Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, 401 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003, USA.
Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
Matern Child Health J. 2024 Oct;28(10):1768-1781. doi: 10.1007/s10995-024-03978-4. Epub 2024 Aug 7.
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.
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.
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).
Women who participated in vigorous activity, regardless of their assigned intervention arm, had more favorable changes in biomarkers of insulin resistance.
母亲超重或肥胖与产后 1 年内的代谢综合征有关，但目前尚不清楚经过文化调整、以动机为目标、个体化定制的生活方式干预是否能改善超重或肥胖的西班牙裔女性产后心血管代谢健康。
Proyecto Mamá 是一项随机对照试验，于 2014 年至 2020 年在马萨诸塞州西部进行，其中超重/肥胖的西班牙裔女性被随机分配到生活方式干预（LI）组，包括饮食和运动，或健康和健康干预（HW）组。在基线（早孕）、孕中期以及产后 6 周、6 个月和 12 个月时，测量心血管风险的生物标志物（即血脂、C 反应蛋白）和胰岛素抵抗（空腹胰岛素、血糖、HbA1c、稳态模型评估 [HOMA-IR]、瘦素、脂联素）。使用广义线性混合效应模型评估产后随访期间生物标志物变化的差异。
在符合条件的女性（LI；n=51，HW；n=58）的意向治疗分析中，在产后一年内，CVD 风险或胰岛素抵抗的生物标志物变化没有显著差异；例如，总胆固醇的干预效应为 6.98（SE：6.36，p=0.27），HbA1c 为-0.01（SE：0.4，p=0.85）。在 pooled 分析中，无论干预臂如何，与没有剧烈活动的女性相比，参加任何剧烈活动的女性 HbA1c 的增加幅度较小（干预效应=-0.17，SE：0.05，p=0.002），并且与其他心血管风险生物标志物也有类似的有益关联（p<0.05）。
无论参与干预组如何，只要参加剧烈活动，女性的胰岛素抵抗生物标志物变化就更为有利。
