationale and recommendations for translational behavioral interventions

Onaade

Maples

Rand

et al. 2021

Clin Diabetes Endocrinol

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“…The MOMFIT Study participant recruitment and methodology are described elsewhere [14]. Briefly, ethnically diverse pregnant women aged 18-40 years with overweight or obesity (BMI 25-40 kg/m 2 ) from Chicago (USA) were enrolled at 9-15 weeks of gestation in a randomized diet and lifestyle intervention trial: MOMFIT; www.clinicaltrials.gov NCT01631747.…”

Section: Participant Recruitmentmentioning

confidence: 99%

“…The "Mama" DASH dietary intervention group was prescribed calorie goals based on height, preconception weight, physical activity level, and nutrient needs relevant for restricted total GWG (0.18-0.27 kg/week for women with overweight and obesity respectively) during the second and third trimesters. The MOMFIT intervention group participants received training in self-monitoring their diet intake using a commercially available mobile application, coaching calls from the registered dietitian nutritionist and group or webinar-based DASH diet intervention sessions [14]. They also received a simple pedometer (Accusplit accelerometer AX2710) or were encouraged to monitor activity using their smartphone tracking device and log activity in their mobile application account.…”

Section: Participant Recruitmentmentioning

confidence: 99%

“…Women tend to be conscious of providing a healthy start to life for their offspring and thus are often motivated to adopt diet and lifestyle changes, thereby providing a potential window of opportunity for intervention [13]. Recent lifestyle intervention research programs such as the UPBEAT, GLOW, GeliS, and the LIFE-Moms studies were funded to promote the aim of reducing the heath burden of excess GWG in pregnant women [14][15][16][17]. The Maternal-Offspring Metabolics: Family Intervention Trial (MOMFIT) is one of seven different randomized clinical trials aimed at restriction of excess GWG funded by NIDDK/NHLBI LIFE-Moms Consortium [16].…”

Section: Introductionmentioning

confidence: 99%

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Metabolic Signatures of Gestational Weight Gain and Postpartum Weight Loss in a Lifestyle Intervention Study of Overweight and Obese Women

et al. 2020

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Background: Overweight and obesity amongst women of reproductive age are increasingly common in developed economies and are shown to adversely affect birth outcomes and both childhood and adulthood health risks in the offspring. Metabolic profiling in conditions of overweight and obesity in pregnancy could potentially be applied to elucidate the molecular basis of the adverse effects of gestational weight gain (GWG) and postpartum weight loss (WL) on future risks for cardiovascular disease (CVD) and other chronic diseases. Methods: Biofluid samples were collected from 114 ethnically diverse pregnant women with body mass index (BMI) between 25 and 40 kg/m2 from Chicago (US), as part of a randomized lifestyle intervention trial (Maternal Offspring Metabolics: Family Intervention Trial; NCT01631747). At 15 weeks, 35 weeks of gestation, and at 1 year postpartum, the blood plasma lipidome and metabolic profile of urine samples were analyzed by liquid chromatography mass spectrometry (LC-MS) and 1H nuclear magnetic resonance spectroscopy (1H NMR) respectively. Results: Urinary 4-deoxyerythronic acid and 4-deoxythreonic acid were found to be positively correlated to BMI. Seventeen plasma lipids were found to be associated with GWG and 16 lipids were found to be associated with WL, which included phosphatidylinositols (PI), phosphatidylcholines (PC), lysophospholipids (lyso-), sphingomyelins (SM) and ether phosphatidylcholine (PC-O). Three phospholipids found to be positively associated with GWG all contained palmitate side-chains, and amongst the 14 lipids that were negatively associated with GWG, seven were PC-O. Six of eight lipids found to be negatively associated with WL contained an 18:2 fatty acid side-chain. Conclusions: Maternal obesity was associated with characteristic urine and plasma metabolic phenotypes, and phospholipid profile was found to be associated with both GWG and postpartum WL in metabolically healthy pregnant women with overweight/obesity. Postpartum WL may be linked to the reduction in the intake of linoleic acid/conjugated linoleic acid food sources in our study population.

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“…The use of group and telephone contact sessions may improve participation, engagement and outcomes of intervention programmes compared to wholly face-face strategies. 15-17 Session content and timing are summarised in Table 1 and in the Supplementary Online Materials . The Intervention programme was supported by written materials for participants, translated into local languages.…”

Section: Preparatory Workmentioning

confidence: 99%

The iHealth-T2D study: rationale and design of a cluster randomised trial for prevention of Type 2 Diabetes amongst South Asians with central obesity and prediabetes

Kasturiratne

Ahmad

et al. 2020

Preprint

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BackgroundPeople from South Asia are at increased risk of type 2 diabetes (T2D). There is an urgent need to develop approaches for prevention of T2D in South Asians, that are cost-effective, generalisable and scalable across settings.HypothesisCompared to usual care, risk of T2D can be reduced amongst South Asians with central obesity or raised HbA1c, through a 12 month lifestyle modification programme delivered by community health workers.DesignCluster randomised clinical trial (1:1 allocation to Intervention or Usual care), carried out in India, Pakistan, Sri Lanka, and UK, with 30 sites per country (120 sites total). Target recruitment 3,600 (30 participants per site) with annual follow-up for three years.Entry criteriaSouth Asian, men or women, age 40-70 years with i. Central obesity (waist circumference ≥100cm in India and Pakistan; ≥90cm in Sri Lanka) and / or ii. Prediabetes (HbA1c 6.0-6.4% inclusive). Exclusion criteria: known type 1 or 2 diabetes, normal or underweight (body mass index<22kg/m2); pregnant or planning pregnancy; unstable residence or planning to leave the area; serious illness.EndpointsThe primary end point is new onset T2D at 3 years, defined as: i. HbA1c≥6.5% or ii. Physician diagnosis and on treatment for T2D. Secondary endpoints at 1 and 3 years are: i. Physical measures: waist circumference, weight and blood pressure; ii. Lifestyle measures: smoking status, alcohol intake, physical activity, dietary intake; iii. Biochemical measures: Fasting glucose, insulin and lipids (total and HDL cholesterol, triglycerides); and iv. Treatment compliance.InterventionLifestyle intervention (60 sites) or Usual care (60 sites). Lifestyle intervention was delivered by a trained community health worker over 12 months (5 one-one session, 4 group sessions, 13 telephone sessions) with the goal of the participants achieving e a 7% reduction in body mass index and a 10 cm reduction in waist circumference through i. improved diet and ii. increased physical activity. Usual care comprised a single 30 minute session of lifestyle modification advice from the community health worker.ResultsWe screened 33,212 people for inclusion into the study. We identified 10,930 people who met study entry criteria, amongst whom, 3,682 agreed to take part in the intervention. Study participants are 49.2% female and aged 52.8 (SD 8.2) years. Clinical characteristics are well balanced between Intervention and Usual care sites. More than 90% of follow-up visits are scheduled to be complete December 2020. Based on follow-up to end 2019, the observed incidence of T2D in the study population is in line with expectations (6.1% per annum).ConclusionThe iHealth-T2D study will advance understanding of strategies for prevention of diabetes amongst South Asians, use approaches for screening and intervention that are adapted for low-resource settings. Our study will thus inform the implementation of strategies for improving the health and well-being of this major global ethnic group.IRB approval16/WM/0171Trial registrationEudraCT 2016-001350-18. Registered 14 April 2016 https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/ihealth-t2d/ ; ClinicalTrials.gov NCT02949739. Registered 31 October 2016, https://clinicaltrials.gov/ct2/show/NCT02949739, First posted 31/10/2016.FunderEuropean Commission (award 643774) and National Institute for Health Research (award 16/136/68)

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A telehealth lifestyle intervention to reduce excess gestational weight gain in pregnant women with overweight or obesity (GLOW): a randomised, parallel-group, controlled trial

Cited by 110 publications

References 28 publications

Physical activity for blood glucose control in gestational diabetes mellitus: rationale and recommendations for translational behavioral interventions

Physical activity for blood glucose control in gestational diabetes mellitus: rationale and recommendations for translational behavioral interventions

Metabolic Signatures of Gestational Weight Gain and Postpartum Weight Loss in a Lifestyle Intervention Study of Overweight and Obese Women

The iHealth-T2D study: rationale and design of a cluster randomised trial for prevention of Type 2 Diabetes amongst South Asians with central obesity and prediabetes

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