Group versus Traditional Prenatal Care for Diabetes: A Randomized Controlled Trial

项目概要/摘要 随着2型糖尿病、妊娠期糖尿病和妊娠期高血压疾病的发病率上升， 产前治疗和产后降低未来不良心血管疾病风险的挑战 事件这个指导病人为导向的职业发展奖（K23）的目的是使 候选人开发一个资助的研究计划，优化医疗共病的管理， 并确定了改变妇女未来慢性病轨迹的创新方法。实现这一 目标，培训和指导提出了三个关键领域：1）先进的培训，以社区为基础的 参与性研究，生物统计学和临床试验，2）保护时间进行以患者为导向的研究， 以糖尿病为重点的产前护理计划对改善产后健康的能力，以及3） 基础研究和相关数据库的介绍，以促进未来的关系研究 妊娠并发症和未来心血管疾病之间的关系，以促进下一阶段的研究。 该奖项的研究计划将在培训计划的支持下实施， 由专家导师和顾问组成的跨学科团队。该项目将考察小组的能力， 产前糖尿病护理，以糖尿病为中心的妊娠（糖尿病CP），以改善低收入 患有糖尿病的非裔美国孕妇这些妇女患上乳腺癌的长期风险增加 心血管疾病，该项目利用产前时期促进健康行为 这可能会延续到产后时期，从而降低这种风险。具体而言，该项目将确定 糖尿病CP是否会降低产妇产后一年的体重保持率。该项目将采用 随机对照设计和严格的系统方法。本研究的预期结果是 高质量的试点数据评估组产前护理在2型和妊娠期妇女的疗效 糖尿病如果试验提供证据表明糖尿病CP有效，则本研究的数据和经验将 支持R 01应用程序的开发，以在多中心随机试验中测试糖尿病CP。如果 小组产前护理减少产妇产后体重保留的假设得到证实， 将彻底改变美国的糖尿病治疗。小组产前护理将是一个简单，成本效益高， 为越来越多的妊娠期糖尿病妇女采取干预措施。培训和研究 本提案中概述的活动将补充候选人在公共卫生方面的背景，并将其置于 一个独特的地位，以提高我们的能力，治疗妇女慢性疾病的怀孕，并提高他们的 长期健康。最终，这项工作将导致新的，创新的方式提供产前护理的妇女 患有可能损害她们健康的共病，无论是在怀孕期间还是未来几年。

Project Summary/Abstract As rates of Type 2 Diabetes, Gestational diabetes mellitus, and hypertensive disorders of pregnancy rise, so do the challenges of antepartum treatment and postpartum risk-reduction for future adverse cardiovascular events. The purpose of this Mentored Patient-Oriented Career Development Award (K23) is to enable the candidate to develop a funded research program that optimizes management of medical co-morbidities during pregnancy and identifies innovative ways to alter a woman's future chronic disease trajectory. To achieve this goal, training and mentorship are proposed in three key areas: 1) Advanced training in community-based participatory research, biostatistics, and clinical trials, 2) Protected time to perform patient-oriented research on the ability of a group diabetes-focused prenatal care program to improve postpartum health, and 3) Foundational research and introductions to relevant databases to facilitate future research on the relationship between pregnancy complications and future cardiovascular disease to facilitate research in the next phase. The research plan for this award will be implemented with the support of the training plan and an interdisciplinary team of expert mentors and advisors. The proposed project examines the ability of group prenatal diabetes care, Diabetes Centering Pregnancy (Diabetes CP), to improve outcomes for low-income pregnant African-American women with diabetes. These women are at increased long-term risk of developing cardiovascular disease, and this project takes advantage of the antenatal period to promote healthy behaviors that may carry over into the postpartum period and thus reduce this risk. Specifically, this project will determine whether Diabetes CP reduces maternal postpartum weight retention up to one year. The project will employ a randomized controlled design and a rigorous, systematic approach. The expected outcome of this study is high-quality pilot data assessing the efficacy of group prenatal care in women with type 2 and gestational diabetes. If the trial provides evidence that Diabetes CP is effective, data and experience from this study will support the development of an R01 application to test Diabetes CP in a multi-center randomized trial. If the hypothesis that group prenatal care reduces maternal postpartum weight retention is confirmed, the findings will revolutionize diabetes care in the United States. Group prenatal care will be a simple, cost-effective intervention for the increasing numbers of women with diabetes in pregnancy. The training and research activities outlined in this proposal will complement the candidate's background in public health and place her in a unique position to advance our ability to treat women with chronic diseases of pregnancy and improve their long-term health. Ultimately, this work will lead to new, innovative ways of providing prenatal care to women with co-morbid diseases that may impair their health, both during pregnancy and for years to come.