Pregnancy, Preconception Education, Preconception Care, Preconception Risk, Adverse Pregnancy Outcomes
Conditions
Keywords
Preconception education, Cardiovascular health, Pregnancy, Lifestyle intervention
Brief summary
The goal of this randomized controlled clinical trial is to determine if healthy lifestyle education can help improve cardiovascular health and reduce pregnancy complications in women during the preconception period or early pregnancy. The main aims include: 1. Determine the feasibility and acceptability of the LEAN into pregnancy study. 2. Determine the impact of healthy lifestyle education on Life's Essential 8 cardiovascular health score. 3. Determine the impact of health lifestyle education on adverse pregnancy outcomes, specifically gestational diabetes and preeclampsia. A total of 200 participants will be randomly assigned to receive healthy lifestyle education in addition to routine care, or routine care alone. Participants will be asked to participate in the following activities: * Blood draws to test hemoglobin A1c and lipids * Surveys about diet, physical activity, sleep, and tobacco use * Gaples Nutritional Education Modules (if applicable)
Detailed description
Studies investigating adverse pregnancy outcomes have shown contributing effects from increased rates of diabetes, hypertension, and abnormal cholesterol and cardiovascular disease events. Previous studies have additionally shown that lifestyle modifications such as the DASH diet, regular exercise, and reduction in stress can lower blood pressure, lower LDL cholesterol levels, and decrease poor health behaviors that are linked to cardiovascular disease. However, studies have failed to quantify the effects of lifestyle modifications on more short-term cardiovascular health that may increase adverse pregnancy outcomes. By shifting the focus from cardiovascular disease treatment to positive health promotion, it promotes a paradigm shift to focus on prevention of disease and improved societal health overall. Preliminary data from our group showed significant correlations between preeclampsia and lower availability of healthy food, which is one of the factors quantified in Life's Essential 8. A major gap in the literature remains lifestyle interventions that can lead to risk factors for cardiovascular health in pregnant populations during gestation and also in the preconception period. We believe that lifestyle interventions preconception or during pregnancy can improve cardiovascular health during gestation and reduce adverse pregnancy outcomes. We hypothesize that the implementation of specific educational modules surrounding diet and exercise and repeated patient interaction will improve Life's Essential 8 cardiovascular score and, in those who are pregnant, potentially reduce the risk for gestational diabetes and preeclampsia.
Interventions
Healthy lifestyle education via nutritional educational modules from the Gaples Institute.
Sponsors
Medical College of Wisconsin
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 35 Years
Healthy volunteers
No
Inclusion criteria
* Patients in a period of preconception who want to become pregnant within 2 years, or patients in their first trimester of pregnancy * English-speaking * At risk for preeclampsia based on the following ACOG criteria: ≥1 high-risk factor: history of preeclampsia, multifetal gestation, chronic hypertension, gestational hypertension, pregestational diabetes, renal disease, or autoimmune disease, OR ≥2 moderate-risk factors: nulliparity, obesity (BMI\>30 kg/m2), family history of preeclampsia, Black or African American race, age ≥35 years, or personal history factors (previous pregnancy low birth weight, previous stillbirth, previous preterm birth, \>10-year pregnancy interval). * At risk for gestational diabetes, defined by ACOG as a BMI \> 25 plus one or more of the following risk factors: physical inactivity, first-degree relative with diabetes, high-risk race/ethnicity (African American, Latino, Native American, Asian American, Pacific Islander), previous infant weight \>4,000g, previous GDM, chronic hypertension, HDL \<35, triglyceride \>250, PCOS, A1c ≥ 5.7, prepregnancy BMI \>40.
Exclusion criteria
* No access to a smartphone * Major fetal anomaly diagnosed during current pregnancy, if pregnant at consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Feasibility of the LEAN into Pregnancy Study | From enrollment through the end of intervention at 3 months. | Determine feasibility (as measured by recruitment, completion of all modules and surveys, and retention in the study for three months) of the LEAN into Pregnancy study. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Life's Essential 8 | At enrollment and after intervention at 3 months. | Determine the impact of healthy lifestyle education on Life's Essential 8 cardiovascular score pre- and post-intervention. |
| Incident rate of gestational diabetes among participants who become pregnant. | Up to 2 years after enrollment | Determine the impact of healthy lifestyle education on adverse pregnancy outcomes among participants who become pregnant, specifically the rate of gestational diabetes. |
| Acceptability of the LEAN into Pregnancy Study | 3 months from enrollment (end of intervention) | Acceptability will be measured by surveys distributed to participants in the intervention arm at the final study visit. |
| Incident rate of hypertensive disorders of pregnancy in participants who become pregnant | Up to 2 years after enrollment | Determine the impact of healthy lifestyle education on adverse pregnancy outcomes among participants who become pregnant, specifically the rate of hypertensive disorders of pregnancy. |
Countries
United States
Contacts
CONTACTAlyssa M Hernandez, DO
PRINCIPAL_INVESTIGATORAnna Palatnik, MD
Medical College of Wisconsin
Outcome results
None listed