Transcript Slide 1

Diabetes Prevention: Targeting Preconceptional Women
Danielle Symons Downs, Ph.D., Carol S. Weisman, Ph.D., Marianne Hillemeier, Ph.D., and John J. Botti, M.D.
Departments of Kinesiology, Health Evaluation Sciences, Health Policy and Administration, and Obstetrics and Gynecology
What is CePAWHS?
Conceptual Framework
Phase One Preliminary Findings
Central Pennsylvania Women’s Health Study: CePAWHS is a twophase research project funded by the PA Department of Health.
To study preterm birth and low birth weight outcomes, this project
is guided by a multidimensional framework adopted from Misra et
al. (2003; see Figure 2).
Preliminary results from the random digit dial survey conducted in
Fall 2004 by the Penn State Survey Research Center (N = 2002
women):
Figure 1: Geographic Location
Phase One is a population-based survey
in Central PA (see figure 1) with the following
two specific aims: (1) to establish the prevalence
of multiple risk factors for preterm birth and low
birth weight, and (2) to identify sub-populations
most at risk for negative pregnancy outcomes.
Figure 2: Conceptual Framework (Misra et al., 2003)
28 county region with both rural
and urban areas
Phase Two is a randomized multidimensional
behavioral intervention targeting high risk preconceptional women
with the aim of changing negative health behaviors (e.g., low
levels of physical activity, overweight, poor eating habits) and
reducing risk of adverse pregnancy outcomes.
Why Target Preconceptional Women?
Research focusing on women’s health before they are pregnant
and/or in between pregnancies is scant. In addition, most chronic
conditions cannot be treated optimally during pregnancy. Thus,
reducing negative health behaviors and chronic conditions before
women get pregnant may reduce the risk of poor pregnancy
outcomes. This “preconceptional period” may be an important time
to focus on strategies for preventing – or at least delaying – the
onset of conditions such as gestational diabetes mellitus (GDM)
and type 2 diabetes in women.
Women’s Preconceptional Health and Diabetes
In addition to the factors associated with insulin resistance (e.g.,
impaired glucose tolerance / fasting glucose, hypertension),
several biobehavioral and psychological risk factors have been
identified as the impetus for diabetes onset in women including
obesity (Fletcher et al., 2002), physical inactivity (ADA, 2004),
various dietary factors (Frank et al., 2001), and negative affect
(Woods, 2004). Identifying high risk women for diabetes before
they become pregnant may help to decrease the onset of GDM
and type 2 diabetes later in life. Furthermore, these high risk
women may be more receptive to behavioral lifestyle modifications
knowing that they plan to become pregnant in the near future.
Thus, an ideal time to intervene and change negative health
behaviors may be during this preconceptional period.
Measure
Distal Determinants
Proximal Determinants
Community size
Sociodemographics
Family context
Environments
Occupation exposures
Genetic factors
Psychosocial stress
Infections
Chronic conditions
(diabetes, obesity, hypertension)
Pregnancy history
(GDM, pre-eclampsia, infertility)
Outcomes
Preterm birth
Low birth weight
Modifiers
Healthcare access / use
Health information / literacy
We focus on women’s preconceptional health, including chronic
conditions, infections, and psychosocial stress as proximal risk
factors, and we include pregnancy-specific factors such as a
history of GDM and pre-eclampsia. The risk factors in each
preconceptional health category were identified in previous studies
of preterm birth and low birth weight, although some have been
subjected to less research than others.
Frequency
BMI between 25.0 to 29.9 (overweight)
27%
BMI of 30.0 or higher (obese)
25%
No days/week of 30 min of moderate-strenuous exercise behavior
35%
1-3 days/week of 30 min of moderate-strenuous exercise behavior
41%
4 or more days/week of 30 min of moderate-strenuous exercise behavior (meeting current guidelines)
24%
Reported having hypertension
12%
Reported having high cholesterol
10%
Reported having diabetes
3%
Phase Two Intervention Plan
Planning for the intervention began in Fall 2004. The content of
the intervention will depend on the prevalent risk factors identified
in Phase One. The targeted populations will also depend on the
Phase One survey results. See Figure 3 for the intervention
design.
Figure 3: Intervention Design
The focus on multiple determinants is consistent with a socialecological perspective of human behavior which suggests that
individual behaviors cannot be isolated from the social and
physical environment in which they occur (Bronfrenbrenner, 1977;
McLeroy et al., 1988; Stokols, 1992).
Interventions designed to decrease adverse pregnancy outcomes
by targeting proximal factors (e.g., stress-related behaviors) may
have short-term benefits, but long-term impact is unlikely unless
the interaction of these factors with women’s environment is
considered. Ecological models posit that multiple levels of
influence determine individual behavior, and therefore that
interventions targeting a variety of intervention points are more
successful in changing behavior than interventions focusing on
isolated factors (Blakely & Woodward, 2000). Working with an
ecological model requires that measurement and assessment
occur at more than one level (Spence & Lee, 2003).
Presented at the Penn State Diabetes Research Congress on May 6, 2005
Collaborating organizations: Family Health Council of Central Pennsylvania, Franklin
& Marshall College, and Lock Haven University of Pennsylvania
Additional Penn State collaborators: Colin MacNeill, M.D. (ObGyn), Heather Cecil,
Ph.D. (Psychology), Mark Feinberg, Ph.D. (Prevention Research Center), David
Johnson, Ph.D. (Survey Research Center), Gary A. Chase, Ph.D. (HES), Christopher S.
Hollenbeak (Surgery and HES)
Investigators at collaborating organizations: Patricia Fonzi, M.A. (FHCCP), D. Alfred
Owens, Ph.D. (F&M), Berwood Yost, M.A. (F&M), Sean Flaherty, Ph.D. (F&M), Kirk
Miller, Ph.D. (F&M), and Walter Eisenhauer, M.M.Sc., PA-C (LHUP)
Questions about this project: Please contact Sara A. Baker, M.S.W., Project Manager:
[email protected]