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

心血管疾病高危产后妇女的肥胖预防

• 批准号: 10676792
• 负责人: Jennifer Lewey
• 金额: $ 17.52万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10676792
• 关键词: 2 arm randomized control trial; Accountability; Adult; Affect; Award; Behavior; Behavior Therapy; Behavioral; Body Weight decreased; Cardiovascular Diseases; Cardiovascular system; Censuses; Clinical; Clinical Trials Design; Data; Databases; Diabetes Mellitus; Diagnosis; Disease; Electronic Health Record; Elements; Face; Feedback; Future; Goals; Health Sciences; Health behavior; Heart Diseases; High Risk Woman; Hypertension; Incentives; Incidence; Individual; Infrastructure; Institution; Intervention; Knowledge; Life; Life Style; Link; Machine Learning; Maternal-fetal medicine; Medicine; Mentors; Mentorship; Methods; Mission; Modeling; Mothers; National Heart, Lung, and Blood Institute; Nature; Neighborhoods; Obesity; Outcome; Overweight; Patients; Pennsylvania; Perinatal; Persons; Physical activity; Physical environment; Population Heterogeneity; Population Sciences; Positioning Attribute; Postpartum Period; Postpartum Women; Pre-Eclampsia; Pregnancy; Qualitative Methods; Research; Research Personnel; Rewards; Risk Factors; Site; Social Characteristics; Social Environment; Statistical Methods; Techniques; Technology; Testing; Time; Training; Universities; Vulnerable Populations; Weight; Weight Gain; Woman; Women' s Health; Work; arm; behavior change; behavioral clinical trial; behavioral economics; cardiovascular disorder risk; cardiovascular health; cardiovascular risk factor; career; career development; clinical predictors; cohort; cost; design; excessive weight gain; gestational weight gain; health care service utilization; healthy lifestyle; high risk; improved; innovation; intervention refinement; mortality; neighborhood disadvantage; novel strategies; obesity prevention; patient engagement; patient oriented; peer support; postpartum weight; prediction algorithm; predictive modeling; predictive tools; pregnancy disorder; pregnancy hypertension; prevent; programs; racial diversity; randomized, clinical trials; recruit; remote delivery; remote intervention; secondary outcome; skills; social; weight loss intervention; weight loss program

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.

项目概要 肥胖是心血管 (CV) 疾病的一个重要危险因素，影响着 39% 的美国成年人。 女性肥胖率不成比例地上升，导致糖尿病和糖尿病的发病率上升 55 岁以下女性的心血管死亡率。怀孕代表着人生的转变，许多女性 体重增加。肥胖对患有先兆子痫的女性的影响进一步放大，先兆子痫是一种独立的、独立的疾病。 未来心血管疾病的危险因素被低估。迫切需要更好地理解预测因素 过度产后体重滞留，以提供有效且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。 社会激励或基于关系影响行为改变的影响力很强 健康行为的激励因素。游戏设计元素（例如目标设定）的使用已成功 与社会激励相结合，以增强其他疾病环境中的健康行为。中心假设 该提案的主要内容是使用这些新颖的方法并结合既定的方法进行行为干预 行为减肥计划将提供有效且可扩展的解决方案，以减少 产后肥胖。该提案将利用高级研究人员（Michal Elovitz 博士和 Peter Groeneveld）和宾夕法尼亚大学在心血管医学、母胎医学、 和行为经济学。研究将在城市和种族多样化的人群中进行，因为这些 女性最有可能从降低心血管风险的干预措施中受益。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产后体重保留的临床预测工具 包含社区级数据的健康记录数据库。目标 2 将使用定性和混合方法 利用患者反馈确定加强试点干预设计的策略。目标 3 将实施 2 组单中心随机临床试验，旨在帮助患有先兆子痫或妊娠期的女性实现减肥 高血压参与使用远程技术和社交的在线行为减肥计划 其他产后妇女的反馈。 该提案将确定处于生命早期阶段的女性，她们将从强化训练中受益最多。 生活方式的改变，并将测试和完善能够传播给产后妇女的干预措施 远程。 Lewey 博士是一位普通心脏病专家，接受过女性健康和人口科学方面的培训 建立了妊娠相关心血管疾病方面的专业知识。她建议的培训 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。完成该计划后，她将能够 独立设计、瞄准和评估预防女性心脏病的行为干预措施。这 拟议的 K23 的结果将为计划的 R01 级应用提供宝贵的试点工作。