Obesity Prevention in Postpartum Women at High-Risk of Cardiovascular Disease

项目总结 肥胖是心血管疾病的一个重要风险因素，在美国39%的成年人受到这种疾病的影响。 肥胖率在女性中不成比例地上升，并导致糖尿病和 55岁以下女性的心血管死亡率。怀孕代表着生命的转变，因为许多女性 体重超标。肥胖的影响在患有先兆子痫的女性中进一步放大，这是一项独立和 对未来心血管疾病的危险因素认识不足。迫切需要更好地了解预测因素 产后过度体重保留，以提供有效和可扩展的减肥干预措施 在风险最高的女性可能特别容易接受生活方式改变的时期。 社会激励，或影响基于关系的行为改变的影响，是很强的 健康行为的推动者。游戏设计元素的使用，如目标设定，已经成功地 与社会激励相结合，加强在其他疾病环境中的健康行为。中心假说 这一提议的一个特点是，使用这些新方法的行为干预，与既定的 行为减肥计划，将提供一个有效的，可扩展的解决方案，以减少 产后肥胖。这项提议将利用高级调查人员(Michal Elovitz博士和 Peter Groeneveld)和宾夕法尼亚大学在心血管医学、产妇胎儿医学、 和行为经济学。研究将在城市和种族多元化的人群中进行，因为这些 女性最有可能受益于降低简历风险的干预措施。目标1将使用稳健的统计方法 和机器学习在现有的电子设备中创建用于产后体重保留的临床预测工具 健康记录数据库，丰富了邻里层面的数据。目标2将使用定性和混合方法来 确定使用患者反馈加强试点干预设计的策略。AIM 3将实施一个 双臂单点随机临床试验对先兆子痫或妊娠期妇女的减肥效果 高血压使用远程技术和社交网络参与在线行为减肥计划 来自其他产后妇女的反馈。 这项建议将确定生命早期阶段的女性，谁将从密集的生活中受益最大 改变生活方式，并将测试和改进能够传播到产后妇女的干预措施 远程的。Lewey博士是一名普通心脏病专家，接受过妇女健康和人口科学方面的培训 在妊娠相关心血管疾病方面具有成熟的专业知识。她提出的培训方案 先进的统计方法、定性分析和行为临床试验设计将使她能够 成为女性心血管健康领域的领导者。在这个节目结束的时候，她将能够 独立设计、定位和评估预防女性心脏病的行为干预措施。这个 拟议的K23的结果将是计划中的R01级应用程序的宝贵试点工作。

PROJECT SUMMARY Obesity is a significant risk factor for cardiovascular (CV) disease that affects 39% of adults in the U.S. Obesity rates are disproportionately rising among women and contribute to increasing rates of diabetes and CV mortality among women younger than 55 years. Pregnancy represents a life transition when many women gain excess weight. The effect of obesity is further magnified in women with preeclampsia, an independent and underappreciated risk factor for future CV disease. There is a pressing need to better understand predictors of excessive postpartum weight retention in order to deliver effective and scalable weight loss interventions during a period when women at highest risk may be particularly receptive to lifestyle change. Social incentives, or the influences that impact behavior change based on relationships, are strong motivators of healthy behavior. The use of game design elements, such as goal-setting, has been successfully combined with social incentives to enhance healthy behavior in other disease settings. The central hypothesis of this proposal is that a behavioral intervention using these novel approaches, combined with an established behavioral weight loss program, will provide an effective, and scalable solution to reduce the incidence of postpartum obesity. This proposal will leverage mentorship of senior investigators (Drs. Michal Elovitz and Peter Groeneveld) and Penn’s mature research programs in cardiovascular medicine, maternal fetal medicine, and behavioral economics. Research will be conducted in an urban and racially diverse population since these women are most likely to benefit from interventions to reduce CV risk. Aim 1 will use robust statistical methods and machine learning to create a clinical prediction tool for postpartum weight retention in an existing electronic health record database enriched with neighborhood-level data. Aim 2 will use qualitative and mixed methods to identify strategies to enhance the design of a pilot intervention using patient feedback. Aim 3 will implement a 2-arm single site randomized clinical trial to achieve weight loss in women with preeclampsia or gestational hypertension participating in an online behavioral weight loss program using remote technology and social feedback from other postpartum women. This proposal will identify women at an early stage in life who will benefit the most from intensive lifestyle changes and will test and refine interventions that are able to be disseminated to postpartum women remotely. Dr. Lewey is a general cardiologist trained in women’s health and population science with established expertise in pregnancy associated cardiovascular disorders. The training she proposes in advanced statistical methods, qualitative analysis, and behavioral clinical trial design will position her to become a leader in women’s cardiovascular health. By the conclusion of this program, she will be able to independently design, target, and evaluate behavioral interventions to prevent heart disease in women. The results of the proposed K23 will be invaluable pilot work for a planned R01-level application.