A Randomized Control Trial to improve metabolic outcomes in African American pregnant women

母亲高血糖症包括妊娠糖尿病（GDM）不成比例地影响5-11%的 非裔美国孕妇（AAPW）GDM甚至非糖尿病性高血糖与 先兆子痫，初次剖宫产，巨大儿，短期产伤， 肥胖症、2型糖尿病和心血管疾病的母亲和后代的长期。国家医疗 即使是短期后果，GDM的成本也高达每年18亿美元。超重/肥胖的AAPW有 GDM、GDM复发和非糖尿病性高血糖的风险增加最高。睡眠 差距也存在。AAPW的睡眠时间较短，睡眠中点（时间）较晚，睡眠连续性较差， 比白色女人更好。我们和其他人都表现出睡眠时间短、睡眠质量差和晚睡 时间与GDM风险增加有关。睡眠障碍，普遍存在于怀孕期间，可能代表 母亲高血糖的可改变的危险因素。虽然认知/行为方法已经产生了强大的 改善一般人群的睡眠时间和质量，我们是唯一一组测试的影响， 非药物性睡眠干预改善AAPW孕妇的糖代谢。我们的前期工作 表明睡B.E.T.T.E.R.解决6个原则的唤醒睡眠卫生（卧室，运动，紧张， 在床上的时间，饮食和节奏），针对24小时的行为和多种生活方式的组成部分，可以成功地 改善孕妇睡眠。这项随机对照试验的目的是建立 我们针对不同文化的、针对个人的更好的干预措施的有效性， AAPW中的葡萄糖代谢。我们将入组150例年龄在18-40岁的超重/肥胖未经产AAPW。他们将 随机分配（每组75名）：1）睡眠更好或2）注意力控制（睡眠-准备）。数据将在16- 20（基线）、28-30（治疗结束）和34-36（治疗后）孕周（GW），使用有效和 在自由生活条件下使用可靠的仪器监测睡眠，并采用最先进的方法评估血糖 水平和胰岛素敏感性。我们的具体目标是：（1）定义BETTER与BETTER-Prep对 葡萄糖耐量（空腹血糖-主要结局）和胰岛素敏感性，以及（2）确定 更好地与睡眠准备，以改善睡眠持续时间，睡眠质量和参与者的时间，和（3）确定 其他因素在多大程度上代表了关键的影响因素，包括经济困难、心理社会 压力和种族歧视的干预措施（探索性目的）。我们研究的长期目标是 1)开发低成本和有效的方法来优化产妇的新陈代谢和福祉， 易于在医院或社区诊所的产前护理中使用，以及2）整合睡眠卫生 产前教育主流化原则，以改善低收入非洲妇女的母亲葡萄糖代谢 美国女人这有助于改善母亲、其后代和下一代的健康状况。 该提案支持NIMHD改善少数民族健康和消除健康差距的使命。

Maternal hyperglycemia including Gestational Diabetes Mellitus (GDM) disproportionately affects 5-11% of African American Pregnant Women (AAPW). GDM and even nondiabetic hyperglycemia are linked to preeclampsia, primary cesarean section, macrosomia, birth trauma in the short-term, and increased risks of obesity, Type 2 diabetes and cardiovascular disease in mothers and offspring in the long-term. National medical costs of GDM even for short-term consequences are high at $1.8 billion yearly. Overweight/obese AAPW have the highest increased risk of GDM, GDM recurrence and nondiabetic hyperglycemia of any race. Sleep disparities also exist. AAPW have shorter sleep, later midpoints of sleep (timing), worse sleep continuity and quality than White women. We and others have shown short sleep duration, poor sleep quality and later sleep timing are associated with increased GDM risk. Sleep disturbances, ubiquitous in pregnancy, may represent MODIFIABLE risk factors for maternal hyperglycemia. While cognitive/behavioral methods have yielded robust improvement in sleep duration and quality in general population, we are the only group to test the effects of a nonpharmacologic sleep intervention to improve maternal glucose metabolism in AAPW. Our preliminary work suggests that sleep B.E.T.T.E.R. addressing 6 principles of wake-sleep hygiene (Bedroom, Exercise, Tension, Time in bed, Eating, and Rhythm), targeting 24-hr behaviors and multiple lifestyle components can successfully improve sleep in pregnant women. The purpose of this randomized controlled trial is to establish the effectiveness of our culturally targeted and individually tailored BETTER intervention to promote maternal glucose metabolism in AAPW. We will enroll 150 overweight/obese nulliparous AAPW aged 18-40. They will be randomized (75 per group) to: 1) sleep BETTER or 2) attention control (Birth-Prep). Data will be collected at 16- 20 (baseline), 28-30 (end of treatment) and 34-36 (post treatment) gestational weeks (GWs) using valid and reliable instruments monitoring sleep in free-living conditions with state-of-the-art methods assessing glucose levels and insulin sensitivity. Our specific aims are to: (1) Define the impact of BETTER versus Birth-Prep on glucose tolerance (fasting glucose-primary outcome) and insulin sensitivity, and (2) Determine the efficacy of BETTER versus Birth-Prep to improve sleep duration, sleep quality and timing in participants, and (3) Determine the extent to which other factors represent key effect modifiers including economic hardships, psychosocial stress and racial discrimination for the intervention (exploratory aim). The long-term goals of our research are 1) to develop low-cost and effective approach on optimizing maternal metabolism and well-being that can be easily employed in prenatal care from hospital- or community-based clinics, and 2) to integrate sleep hygiene principles in mainstream prenatal education to improve maternal glucose metabolism in low income African American women. This can contribute to better health outcomes in mothers, their offspring and next generations. This proposal supports NIMHD’s mission of improving minority health and eliminating health disparities.