Abstract
Introduction
Maternal overweight or obesity has been associated with metabolic syndrome through 1 year postpartum, but it remains unknown whether a culturally-modified, motivationally-targeted, and individually-tailored Lifestyle Intervention could improve postpartum cardiometabolic health among Hispanic women with overweight or obesity.
Methods
Proyecto Mamá was a randomized controlled trial conducted in Western Massachusetts from 2014 to 2020 in which Hispanic women with overweight/obesity were randomized to a Lifestyle Intervention (LI) involving diet and exercise or to a comparison Health and Wellness Intervention (HW). Biomarkers of cardiovascular risk (i.e., lipids, C-reactive protein) and insulin resistance (fasting insulin, glucose, HbA1c, homeostasis model assessment [HOMA-IR], leptin, adiponectin) were measured at baseline (early pregnancy), mid-pregnancy, and 6 weeks, 6 months, and 12 months postpartum. Generalized linear mixed effect models were used to evaluate differences in the change in biomarkers over the course of postpartum follow-up time.
Results
In intent-to-treat analyses among eligible women (LI; n=51, HW; n=58) there were no significant differences in changes in biomarkers of CVD risk or insulin resistance over the postpartum year; for example, the intervention effect for total cholesterol was 6.98 (SE: 6.36, p=0.27) and for HbA1c was −0.01 (SE: 0.4, p=0.85). In pooled analyses, regardless of intervention arm, women who participated in any vigorous activity had less of an increase in HbA1c (intervention effect = −0.17, SE: 0.05, p=0.002) compared to those with no vigorous activity, and similarly beneficial associations with other cardiovascular risk biomarkers (p<0.05).
Discussion
Women who participated in vigorous activity, regardless of their assigned intervention arm, had more favorable changes in biomarkers of insulin resistance.
Significance
Women with overweight/obesity during pregnancy are at an increased risk of adverse cardiometabolic profiles and future development of type 2 diabetes and cardiovascular disease. Hispanic women are disproportionately affected by cardiometabolic disorders but have largely been excluded from lifestyle intervention studies. Although providing a lifestyle intervention to Hispanic women with overweight/obesity resulted in no significant differences in postpartum cardiometabolic biomarkers, women who articipated in vigorous activity, regardless of their assigned intervention arm, had favorable changes in insulin resistance biomarkers. These findings suggest that the intensity of physical activity may be important for improving postpartum cardiometabolic biomarkers among high-risk, Hispanic women.
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Data Availability
The dataset analyzed during the current study is available from the corresponding author on reasonable request.
Code Availability
Not applicable.
Abbreviations
- IOM:
-
Institute of Medicine
- T2D:
-
Type 2 diabetes
- CVD:
-
Cardiovascular disease
- BMI:
-
Body mass index
- ACOG:
-
American College of Obstetricians and Gynecologists
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This work was funded by the National Institutes of Health NIH/NIDDK 1R01DK097011. Clinical Trial Registration: clinicaltrials.gov NCT01679210
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LCT is the principal investigator of the study. LCT, BM, and MCR conceived of the study topic. KAW and PP conducted the data analysis. LCT, KAW, PP, BM, MCR, BB, JEM, and BWW interpreted the data. KAW and LCT drafted the manuscript. All authors critically reviewed and edited the draft manuscript and read and approved the final manuscript.
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Wagner, K.A., Pekow, P., Marcus, B. et al. The Impact of a Lifestyle Intervention on Cardiometabolic Risk Factors among Postpartum Hispanic Women with Overweight and Obesity in a Randomized Controlled Trial (Proyecto Mamá). Matern Child Health J 28, 1768–1781 (2024). https://doi.org/10.1007/s10995-024-03978-4
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DOI: https://doi.org/10.1007/s10995-024-03978-4