An Exercise Intervention to Prevent Recurrent GDM

描述（由申请人提供）：诊断为妊娠期糖尿病（GDM）的妇女患2型糖尿病和肥胖的风险显著增加，目前在美国呈流行病趋势。因此，GDM确定了发生2型糖尿病的高危女性人群，从而提供了在这种疾病发生前几年进行干预的绝佳机会。众所周知，急性和慢性体育活动可降低2型糖尿病患者的空腹血糖并改善葡萄糖耐量。最近的流行病学研究表明，体力活动水平较高的女性患GDM的风险较低。因此，我们建议验证运动干预是预防有GDM病史的女性GDM的有效工具的假设。该应用程序的主要目标是调查动机量身定制的、针对个体的12周体育活动干预对以下方面的影响：1)复发性GDM的风险；2)与胰岛素抵抗相关的血清生物标志物；3)怀孕期间锻炼的采用和维持。次要目标是调查干预对妊娠期体重增加和选定出生结局的影响。在妊娠早期（妊娠10周）共招募364名妊娠期患有GDM的多胎妇女（49%来自少数群体），并随机分为个体目标（IT）干预组（n=182）或比较健康与保健（HW）干预组（n=182）。干预的总体目标是鼓励孕妇通过增加步行和养成更积极的生活方式，达到美国妇产科学院（ACOG）孕期身体活动指南（每周大部分时间进行30分钟或更长时间的中等强度活动）。该干预措施借鉴了体育活动行为的动机准备阶段理论和社会认知理论，并将考虑到不同社会经济和种族背景的女性所面临的具体社会、文化、经济和物理环境挑战。据我们所知，该应用程序的创新之处在于，它是第一个测试旨在预防高危女性GDM的体育活动干预的应用程序。干预方案可以很容易地转化为服务不足和少数民族人群的临床实践。

DESCRIPTION (provided by applicant): Women diagnosed with gestational diabetes mellitus (GDM) are at substantially increased risk of developing type 2 diabetes and obesity, currently at epidemic rates in the United States. GDM, therefore, identifies a population of women at high risk of developing type 2 diabetes and thus provides an excellent opportunity to intervene years before the development of this disorder. It is well recognized that acute as well as chronic physical activity reduce fasting plasma glucose as well as improve glucose tolerance in type 2 diabetes. Recent epidemiologic studies have suggested that women with higher levels of physical activity have reduced risk of GDM. Therefore, we propose to test the hypothesis that an exercise intervention is an effective tool for preventing GDM among women with a history of GDM. The primary goals of the application are to investigate the effects of a motivationally-tailored, individually targeted 12-wk physical activity intervention on 1) risk of recurrent GDM, 2) serum biomarkers associated with insulin resistance, 3) and the adoption and maintenance of exercise during pregnancy. Secondary goals are to investigate the impact of the intervention on gestational weight gain and selected birth outcomes. A total of 364 multiparous women who had GDM in a prior pregnancy (49 percent will be from minority groups) will be recruited in early pregnancy (10 wks gestation) and randomized to either an Individually Targeted (IT) intervention (n=182) or a Comparison Health and Wellness (HW) intervention (n=182). The overall goal of the intervention is to encourage pregnant women to achieve the American College of Obstetricians and Gynecologists (ACOG) Guidelines for physical activity during pregnancy (30 minutes or more of moderate- intensity activity on most days of the week) through increasing walking and developing a more active lifestyle. The intervention draws from the theory of Stages of Motivational Readiness for Change and Social Cognitive Theory constructs for physical activity behavior and will take into account the specific social, cultural, economic, and physical environmental challenges faced by women of diverse socioeconomic and ethnic backgrounds. The application is innovative in being the first, to our knowledge, to test a physical activity intervention designed to prevent GDM among high risk women. The intervention protocol can readily be translated into clinical practice in underserved and minority populations.