Danielle S. Downs, Ph.D. - US grants

[unreadable] DESCRIPTION (provided by applicant): The overall goal of this proposed research is to test the effectiveness of ACTIVE MOMS, a 12-week cognitive behavioral physical activity program, delivered as two interventions (semi-intensive structured exercise and minimum-contact physical activity), for increasing physical activity behaviors of women with gestational diabetes mellitus (GDM), and to determine the impact of this program on maternal and fetal outcomes. Because GDM increases maternal and fetal morbidity and it is associated with the onset of type 2 diabetes and obesity later in life for these women and their children, it is critically important that interventions be studied to treat and prevent GDM. Preliminary research has shown that physical activity may be effective at treating GDM; however, this research is limited in scope and no studies to date have 1) intervened with GDM women with a primary objective of increasing their physical activity behaviors, and 2) examined GDM women's physical activity behaviors with a combination of standardized self-report and objective assessments. Also, the research studying the effects of maternal physical activity on psychological correlates and infant outcomes in this population is scant. As a result of early screening and detection for GDM in the standard care setting, women will be identified as having GDM by 17-18 weeks gestation. Participants will be randomized to receive either the structured exercise, lifestyle physical activity, or standard care control condition. All participants will undergo a baseline (about 19 weeks gestation) and two follow-up assessments (about 33 weeks gestation, 6-weeks postpartum) to measure a series of biobehavioral outcomes. The medical records will be obtained for the participants and their offspring to assess pregnancy biomarkers (e.g., glucose tolerance, maternal weight status), pregnancy and delivery complications, and infant birth outcomes. The intervention will be implemented during the second and third pregnancy trimesters (approximately 20-32 weeks gestation). The primary outcome is women's physical activity behaviors (e.g., mean counts/min, energy expenditure, meeting physical activity recommendations). Secondary outcomes include the effects of maternal physical activity behaviors on psychosocial correlates (e.g., physical activity attitude, self-efficacy, social support; depression, quality of life), pregnancy and delivery complications (e.g., excessive maternal weight gain, need for insulin), and infant outcomes (e.g., birth weight). [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): Managing gestational weight gain (GWG) offers lifelong health benefits in both mothers and their offspring (e.g., reducing risk of preeclampsia, development of metabolic syndrome, obesity, cardiovascular disease). Because overweight and obese pregnant women (OW/OBPW) often exceed GWG guidelines and have difficulty with managing weight, there is a critical need to identify effective weight management interventions for this population. An individually-tailored intervention that provides OW/OBPW with support for managing GWG on a weekly basis and adapts to their unique needs over pregnancy may be a highly promising way to prevent high GWG. We have synergistically integrated methods/key concepts from the behavioral sciences and control systems engineering to construct a framework for an individually-tailored, behavioral intervention (e.g., components of education, goal-setting, self-monitoring, and engaging in healthy eating/ physical activity [PA] behaviors) to control GWG in OW/OBPW. This intervention has several unique features: (a) individualized treatment to manage GWG on a weekly basis over pregnancy, (b) a validated differential equation model for energy balance to predict GWG trajectories over pregnancy and provide feedback in real- time to adapt treatment as needed, (c) e-health technology to promote self-monitoring and collect data on weight, dietary intake, PA, and psychological factors, and (d) control systems engineering to relate intensive data collected on each participant and dynamical systems modeling to optimize this intervention; in other words, manage GWG in OW/OBPW as effectively and efficiently as possible. The proposed research aims are to first, establish feasibility of delivering this individually-tailored intervention for managing GWG in OW/OBPW by conducting two studies to examine viability of delivering intervention dosages and component sequencing, procedures for self-monitoring of GWG, dietary intake, and PA with e-health technology mechanisms, randomization/retention/data collection procedures with treatment and control groups, and to establish user acceptability. Second, control systems engineering will be used to relate intensive data collected on each participant to a dynamical model that considers how changes in GWG responds to changes in energy intake, PA, and planned/self-regulatory behaviors. We will then make modifications to the intervention and identify a customized intervention plan for each woman; resulting in an optimized (effective and efficient) intervention. We will test the efficacy of this optimized intervention for managing GWG in OW/OBPW in a future randomized controlled trial. Our long-range goal is to make this intervention available to all pregnant women (via e- health technology) to improve the health of mothers and infants and impact the etiology of obesity and cardiovascular disease at a critical time in the life cycle. Thi research compliments the over-reaching goal of NIH to improve maternal/infant health and it is consistent with NHLBI's mission to promote research to reduce the burden of heart, lung, and blood diseases and their related comorbidities worldwide.