Pregnancy and EARly Lifestyle improvement Study (PEARLS)

怀孕和早期生活方式改善研究 (PEARLS)

• 批准号: 8728972
• 负责人: Paul William Franks
• 金额: $ 71.49万
• 依托单位: UNIVERSITY OF PUERTO RICO MED SCIENCES
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-30 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8728972
• 关键词: Address; Adult; Affect; Age; Alcohols; Behavior Therapy; Behavioral; Behavioral Risk Factor Surveillance System; Beta Cell; Birth; Birth Weight; Blood Pressure; Body Weight decreased; Cardiovascular Diseases; Caring; Categories; Cause of Death; Cell physiology; Centers for Disease Control and Prevention (U.S.); Cessation of life; Child; Clinic; Consumption; Control Groups; Data; Data Analyses; Diabetes Mellitus; Diabetes prevention; Diet; Diet Records; Dietary Fiber; Disadvantaged; Discipline of obstetrics; Event; Fasting; Female; Fetal Growth; Funding; Future; Future Generations; Generations; Glucose; Growth; Hair; Health; Health behavior; Hispanics; Human Milk; Hyperglycemia; Infant; Infant Mortality; Institute of Medicine (U.S.); Insulin; Intake; Intervention; Intervention Studies; Knowledge; Lactation; Length; Life; Life Style; Live Birth; Maintenance; Measures; Mental Depression; Metabolic; Modeling; Morbidity - disease rate; Mothers; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Oral; Outcome; Overweight; Pancreas; Participant; Physical activity; Placenta; Plasma; Population; Postpartum Period; Pregnancy; Pregnant Women; Premature Birth; Prenatal care; Prevention strategy; Preventive; Preventive Intervention; Public Health; Puerto Rican; Puerto Rico; Randomized; Randomized Controlled Trials; Reporting; Risk; Risk Factors; Saliva; Sampling; Sleep; Smoke; Source; Stress; Telephone; Time; Translating; Umbilical Cord Blood; University Hospitals; Weight; Weight Gain; Woman; Work; arm; diabetes risk; fruits and vegetables; good diet; health disparity; high risk; imprint; improved; in utero; indexing; infancy; insulin sensitivity; intervention effect; nutrition; obesity in children; offspring; pregnant; premature; programs; psychosocial; research study; response; satisfaction; sex; socioeconomics; standard care; trend; young woman

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.

描述（由申请人提供）：妊娠期肥胖和高血糖通过营养过剩影响胎儿生长，并可能对羊胰腺造成压力。这些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，患有糖尿病的母亲的雌性后代本身更有可能在分娩前患上糖尿病，从而将发病率的负担从一代传给下一代。这一悲惨但可预防的趋势可能是妊娠期糖尿病和2型糖尿病惊人增长的原因。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，以积极影响母亲和婴儿的代谢健康。在妊娠20周前就诊的妇女将被随机分为生活方式改变干预组或标准护理对照组。波多黎各主要是西班牙裔美国人居住的地区，是体育活动和水果摄入量最低的地区之一，