An Exercise Intervention to Prevent Recurrent GDM

描述（由申请人提供）：被诊断患有妊娠期糖尿病（GDM）的妇女患2型糖尿病和肥胖症的风险显著增加，目前在美国处于流行率。因此，GDM确定了发展2型糖尿病的高风险女性人群，从而提供了一个极好的机会，在这种疾病发展之前进行干预。众所周知，急性和慢性体力活动可降低空腹血糖并改善2型糖尿病的葡萄糖耐量。最近的流行病学研究表明，妇女与较高水平的体力活动有降低GDM的风险。因此，我们建议测试的假设，运动干预是一种有效的工具，以防止GDM的妇女与GDM的历史。本申请的主要目的是研究动机定制的、个体针对性的12周体力活动干预对1）复发性GDM风险，2）与胰岛素抵抗相关的血清生物标志物，3）以及妊娠期间采用和维持运动的影响。第二个目标是调查干预对妊娠期体重增加和选定的出生结局的影响。共有364名在怀孕前患有GDM的经产妇女（49%来自少数群体）将在怀孕早期（妊娠10周）招募，并随机接受个体针对性（IT）干预（n=182）或比较健康和健康（HW）干预（n=182）。干预措施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来实现美国妇产科医师学会（ACOG）关于怀孕期间身体活动的指南（一周中大部分日子进行30分钟或更长时间的中等强度活动）。该干预措施借鉴了改变动机准备阶段理论和社会认知理论为体育活动行为构建的理论，并将考虑到不同社会经济和种族背景的妇女所面临的特定社会，文化，经济和物理环境挑战。据我们所知，该应用程序是第一个测试旨在预防高危女性GDM的身体活动干预的创新。干预方案可以很容易地转化为临床实践中服务不足和少数群体。

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.