Study of a Postpartum Diabetes Prevention Program for Hispanic Women
Study of a Postpartum Diabetes Prevention Program for Hispanic Women
The overall goal of this randomized controlled trial is to test the efficacy of a culturally
 and linguistically modified, individually-tailored lifestyle intervention to reduce risk
 factors for type 2 diabetes and cardiovascular disease among postpartum Hispanic women with a
 history of abnormal glucose tolerance during pregnancy.
Specific aims are to evaluate the impact of the intervention on 1) postpartum weight loss, 2)
 biomarkers associated with insulin resistance (i.e., glucose, insulin, HbA1c, leptin, TNF-α,
 HOMA, AUCgluc, adiponectin), 3) other cardiovascular risk factors (i.e., blood lipids, blood
 pressure, CRP, fetuin-A, albumin-to-creatinine ratio), and 4) the adoption and maintenance of
 postpartum behaviors associated with weight loss and prevention of diabetes risk (i.e.,
 physical activity, diet). Eligible Hispanic women will be recruited after routine GDM
 screening and randomly assigned to a Lifestyle Intervention (n=150) or a Comparison Health
 and Wellness (control) intervention (n=150). The intervention will be based on our
 efficacious exercise and dietary interventions for Hispanics (R01NR011295; WIC Common
 Pathways). Multimodal contacts (i.e., in-person, telephone counseling, and mailed print-based
 materials) will be used to deliver the intervention from randomization (29 wks gestation) to
 12 months postpartum. Targets of the intervention are to achieve Institute of Medicine
 Guidelines for postpartum weight loss; American College of Obstetrician and Gynecologist
 guidelines for physical activity; and American Diabetes Association guidelines for diet. The
 intervention draws from Social Cognitive Theory and the Transtheoretical Model and addresses
 the specific social, cultural, economic, and physical environmental challenges faced by
 underserved Hispanic women. Measures of adherence will include the Pregnancy Physical
 Activity Questionnaire (PPAQ), accelerometers, and dietary recalls. The project is a Renewal
 Application of R01 DK064902, a study of lifestyle risk factors for GDM in Hispanic women. The
 proposed project builds upon the expertise of the investigative team in conducting randomized
 controlled trials of lifestyle interventions among Hispanic pregnant women (R01 DK074876;
 S3948 ASPH/CDC) and controlled trials of lifestyle interventions among low-income Hispanics
 with type 2 diabetes and pre-diabetes (R18 DK0658850; R18DK067549) and can readily be
 translated into clinical practice in underserved and minority populations.
Inclusion Criteria:

 -  Hispanic women with one or more glucose values during the diagnostic test meeting or
 exceeding the thresholds defined according to the American Diabetes Association

 Exclusion Criteria:

 -  history of type 1 or type 2 diabetes, heart disease, or chronic renal disease

 -  contraindications to postpartum participation in moderate physical activity or a
 low-fat/high-fiber diet (e.g., Crohn's disease, ulcerative colitis)

 -  inability to read English or Spanish at a 6th grade level

 -  <18 or >45 yrs of age

 -  women carrying multiples