Diabetes, Gestational
Conditions
Keywords
Exercise, Contraception, Vaccination
Brief summary
This pilot feasibility randomized controlled trial will be conducted among women at risk for or diagnosed with gestational diabetes (GDM) at the University of Tennessee Medical Center Knoxville (UTMC). The trial will be called Project Wellness. It will compare a physical activity (behavior change) intervention (i.e., walking/stepping in place) versus a general wellness intervention (e.g., health education focusing on immunizations, contraceptive options following delivery, etc.) on physical activity levels, maternal glycemic profile in the third trimester, and infant size and anthropometric measurements soon after birth (i.e., weight, length, circumference, skinfolds). It is hypothesized that the physical activity intervention will increase physical activity levels, and improve maternal glycemic profile and infant anthropometric measures at birth. It is also hypothesized that maternal glycemic profile in the third trimester will be associated with infant anthropometric measurements at birth.
Detailed description
Participants will also be followed through 12 months postpartum: Maternal weight and device-based and self-reported measures of physical activity will be assessed at 3, 6, 9 and 12 months postpartum, as well as the same infant size and anthropometric measurements assessed soon after delivery.
Interventions
BEHAVIORALPhysical Activity Intervention
Motivational interviewing techniques helped participants set reasonable, specific, and achievable individual goals at each session: a duration (i.e., minutes) and frequency (i.e., days of the week) of walking or stepping, and potentially, a step count (i.e., a proxy for intensity). Individual goals often differed from the program goal in an effort to meet the participants 'where they are'.
OTHERWellness Education
The following topics were addressed: postpartum contraception, maternal immunizations, infant immunizations, car seat safety and planning for your hospital stay, and safe sleep and skin to skin. No information on PA was provided to the control group (i.e., neither encouragement for PA nor instructions to limit PA).
Sponsors
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
The University of Tennessee, Knoxville
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
DOUBLE (Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* Age 18-40 years * Singleton viable pregnancy with low suspicion for clinically significant abnormality or aneuploidy * Hyperglycemia after 24 weeks identified by: One step diagnostic procedure 75-g Oral Glucose Tolerance Test (OGTT) after an overnight fast, with plasma glucose measured fasting and at 1 and 2 hrs, and any of the following plasma glucose values are met or exceeded: Fasting: 92 mg/dL (5.1 mmol/L) 1. hr: 180 mg/dL (10.0 mmol/L) 2. hr: 153 mg/dL (8.5 mmol/L) For the Two step diagnostic procedure, only Step 1 (i.e., at risk for GDM) is required for eligibility: Step 1: 50-g glucose screening test (non-fasting), with plasma glucose measured at 1-hr ≥130 mg/dL Any other abnormal value on oral glucose tolerance testing associated with macrosomia * English speaker and comfortable completing surveys in English (i.e., no translator needed) * Planning to remain in the area for baby's first year
Exclusion criteria
* Previously diagnosed with diabetes (i.e., Type I or Type II diabetes) outside of pregnancy * Contraindications to exercise (i.e., absolute contraindications according to published recommendations for exercise during pregnancy), as follows: Hemodynamically significant heart disease, Restrictive lung disease, Incompetent cervix/cerclage, Persistent second or third trimester bleeding, Placenta previa or vasa previa after 26 weeks gestation, Premature labor during the current pregnancy, Ruptured membranes, Preeclampsia/pregnancy-induced hypertension, severe anemia * Currently non-smoker * Current illicit drug use * Current use of daily medications known to alter insulin resistance and metabolic profiles (e.g., metformin, corticosteroids, anti-psychotics) * Currently taking medication for polycystic ovarian syndrome (PCOS) (i.e., history of PCOS okay as long as she is not currently taking medication for PCOS)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Self-reported Physical Activity (Assessed by Pregnancy Physical Activity Questionnaire) From Baseline to Follow-up | approximately 6 weeks | Change in self-reported moderate to vigorous intensity walking or running activity within the sports & exercise domain, as assessed by Pregnancy Physical Activity Questionnaire (i.e., measure at follow-up study visit minus the measure at baseline study visit). Reference: Chasan-Taber L, Schmidt MD, Roberts DE, Hosmer D, Markenson G, Freedson PS. Development and Validation of a Pregnancy Physical Activity Questionnaire. Med Sci Sports Exerc. 2004;36(10):1750-1760. |
| Change in Physical Activity Assessed by ActiGraph Monitoring Device From Baseline to Follow-up | approximately 6 weeks | Change in minutes per day of walk/run activity, as assessed by ActiGraph monitoring device (i.e., measure at follow-up study visit minus the measure at baseline study visit). Reference: Hibbing PR, Lamunion SR, Kaplan AS, Crouter SE. Estimating Energy Expenditure with ActiGraph GT9X Inertial Measurement Unit. Med Sci Sports Exerc. May 2018;50(5):1093-1102. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Neonatal Subscapular Skinfolds | Within 5 days of birth | Neonatal Subscapular Skinfolds (i.e., caliper measurement to assess neonatal body composition) |
| Birthweight-for-gestational-age Z-score | Within 5 days of birth | Birthweight-for-gestational-age Z-score based on the sex- and gestational-age-specific birth-weight distributions of the 2017 U.S. Natality files. Z-scores more extreme than -1.645 and +1.645 indicate birthweight-for-gestational-age-and-sex at \<10th and \>90th percentiles, respectively, and thus indicate increased risks for adverse health outcomes (as the relationship is U-shaped). A Z-score of 0 represents birthweight-for-gestational-age-and-sex at the 50th percentile. Reference: Aris IM, Kleinman KP, Belfort MB, Kaimal A, Oken E. A 2017 U.S. Reference for Singleton Birth Weight Percentiles Using Obstetric Estimates of Gestation. Pediatrics. Jul 2019;144(1). |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Physical Activity Intervention The behavioral physical activity (PA) intervention focuses on walking, or stepping in place when it is not possible to walk (e.g., stormy weather). The primary goal of the PA intervention is to achieve at least 30 minutes per day of walking/stepping in place. The secondary goal is to use a PA tracker (e.g., the Fitbit Charge 3 provided by the intervention) to log and review walking/stepping, and to accumulate at least 3,000 steps during their 30 minutes of walking/stepping each day.
Physical Activity Intervention: Participants in both arms will wear the CGM (FDA-regulated device) | 10 |
| Wellness Education The Wellness Education intervention will deliver information on mom and baby wellness that is unrelated to physical activity, diet, metabolism, or weight (e.g., immunizations during pregnancy and encouragement to immunize the baby on schedule, postpartum contraceptive options and developing a contraceptive plan, infant car seats & safety checks).
Wellness Education: Participants in both arms will wear the CGM (FDA-regulated device) | 10 |
| Total | 20 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 1 | 0 |
Baseline characteristics
| Characteristic | Physical Activity Intervention | Total | Wellness Education |
|---|---|---|---|
| Age, Continuous | 32.5 years STANDARD_DEVIATION 4.6 | 32.5 years STANDARD_DEVIATION 4 | 32.5 years STANDARD_DEVIATION 3.7 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 2 Participants | 4 Participants | 2 Participants |
| Race (NIH/OMB) White | 8 Participants | 16 Participants | 8 Participants |
| Region of Enrollment United States | 10 participants | 20 participants | 10 participants |
| Sex: Female, Male Female | 10 Participants | 20 Participants | 10 Participants |
| Sex: Female, Male Male | 0 Participants | 0 Participants | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 10 | 0 / 10 |
| other Total, other adverse events | 0 / 10 | 0 / 10 |
| serious Total, serious adverse events | 0 / 10 | 0 / 10 |
Outcome results
Primary
Change in Physical Activity Assessed by ActiGraph Monitoring Device From Baseline to Follow-up
Change in minutes per day of walk/run activity, as assessed by ActiGraph monitoring device (i.e., measure at follow-up study visit minus the measure at baseline study visit). Reference: Hibbing PR, Lamunion SR, Kaplan AS, Crouter SE. Estimating Energy Expenditure with ActiGraph GT9X Inertial Measurement Unit. Med Sci Sports Exerc. May 2018;50(5):1093-1102.
Time frame: approximately 6 weeks
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Physical Activity Intervention | Change in Physical Activity Assessed by ActiGraph Monitoring Device From Baseline to Follow-up | 0.90 Minutes per day of walk/run activity |
| Wellness Education | Change in Physical Activity Assessed by ActiGraph Monitoring Device From Baseline to Follow-up | -1.58 Minutes per day of walk/run activity |
Primary
Change in Self-reported Physical Activity (Assessed by Pregnancy Physical Activity Questionnaire) From Baseline to Follow-up
Change in self-reported moderate to vigorous intensity walking or running activity within the sports & exercise domain, as assessed by Pregnancy Physical Activity Questionnaire (i.e., measure at follow-up study visit minus the measure at baseline study visit). Reference: Chasan-Taber L, Schmidt MD, Roberts DE, Hosmer D, Markenson G, Freedson PS. Development and Validation of a Pregnancy Physical Activity Questionnaire. Med Sci Sports Exerc. 2004;36(10):1750-1760.
Time frame: approximately 6 weeks
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Physical Activity Intervention | Change in Self-reported Physical Activity (Assessed by Pregnancy Physical Activity Questionnaire) From Baseline to Follow-up | 0.22 MET hours per week |
| Wellness Education | Change in Self-reported Physical Activity (Assessed by Pregnancy Physical Activity Questionnaire) From Baseline to Follow-up | -0.70 MET hours per week |
Secondary
Birthweight-for-gestational-age Z-score
Birthweight-for-gestational-age Z-score based on the sex- and gestational-age-specific birth-weight distributions of the 2017 U.S. Natality files. Z-scores more extreme than -1.645 and +1.645 indicate birthweight-for-gestational-age-and-sex at \<10th and \>90th percentiles, respectively, and thus indicate increased risks for adverse health outcomes (as the relationship is U-shaped). A Z-score of 0 represents birthweight-for-gestational-age-and-sex at the 50th percentile. Reference: Aris IM, Kleinman KP, Belfort MB, Kaimal A, Oken E. A 2017 U.S. Reference for Singleton Birth Weight Percentiles Using Obstetric Estimates of Gestation. Pediatrics. Jul 2019;144(1).
Time frame: Within 5 days of birth
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Physical Activity Intervention | Birthweight-for-gestational-age Z-score | -0.87 Z-score |
| Wellness Education | Birthweight-for-gestational-age Z-score | -0.064 Z-score |
Secondary
Neonatal Subscapular Skinfolds
Neonatal Subscapular Skinfolds (i.e., caliper measurement to assess neonatal body composition)
Time frame: Within 5 days of birth
Population: Subscapular skinfolds
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Physical Activity Intervention | Neonatal Subscapular Skinfolds | 4.37 mm |
| Wellness Education | Neonatal Subscapular Skinfolds | 5.24 mm |