Pregnancy and EARly Lifestyle improvement Study (PEARLS)

描述(申请人提供)：怀孕期间的肥胖和高血糖通过过度营养影响胎儿生长，并可能对胎儿胰腺造成压力。这种宫内编程事件会影响出生体重，并增加后代未来肥胖、2型糖尿病、心血管疾病和过早死亡的风险轨迹。通过这种恶性循环，糖尿病母亲的女性后代本身更有可能在分娩前患上糖尿病，将发病率的负担从一代传给下一代。这一悲剧性但可预防的趋势很可能是妊娠期糖尿病和2型糖尿病惊人增加的基础。我们建议在400名超重或肥胖的波多黎各孕妇(无糖尿病)及其婴儿中进行一项随机对照试验，以有利地影响母亲和婴儿的代谢健康。怀孕20周前分娩的妇女将被随机分成生活方式调整干预组或标准护理对照组。波多黎各是以西班牙裔为主的美国领土，体力活动和水果的水平最低， 蔬菜和全谷物的摄入量是美国所有司法管辖区中糖尿病、儿童肥胖症和婴儿死亡率最高的；然而，这里的研究性研究的招聘率高于美国其他地方。干预将在孕妇及其婴儿中进行，重点是改善：(1)体力活动水平，(2)饮食质量和卡路里摄入量，(3)行为印记和(4)产前护理。干预将通过以下方式进行 六个集中的核心小组会议(每组10人)，随后是助产士会议和电话，并将在哺乳期持续到产后第一年。我们将评估联合干预是否将：(1)增加妊娠体重适当增加的妇女的百分比，(2)优化早期婴儿生长，(3)实现足够的保留和依从性。作为次要目标，我们将评估这些干预措施是否改善了女性的胰岛素敏感性和β细胞功能，以及她们婴儿的空腹胰岛素浓度。这项研究还将帮助我们克服后勤和其他障碍，以 制定更有效的孕期干预方法，最大限度地减少子孙后代的心脏代谢风险。在波多黎各进行这项研究将解决美国许多地区普遍存在的重大健康差距，同时还将促进有关早期生命风险因素如何受到影响以降低年轻女性及其后代的代谢风险的知识。

DESCRIPTION (provided by applicant): Obesity and hyperglycemia in pregnancy impact fetal growth through over-nutrition and may stress the feta pancreas. Such intrauterine programming events affect birth weight and raise the offspring's risk trajectory for future obesity, type 2 diabetes, cardiovascular disease and premature death. This vicious cycle, through which female offspring of mothers with diabetes are themselves more likely to develop diabetes prior to delivery, transmits the burden of morbidity from one generation to the next. This tragic but preventable trend likely underlies the alarming increase in gestational and type 2 diabetes. We propose to conduct a randomized controlled trial in 400 overweight or obese pregnant Puerto Rican women (free of diabetes) and their infants, to favorably impact metabolic health in mothers and infants. Women presenting before 20 gestational weeks will be block randomized to a lifestyle modification intervention or standard care control group. Puerto Rico is a predominantly Hispanic U.S. territory with among the lowest levels of physical activity and fruit, vegetable and whole grain intake, and the highest rates of diabetes, childhood obesity and infant mortality of all U.S. jurisdictions; nevertheless, recruitment rates for research studies ae higher here than elsewhere in the U.S.. The intervention will be conducted in pregnant women and their infants, focusing on improving: (1) physical activity levels, (2) diet quality and calori intake, (3) behavioral imprinting and (4) prenatal care. The intervention will be delivered through six intensive core group sessions (10 participants per group), followed by booster sessions and phone calls, and will continue during lactation through the first postpartum year. We will evaluate whether the combined intervention will: (1) increase the percent of women with adequate gestational weight gain, (2) optimize early infant growth and (3) achieve adequate retention and compliance. As secondary aims, we will evaluate whether the interventions improve insulin sensitivity and beta-cell function in the women and fasting insulin concentrations in their infants. This study will also help us to work through the logistical and other barriers to develop more effective ways to intervene during pregnancy to maximally reduce cardio-metabolic risk trajectories of future generations. Undertaking this study in Puerto Rico will address a major health disparity common to many parts of the US, whilst also advancing knowledge about how early life risk factors could be influenced to reduce metabolic risk in young women and their offspring.