The Impact of a Lifestyle Intervention on Postpartum Cardiometabolic Risk Factors Among Hispanic Women With Abnormal Glucose Tolerance During Pregnancy: Secondary Analysis of a Randomized Trial

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Kathryn A. Wagner Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, USA

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Christine W. St. Laurent Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA

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Penelope Pekow Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, USA

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Bess Marcus Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA

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Milagros C. Rosal Division of Preventive and Behavioral Medicine, Department of Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA

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Barry Braun Department of Health & Exercise Science, Colorado State University, Fort Collins, CO, USA

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Joann E. Manson Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

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Brian W. Whitcomb Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, USA

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Lynnette Leidy Sievert Department of Anthropology, University of Massachusetts Amherst, Amherst, MA, USA

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Lisa Chasan-Taber Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, USA

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Background: Women with abnormal glucose tolerance during pregnancy are at risk for cardiovascular disease (CVD), with higher rates among Hispanics. However, studies on the impact of lifestyle interventions on postpartum CVD profiles are sparse. Methods: This is a secondary analysis of a controlled trial among a subsample of Hispanic women with abnormal glucose tolerance participating in Estudió PARTO (Project Aiming to Reduce Type twO diabetes; mean age = 28.2 y, SD: 5.8) who were randomized to a culturally modified Lifestyle intervention (n = 45) or a comparison Health and Wellness intervention (n = 55). Primary endpoints were biomarkers of cardiovascular risk (lipids, C-reactive protein, fetuin-A, and albumin-to-creatinine ratio) and insulin resistance (fasting insulin, glucose, HbA1c, homeostasis model assessment, leptin, tumor necrosis factor-alpha, and adiponectin) measured at baseline (6-wk postpartum) and 6 and 12 months. Results: In intent-to-treat analyses, there were no significant differences in changes in biomarkers of CVD risk or insulin resistance over the postpartum year. In prespecified sensitivity analyses, women adherent with the Lifestyle Intervention had more favorable improvements in insulin (intervention effect = −4.87, SE: 1.93, P = .01) and HOMA-IR (intervention effect = −1.15, SE: 0.53, P = .03) compared with the Health and Wellness arm. In pooled analyses, regardless of intervention arm, women with higher postpartum sports/exercise had greater increase in HDL-cholesterol (intervention effect = 6.99, SE: 1.72, P = .0001). Conclusions: In this randomized controlled trial among Hispanic women with abnormal glucose tolerance, we did not observe a significant effect on postpartum biomarkers of CVD risk or insulin resistance. Women adherent to the intervention had more favorable changes in insulin and HOMA-IR.

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