MoM Health: Monitoring Movement and Health Study
Study Details
Study Description
Brief Summary
The investigators will study sedentary behavior (SED) across pregnancy in young women. We hypothesize that SED will increase across pregnancy and that higher SED will be related to worse cardiovascular health, specifically elevated blood pressure (BP) and excessive gestational weight gain (GWG). Pregnancy is a biologically relevant period during which CVD risk factors may develop or worsen, contributing to future CVD. Pregnant women also spend most of their day sedentary, which is defined as too much sitting as distinct from too little exercise. SED has emerged as a risk factor, independent from moderate-to-vigorous physical activity (e.g., exercise), for elevated BP, obesity, diabetes, CVD, and mortality in general populations, but there are no recommendations for SED during pregnancy and few studies evaluate SED across pregnancy. These few studies are limited by small sample size, lack of repeated measures across trimesters, suboptimal SED assessment methodology, and a failure to link with clinical outcomes (e.g., BP, GWG). The investigators will address these gaps in a prospective study that will measure SED in 130 pregnant women across three trimesters using state-of-the-art objective activity monitors capable of measuring min-by-min activity by both intensity and posture. We will also measure BP and GWG during each trimester and, further, will link to and abstract all prenatal clinic weights and BPs, glucose screening results, gestational diabetes, preeclampsia, and adverse birth outcomes. Lastly, with the long-term goal of identifying women at high risk of SED during pregnancy and designing effective interventions, the investigators will efficiently evaluate correlates and determinants of SED which have never been studied during pregnancy.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
|
Detailed Description
Objective: The investigators aim to conduct a prospective cohort study using state-of-the-art, noninvasive measurement of sedentary behavior in n=130 pregnant women during each trimester of their first pregnancy. We will link sedentary behavior to gestational weight gain, blood pressure, and potential determinants such as demographics, health conditions and behaviors, psychosocial factors, perceptions/beliefs, and the environment.
Specific Aims:
Aim 1: Objectively measure sedentary behavior across pregnancy trimesters Aim 2: Relate objectively-measured sedentary behavior to blood pressure and gestational weight gain across pregnancy Aim 3: Characterize correlates and determinants of sedentary behavior during pregnancy
1.3 Background: Cardiovacular disease (CVD) remains the leading cause of death in women with minimal declines over the past 30 years among women <55 years old. Stagnant rates of CVD mortality in younger women have occurred alongside notable declines in men and older adults and are thought to be due, in part, to high rates of obesity and elevated blood pressure (BP). Related to this, the American Heart Association (AHA) recently identified primordial prevention, a population-level approach that targets preventing rather than treating CVD risk factors, as a necessary strategy to reduce the CVD burden. To achieve primordial prevention, the target must be populations at risk for developing CVD risk factors (vs. those with existing risk factors), such as younger women.
Pregnancy is a biologically unique period for young women during which CVD risk factors such as obesity and high blood pressure (BP) can develop or worsen, contributing to future CVD. Pregnant women also spend most of their time in sedentary behavior (SED). SED is any behavior that occurs in a seated/reclining position with low energy expenditure and is now recognized as a behavior that is distinct from inactivity, or a lack of moderate-vigorous physical activity (MVPA). Though MVPA has known benefits, SED is an emerging, independent risk factor for obesity, CVD, and mortality. Importantly, prolonged bouts of SED (accumulated in bouts lasting 30 min or more) in non-pregnant persons are more strongly related to obesity and induce unfavorable hemodynamic responses, such as increased BP. We hypothesize that too much SED across pregnancy is an important contributor to excess gestational weight gain (GWG) and elevated BP, two important CVD risk factors in young women.
Remarkably, a dearth of studies evaluates SED across pregnancy. In cross-sectional studies, pregnant women spend 50-60% of their day in SED and SED is highest in the 3rd trimester. Yet, no study has evaluated if SED increases across pregnancy (repeated measurements) using best practice SED assessment methodology (objective device capable of capturing posture and intensity). Moreover, no study has evaluated whether greater SED is associated with increased GWG and BP in pregnant women, which in turn are known to impact pregnancy health and later maternal CVD risk. Current guidelines only advise MVPA for pregnant women with no recommendations about SED, highlighting the research gaps about SED and its consequences during pregnancy. Moreover, clarifying the role of SED in pregnancy is important because lowering SED might be a feasible strategy for pregnant women, who have low participation in9 and unique barriers to MVPA. Lastly, little is known about correlates and determinants of SED in pregnancy. Such data are critical for identifying women at risk for high SED during pregnancy and for developing effective interventions.
1.4 Significance: Sedentary behavior is a novel risk factor for weight gain, high BP, and CVD, yet patterns, correlates, determinants and consequences of sedentary behavior are poorly understood in pregnant women. Sedentary behavior is the most common behavior in pregnant women, but the dearth of research studies applying state-of-the-art sedentary behavior assessment methods and with repeated measures across pregnancy is a major research gap that we intend to address with this proposal. To the investigators' knowledge, no studies with optimal sedentary behavior measurement, assessing both posture and intensity while awake (i.e., activPAL), have been conducted in pregnant women. Beyond this, few studies have evaluated temporal trends in sedentary time across gestation. There is no research examining bouts of extended, uninterrupted sedentary time which have particularly deleterious effects on BP and are more strongly related to high BMI. Lastly, correlates and determinants of sedentary behavior are poorly understood overall and, in particular, among pregnant women. Before effective interventions can be designed to reduce sedentary behavior in pregnancy, nonmodifiable and modifiable factors associated with sedentary behavior must be better understood. Thus, the objective, longitudinal measurement of sedentary behavior in pregnancy proposed in this application will determine patterns, correlates, determinants, and consequences of sedentary behavior in pregnancy to move toward future goals of 1) clarifying risks and whether sedentary behavior recommendations are appropriate for pregnant women, 2) identifying groups at risk for high sedentary behavior, and 3) informing intervention targets. Further, this research addresses the AHA's mission to reduce the burden of CVD by investigating a novel strategy for primordial prevention of cardiovascular disease in young women.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Pregnant women Women in their first trimester of pregnancy, aged 18-45, who plan to receive their prenatal care from University of Pittsburgh Medical Center providers. |
Outcome Measures
Primary Outcome Measures
- Number of Participants Classified as Having High Sedentary Behavior (by Trajectory) [1st, 2nd, and 3rd trimester of pregnancy]
Trajectories identified from objective data across trimesters. High sedentary behavior was defined as the highest group (~10.9 hr/day) based on growth mixture models from the objective data.
- Number of Participants Classified as Having Low Moderate-to-vigorous Intensity Physical Activity (by Trajectory) [1st, 2nd, and 3rd trimester of pregnancy]
Low levels of physical activity across trimesters, identified by growth mixture modelling. The low trajectory corresponded to about 114 minutes per week or about 16 minutes per day.
Secondary Outcome Measures
- Number of Participants With Excessive Gestational Weight Gain [at delivery]
from study visits and medical records excessive gestational weight gain was defined using 2009 Institute of Medicine Guidelines (reference: Institute of Medicine and National Research Council. Weight gain during pregnancy: reexamining the guidelines. Washington, DC: The National Academies Press; 2009)
- Adverse Pregnancy Outcomes [during pregnancy]
from study visits and medical records includes hypertensive disorders of pregnancy, preterm birth, intrauterine growth restrictions, gestational diabetes
Eligibility Criteria
Criteria
Inclusion Criteria:
-
8-12 weeks pregnant
-
18-45 years old
-
plan to receive prenatal care and deliver with University of Pittsburgh Medical Center providers
Exclusion Criteria:
-
use of medication to treat diabetes or hypertension
-
medical condition that severely limits physical activity (e.g., cannot walk 2 blocks)
-
other serious medical condition that could affect outcomes (such as systemic lupus, chronic renal disease, or hepatitis)
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Physical Activity and Weight Management Research Center | Pittsburgh | Pennsylvania | United States | 15261 |
Sponsors and Collaborators
- University of Pittsburgh
- American Heart Association
Investigators
- Principal Investigator: Bethany Barone Gibbs, PhD, University of Pittsburgh
Study Documents (Full-Text)
More Information
Publications
- PRO16120430
Study Results
Participant Flow
| Recruitment Details | |
|---|---|
| Pre-assignment Detail |
| Arm/Group Title | Pregnant Women |
|---|---|
| Arm/Group Description | Women in their first trimester of pregnancy, aged 18-45, who plan to receive their prenatal care from University of Pittsburgh Medical Center providers. |
| Period Title: Overall Study | |
| STARTED | 120 |
| COMPLETED | 105 |
| NOT COMPLETED | 15 |
Baseline Characteristics
| Arm/Group Title | Pregnant Women |
|---|---|
| Arm/Group Description | Women in their first trimester of pregnancy, aged 18-45, who plan to receive their prenatal care from University of Pittsburgh Medical Center providers. |
| Overall Participants | 105 |
| Age (Count of Participants) | |
| <=18 years |
0
0%
|
| Between 18 and 65 years |
105
100%
|
| >=65 years |
0
0%
|
| Age (years) [Mean (Standard Deviation) ] | |
| Mean (Standard Deviation) [years] |
31
(5)
|
| Sex: Female, Male (Count of Participants) | |
| Female |
105
100%
|
| Male |
0
0%
|
| Race (NIH/OMB) (Count of Participants) | |
| American Indian or Alaska Native |
0
0%
|
| Asian |
3
2.9%
|
| Native Hawaiian or Other Pacific Islander |
0
0%
|
| Black or African American |
18
17.1%
|
| White |
80
76.2%
|
| More than one race |
3
2.9%
|
| Unknown or Not Reported |
1
1%
|
| Region of Enrollment (participants) [Number] | |
| United States |
105
100%
|
Outcome Measures
| Title | Number of Participants Classified as Having High Sedentary Behavior (by Trajectory) |
|---|---|
| Description | Trajectories identified from objective data across trimesters. High sedentary behavior was defined as the highest group (~10.9 hr/day) based on growth mixture models from the objective data. |
| Time Frame | 1st, 2nd, and 3rd trimester of pregnancy |
Outcome Measure Data
| Analysis Population Description |
|---|
| [Not Specified] |
| Arm/Group Title | Full Cohort |
|---|---|
| Arm/Group Description | All participants with at least one valid objective data measure |
| Measure Participants | 105 |
| Count of Participants [Participants] |
45
42.9%
|
| Title | Number of Participants Classified as Having Low Moderate-to-vigorous Intensity Physical Activity (by Trajectory) |
|---|---|
| Description | Low levels of physical activity across trimesters, identified by growth mixture modelling. The low trajectory corresponded to about 114 minutes per week or about 16 minutes per day. |
| Time Frame | 1st, 2nd, and 3rd trimester of pregnancy |
Outcome Measure Data
| Analysis Population Description |
|---|
| [Not Specified] |
| Arm/Group Title | Full Cohort |
|---|---|
| Arm/Group Description | All women with at least one valid assessment of objective activity or sedentary behavior data. |
| Measure Participants | 105 |
| Count of Participants [Participants] |
29
27.6%
|
| Title | Number of Participants With Excessive Gestational Weight Gain |
|---|---|
| Description | from study visits and medical records excessive gestational weight gain was defined using 2009 Institute of Medicine Guidelines (reference: Institute of Medicine and National Research Council. Weight gain during pregnancy: reexamining the guidelines. Washington, DC: The National Academies Press; 2009) |
| Time Frame | at delivery |
Outcome Measure Data
| Analysis Population Description |
|---|
| Women with at least one valid trimester of objective data and available medical records. |
| Arm/Group Title | Full Cohort |
|---|---|
| Arm/Group Description | All participants with at least one valid objective data measure |
| Measure Participants | 100 |
| Count of Participants [Participants] |
49
46.7%
|
| Title | Adverse Pregnancy Outcomes |
|---|---|
| Description | from study visits and medical records includes hypertensive disorders of pregnancy, preterm birth, intrauterine growth restrictions, gestational diabetes |
| Time Frame | during pregnancy |
Outcome Measure Data
| Analysis Population Description |
|---|
| [Not Specified] |
| Arm/Group Title | Full Cohort |
|---|---|
| Arm/Group Description | All participants with at least one valid objective data measure |
| Measure Participants | 100 |
| Count of Participants [Participants] |
19
18.1%
|
Adverse Events
| Time Frame | During study participation (6 months) | |
|---|---|---|
| Adverse Event Reporting Description | This study is observational. Only adverse events related to the minimal risk study procedures were collected. | |
| Arm/Group Title | Full Cohort | |
| Arm/Group Description | All participants with at least one valid objective data measure | |
All Cause Mortality |
||
| Full Cohort | ||
| Affected / at Risk (%) | # Events | |
| Total | 0/120 (0%) | |
Serious Adverse Events |
||
| Full Cohort | ||
| Affected / at Risk (%) | # Events | |
| Total | 0/120 (0%) | |
Other (Not Including Serious) Adverse Events |
||
| Full Cohort | ||
| Affected / at Risk (%) | # Events | |
| Total | 0/120 (0%) | |
Limitations/Caveats
More Information
Certain Agreements
All Principal Investigators ARE employed by the organization sponsoring the study.
There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.
Results Point of Contact
| Name/Title | Bethany Barone Gibbs, Associate Professor, University of Pittsburgh |
|---|---|
| Organization | University of Pittsburgh |
| Phone | 412-383-4002 |
| bbarone@pitt.edu |
- PRO16120430