The Effect of an Educational Intervention in Women with Gestational Diabetes: A Pilot Study

Women with gestational diabetes (GD) are at higher risk of developing type 2 diabetes (DM) after delivery compared to those without GD. Numerous studies in the general population have identified that adoption of healthy lifestyles can prevent DM; however limited research has focused on women with GD. The purpose of this randomized pilot study was to determine the effectiveness of an educational intervention of SUGAR (Start Understanding Gestational Diabetes and Risk of Type 2 Diabetes), on women’s perceived risk of developing DM, knowledge of DM, self-efficacy to adopt healthy lifestyle behaviors and adoption of healthy lifestyle behaviors after childbirth among women with GD. A total of 23 women (mean age of 29.7, SD=3.9), 18 in SUGAR group and 5 in control group (CG) completed self-reported standardized questionnaires (Risk Perception Survey for Developing Diabetes adapted for women with GD; Self-Rated Abilities for Health Practices; Health Promotion Lifestyle Profile II; General Sleep Disturbance Scale; and Demographic Questionnaire) at baseline (third trimester) and post-test (postpartum 6-8 weeks). Intervention was given post the baseline data collection with a booster session at 2-4 weeks postpartum. The women in CG received attention control treatment. Study participants were obese (BMI M=33.1, SD=7.7) and a majority had a family history of DM. Findings showed that self-efficacy was the single significant predictor and accounted for 22% of the variance of healthy lifestyle behaviors. Participants had a clinical significant sleep disturbance during both pregnancy and postpartum. At baseline, poor sleepers reported a lower self-efficacy. The intervention significantly increased DM knowledge for women in the SUGAR group; however, not for perceived risk, self-efficacy nor healthy lifestyle behaviors. There was no difference between groups for postpartum glucose screening rates with only 39% receiving recommended testing. Future research needs to focus on prevention programs and center on self-efficacy, postpartum glucose screening, improve sleep, and adoption of healthy lifestyle behaviors. To ensure a better preventive care for GD women, education provided for both patients and health care provider is needed

Are prenatal exercise volume and level different between c-section and natural birth groups?

Title: Are prenatal exercise volume and level different between c-section and natural birth groups? Authors: Brianna Lee1, DJ Phillips1, Ami Eho2, Juliana Meireles, Ph.D.2, Sadaf Dabeer, Ph.D.3, Janeen Amason, Ph.D.1, Katherine Ingram, Ph.D.2 Institution: 1Wellstar School of Nursing, Kennesaw State University, Kennesaw, GA, USA 2Department of Exercise Science and Sports Management, Kennesaw State University, 3 Department of Endocrinology, Emory University, Atlanta, GA, USA Background: According to the World Health Organization (WHO), the ideal rate for c-section births is between 10% and 15% of births. However, the Centers for Disease Control and Prevention (CDC) reports there is a current rate of 31% for C-section births in the United States. The American College of Obstetricians and Gynecologists (ACOG) mentioned that based on observational studies, women who exercise during pregnancy have shown benefits such as decreased C-section births. Objective: The purpose of the study is to compare exercise volume and level between c-section and natural birth groups. Methods: Women who had given birth in the past two years were invited to participate in an online survey that asked for descriptive information (age and race) and mode of delivery. They provided information about the frequency of overall exercise and the frequency of engaging in high, moderate, and light intensity exercise. Exercise volume score was calculated using [(high intensity exercise frequency*3) + (moderate intensity exercise frequency*2) + (light intensity exercise frequency*1)]. Exercise level was calculated as Exercise volume score * Frequency of overall exercise. Comparisons were made using Mann Whitney U test. Results: Data from 232 women (33±4.61 years, 75% white) was used for analysis. Responses show that 163 women (70.3%) gave birth naturally while 69 women (29.7%) had c-section delivery. Natural delivery group (8.19±6.18) had a significantly higher exercise volume score (p=0.048) when compared to the c-section group (6.39±5.50). No statistical difference was found in exercise level (p=0.102) between mode of delivery groups (17.63±17.92 vs 12.72±14.41). Conclusion: Exercise level was similar between mode of delivery groups. However, women who gave birth naturally reported a higher volume of exercise than those who had a c-section. Health care providers should emphasize exercise intensity and frequency guidelines when discussing exercise with pregnant women

The Relationship Between Self-Reported Exercise Levels During Pregnancy and Labor Pains

Abstract Background: Physical activity is important to maintain overall health and wellness even during pregnancy. There are numerous benefits to exercise during pregnancy that include reduced back pain and lower risk of preeclampsia and gestational diabetes. Recent studies have shown an association between aerobic exercise and reduction in the intensity of labor pains. Purpose: The purpose of this study is to determine the association among level of exercise level and the intensity of pain during active labor. Methods: Women up to 2 years postpartum were invited to complete an online survey about the frequency of exercise (none, occasionally, a few times a week, or most days of the week) and intensity (high, moderate, and light). To calculate exercise level, we used the formula exercise level = [(high x 3) + (moderate x 2) +(light x 1)]*Frequency. Participants also answered how intense their active labor pains were using a scale of 1-10, with 10 being the worst. The Kolmogorov-Smirnov test was used to evaluate data distribution and Spearman’s test to verify the correlations. Results: A cohort of 160 women aged between 22 to 47 years (mean age 32±.36 years, BMI 29 ±0.47) suggested no correlation between exercise intensity during pregnancy and pain intensity during active labor (p\u3e0.05). In addition, the mean exercise level was 20.17, the maximum being 69. The labor pain mean was 7.5, with the maximum being 10. For high exercise intensity, half of the population reported none. For moderate exercise intensity, the majority reported sometimes. For light exercise intensity, the majority claimed they exercised 2-3 days of the week. Conclusion:There was no correlation between exercise levels during pregnancy and labor pains. However, ACOG recommends that women include exercise in a healthy pregnancy to ease discomfort. Therefore, further research is needed to determine the role of exercise in labor pains with previous studies showing a linkage between exercise and pain during labor

Abstract P255: Central Fat Distribution and Metabolic Health in Normoglycemic Young Women

Purpose: The purpose of this pilot study is to test the hypothesis that fat distribution, rather than overall obesity, is strongly related to insulin sensitivity in young, normoglycemic women. Methods: Thirty-eight non-diabetic young women completed the study (ages 20.7 ±2.8 years; BMI 27.6 ±3.6; 44% Caucasian (17 of 38). Matsuda Insulin Sensitivity Index was calculated from plasma glucose and insulin at 0, 30, 60, and 90 minutes after ingestion of 75g glucose, using established formula, to estimate whole body insulin sensitivity. Whole body and regional adipose tissue was assessed via DXA, abdominal ultrasound of intra-abdominal and pre-peritoneal adipose depots, circumference measures, and skinfold measures. ANOVA was used to assess mean differences among tertiles of Matsuda Index. Partial correlations were controlled for age and race, then additionally controlled for DXA percent body fat to assess associations of fat distribution independent of overall obesity. Results: ANOVA revealed a higher waist circumference (83.8 ±7.8cm vs. 75.6 ±7.2), waist/hip ratio (0.777 ±0.48 vs. 0.716 ±0.05 ), waist/height ratio (0.524 ±0.028 vs. 0.468 ±0.043), ultrasound intra-abdominal thickness (3.57 ±1.3 vs. 2.48 ±1.1) in the least insulin-sensitive tertile, when compared to the most insulin-sensitive tertile, while age, BMI, and other measures of adiposity were comparable among the three groups. Partial correlations controlled for age and race revealed strong negative relationships between Matsuda Index and measures of upper-body and central adiposity, including waist circumference (r=-.416, p\u3c0.05), waist/hip ratio (r= -0.500, p \u3c0.01), waist/height ratio (r=-0.431, p\u3c0.05), IAAT (r= -0.412, p\u3c0.05), PPAT (r=-0.381, p\u3c0.05), but not BMI (r= -0.173, p=ns) or overall percent fat (r=-0.132, p=ns). When further controlled for percent body fat, correlations persisted between Matsuda and waist circumference (r=-.433, p\u3c0.05), waist/hip ratio (r=-0.488, p\u3c0.01), waist/height ratio (r= -.470, p \u3c0.01), intra-abdominal fat thickness (r=-0.394, p\u3c0.05) and pre-peritoneal fat thickness (r=-0.361, p=0.05). Conclusions: Central and upper-body fat distribution, independent of overall obesity, is strongly associated with metabolic health in young non-diabetic women. These data underscore the clinical utility of central adiposity as an marker of metabolic health

Characteristics of substance-addicted mothers that predict graduation from the family treatment court

Introduction: In the United States, substance addiction is a major contributing factor to incarceration of mothers and separation of children from their families. Five hundred Family Treatment Courts (FTC) operate across the country to combat the growing problem of women addicted to drugs. The FTC model provides mothers with substance addiction treatment, intensive judicial monitoring, repeated drug testing, counseling, incentives or sanctions, and case management with the goal of reaching long-term sobriety and reunification with their children. Design: This retrospective study examined the relationship between sociodemographic characteristics and substance use characteristics, in predicting participants\u27 graduations from the FTC program. Methods: Data were gathered from 317 participants from five Family Treatment Courts in the southeastern United States and analyzed using logistic regression. Results: Participants who completed the FTC program were more likely to be older, completed Cognitive Behavioral Training, completed high school, and Caucasian. Conclusion: Age and completion of Cognitive Behavioral Therapy were the greatest predictors of graduating from the Family Treatment Court. These results convey the need for development of interventions tailored to each participant\u27s age to maximize the success of the FTC participants. In addition, Cognitive Behavioral Therapy should be integrated into all FTC programs. Clinical Relevance: The findings from this study will offer research scholars a foundation for designing future studies, aid researchers in creating interventions to increase success in substance addiction treatment programs, and contribute to the framework for theory development. In addition, understanding characteristics that may influence graduation from the Family Treatment Court will provide valuable information on developing interventions to support participants\u27 success

Knowledge of immediate newborn care and management of complications among midwives in Ghana

Objective: Midwives are instrumental in improving maternal/newborn health outcomes. Since complications after childbirth are leading causes of maternal deaths, midwives’ knowledge of how to manage complications and care for the newborn is important. This study assessed midwives’ knowledge of immediate newborn care and management of postpartum complications. Design: A cross-sectional descriptive survey design was used. Setting: Four hospitals that provide inpatient maternity services in Tamale, Ghana. Participants: 245 midwives who worked in the four hospitals. Measurements: Data were collected in December 2018 using an electronic survey questionnaire by the Johns Hopkins Program for International Education in Gynecology and Obstetrics, and analyzed using descriptive, bivariate, and multivariate statistics. Findings: About 98% of midwives were female. The mean age of midwives was 31.87 years. The percentage of midwives who responded correctly to questions on newborn care and management of postpartum complications ranged from 29.80% to 89.39%, and 32.17% to 91.43% respectively. Midwives were most knowledgeable about breastfeeding and immediate hemorrhage intervention, and least knowledgeable about cord care, thermal protection, newborn resuscitation, contraindications for vacuum extraction, treating metritis, and performing a cervical repair. Years of experience and age are predictive factors of midwives’ knowledge. Conclusion/Implications: There remains the opportunity for continuing education on complication management. Additional training of midwives on newborn resuscitation is recommended

The association between Age, BMI, and Gestational Weight Gain with HOMA-IR during pregnancy

Introduction: The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) is used to determine insulin resistance in individuals. During pregnancy, several variables may be related to HOMA-IR, including age, gestational weight gain (GWG), and body mass index (BMI), which classifies an individual\u27s weight as healthy or unhealthy. The objective of this research is to test the relationships of age, GWG at 20-weeks, and BMI at 20-weeks with log HOMA-IR. Methods: Twenty-six women (27.8±4.2 years; 74.1% white) completed this study between 2015 and 2016. HOMA-IR was measured using fasting plasma insulin and blood glucose (fasting insulin[microU/L] x fasting glucose [nmol/L]/22.5). The Pearson Correlation test was used to determine correlations between the variables. Results: Mean GWG at 20-weeks was 5.3kg±5.1 (range -5.4 kg to 15.9 kg). BMI at 20-weeks ranged from 19.7 kg/m2 to 43.5 kg/m2, with an average of 29.6444 kg/m2, ±5.99733. There was a correlation between (r=0.614, p=0.001) HOMA-IR and BMI at 20-weeks. There was no correlation between HOMA-IR and age (r=0.044, p=0.83), nor between HOMA-IR and GWG at 20-weeks (r=0.173, p=0.39). Conclusion: Our study showed there was no correlation between age and HOMA-IR, nor between GWG at 20-weeks and HOMA-IR; however, a correlation between BMI at 20-weeks and HOMA-IR was found. These findings may allow practitioners to understand how HOMA-IR relates to female body fat and thus monitor this variable during pregnancy to avoid complications

Gestational Weight Gain and Birth Weight: A Comparison by Maternal Race and Socioeconomic Status.

Introduction: Socioeconomic status and race play a role in health of pregnancies. Racial disparities in maternal health have been reported and are linked to inequities in access to equitable prenatal health care. Excessive gestational weight gain (GWG) can lead to gestational diabetes mellitus and childhood obesity in offspring. The objective of this research was to compare GWG and birthweight between socioeconomic status and maternal race groups. Methods: Women (32.9±4.6 years, N=229) who had given birth in the past two years completed a Qualtrics survey in 2019. The survey included questions regarding socioeconomic status, race, age, GWG, and birthweight. Kruskal Wallis and Mann Whitney U tests were performed. Results: Of the participants, 75.11% were Non-Hispanic/White (NHW), and 24.89% were another race (other). Educationally, 5.20% had some college or below, 41.90% Bachelor’s or Associate\u27s, 52.84% graduate degree. Economically, 16.44% made$100K. Birthweight was significantly higher for NHW when compared to others (3.48 kg±0.53 vs 3.08 kg±0.61, p=0.001). There was no difference in birthweight between educations (3.16kg±0.76 vs 3.41kg±0.58 vs 3.38kg±0.55) or between incomes (3.18kg±0.74 vs 3.34kg±0.57 vs 3.45kg±0.51). Similarly, there was no significant difference in GWG between races(13.13kg±6.12 vs 13.22kg±9.88), between educations (7.67kg±17.34 vs 12.64kg±6.34 vs 14.10kg±5.75), or between incomes (10.91kg±12.11 vs 13.25kg±6.27 vs 13.64kg±5.81). Conclusion: Babies born to NHW women had higher birthweight than those of other races, even when no differences exist in GWG. Birthweight and GWG were similar across socioeconomic statuses. Racial and ethnic disparities exist in maternal health and must be considered by health care providers

The Association between Physical Activity levels and Insulin Resistance in College Women

Introduction: The World Health Organization recommends young adults engage in physical activity (PA) daily. Regular PA has been shown to promote a better quality of life and improve overall health. Insulin resistance is a strong indicator of metabolic health in women because of its link to the development of disorders like polycystic ovarian syndrome (PCOS) and diabetes. The objective of this research was to determine the relationships between insulin resistance, and amount of time spent in sedentary, light, moderate, and vigorous PA. Methods: Thirty-eight women (20.8±2.7 years, 28.57±4.11kg/m2, 42.1% white) were asked to wear an accelerometer (Actigraph GT3X) on the waist over the course of 5 days to record their free-living physical activity. Insulin resistance was assessed using fasting blood samples and was estimated using Homeostatic Model Assessment of Insulin Resistance HOMA-IR. HOMA-IR = fasting insulin[microU/L] x fasting glucose [nmol/L]/22.5). To determine associations between HOMA-IR and levels of PA, a Pearson Correlation test was performed. Results: No correlation was found between any level of PA and HOMA-IR (sedentary: r=0.240, p=0.147, light: r=0.275, p=0.095, moderate: r=0.158, p=0.344, vigorous: r=0.239, p=0.148). Conclusion: Our findings did not show an association among different levels of PA and insulin resistance. This is inconsistent with other existing studies. To further confirm the results of this study, more research on accelerometer usage may be needed. Key Words: HOMA-IR, accelerometry, physical activity, healt