Current Funding Sources
CIHR - Institute of Aboriginal Peoples' Health (IAPH)
Capacity-building and participatory research development of a community-based Nutrition & Exercise Lifestyle Intervention Program (NELIP) for pregnant and post-partum Aboriginal women.
Summary:We have developed a successful intervention tool called the Nutrition and Exercise Lifestyle Intervention Program (NELIP) that prevents excessive weight gain and regulates blood sugar concentrations during pregnancy. Objectives and Research Plan: We will 1) continue to develop our Aboriginal Community Partnership NELIP across Ontario. To accomplish this, we will bring together focus groups of those Aboriginal pregnant and post-partum women who a) participated in the NELIP and succeeded in preventing GDM and excessive weight gain and b) declined to participate in the NELIP. Aboriginal women who have successfully completed the community program assist in the focus groups. All four aspects of health; spiritual, mental, physical and emotional would be examined. The information gathered by these groups will help us develop the necessary strategies to encourage success in continuing the community-based program. This will then be used to develop new partnerships; 2) identify barriers and discuss strategies to overcome barriers to the community-based NELIP. Working groups consisting of researchers, community health workers and pregnant women will determine how best to serve the community to develop healthy living; and 3) disseminate the information from the focus and working groups to all of our Aboriginal partners and communities. This will ensure that Aboriginal women learning about healthy living practices will pass on these skills to their family and community.
Impact on Health: Priority must be given to interventions such as NELIP that will PREVENT gestational diabetes, excessive weight gain and weight retention in pregnant and post-partum Aboriginal women, who have tremendous influence on healthy family living and community life. This in turn will lead to improvement in psycho-social factors such as depression, self-esteem and quality of life. Healthy moms=healthy infants=healthy communities!
A Nutrition & Exercise Lifestyle Intervention Program (NELIP) for women with gestational diabetes.
The primary treatment in the conventional management (CM) of gestational diabetes (GDM) is nutrition therapy, although evidence for an optimal dietary program is lacking. Insulin therapy is initiated after 2 weeks of CM, if women with GDM do not achieve specific glycemic targets. The prevalence of GDM is as high as 18% in certain populations with over 60% requiring insulin. Physical activity is encouraged as part of CM, however, no guidelines for frequency, type, duration and intensity of activity currently exist. Although accelerometer use is gaining acceptance as more researchers report physical activity values for specific population groups, to our knowledge accelerometers have not been used to quantify physical activity in pregnant women. Through the current proposal, we will provide specific guidelines for target activity using walking and activity assessment (accelerometer) for the best possible outcomes in women with GDM. Since there is a robust link between the fetal environment and its long-term influence on health and susceptibility to future chronic disease in the offspring, it is imperative that we also provide the best possible environment for fetal growth and development.
- Women with GDM who participate in CM plus our structured walking program, quantified by accelerometer, will prevent excessive pregnancy weight gain, reduce fasting and one hour post meal blood glucose concentrations, have less or delayed insulin requirements, and deliver a baby weighing < 9 lbs, compared to GDM women matched by pre-pregnancy BMI, age and insulin use, receiving similar CM with no formal activity guidelines.
- At a 2 months postpartum follow-up, women who participated in CM plus our walking program will have less weight retention, and improved fasting glucose concentrations compared to the women (as above) who received CM only.
Our structured walking plan is feasible, cost effective, and can be incorporated into the future conventional care of GDM patients. With our expertise, we will formalize the best activity guidelines to help delay or prevent insulin injections. Our program has the ability to prevent excessive pregnancy weight gain, which may decrease the risk of obesity and perhaps, diabetes later in life. Since diabetes and obesity are reaching epidemic proportions in today’s society, the best cost effective management of GDM, which includes research based nutrition and exercise guidelines, will be an important investment in our future and may help decrease the burden of diabetes in subsequent generations.
Preventing childhood obesity:early intervention during pregnancy and first year postpartum for overweight and obese women using a two-pronged family-based Nutrition & Exercise Lifestyle Intervention Program (NELIP).
Overweight and obesity have been identified as major neglected public health issues, as the prevalence of unhealthy body weights is increasing world-wide at an alarming rate. There is a robust link between the fetal environment and its long-term influence on health and susceptibility to future chronic disease in the offspring. Obesity begets obesity, and an unhealthy maternal metabolic state can have a profound influence on the risk of early obesity development in the child and future adult. Since much of the influence of the intrauterine milieu is transmitted to the next generation non-genetically, potentially deleterious effects may be reversed and prevented. To break this spiraling cycle of generations of unhealthy body weights in Canadian families, and to reduce the risk of obesity-related health problems in adulthood, it is imperative to prevent excessive pregnancy weight gain by promoting a healthy prenatal lifestyle, and to encourage healthy lifestyle choices during the postpartum period. Historical control data for the last 10 years from our region (N=32,000) provides overwhelming evidence that the incidence of obesity in pregnant women is on the rise. Interventions are needed now!!
Reversing the obesity epidemic will involve a lifetime of effort by the medical and research communities, however, over the next 5 years, we believe we may contribute to the solution by using a two-pronged approach by first targeting pregnant overweight and obese women with a healthy lifestyle approach called the Nutrition & Exercise Lifestyle Intervention Program (NELIP) combined with a Family-based Behavioral Treatment (FBBT) that will prevent excessive weight gain, and promote a healthy fetal environment. The second prong (NELIP+FBBT) will occur at 2 months postpartum to minimize postpartum weight retention, encourage breastfeeding, and promote a healthy family lifestyle, continuing into the first 4 years postpartum.
Our specific objectives are:
1) To prevent excessive pregnancy weight gain and weight retention postpartum, and to promote a healthy lifestyle in overweight and obese women during the first 4 years after delivery, gradually reducing body weight as needed (0.5 kg per week), and to achieve and maintain a healthy body weight in all family members;
2) To regulate blood lipid profiles and blood glucose concentrations in postpartum women in order to reduce the risk of cardiovascular disease and type 2 diabetes up to 4 years after program initiation;
3) To examine waist:hip ratios, body mass index (BMI) and body fatness in postpartum women up to 4 years after program initiation;
4) To track infant growth within the first year of life (2, 6 and 12 months), and once every year up to 4 years of age, including body weight, height, BMI, body fatness and waist:hip ratios, using the World Health Organization growth charts as a standard.
Currently, the R. Samuel McLaughlin Foundation-Exercise and Pregnancy Lab at the University of Western Ontario is the only research laboratory in North America actively investigating metabolic changes in exercising pregnant and postpartum women.
Our longitudinal aim is to reduce obesity, chronic disease and cardiovascular risks in overweight and obese women and their families using our two-pronged intervention program, which includes healthy food choices and increased physical activity (NELIP and the FBBT) initiated during pregnancy and again in the early postpartum period. With our NELIP team as a cornerstone, we foresee a major impact over the next 5 years on intervention strategies, with emphasis on disease prevention and healthy family lifestyle initiation early in life to reverse the trend of adult and childhood obesity. We will strengthen our successful piloted program via a motivational DVD to improve the health of women and their offspring through our NELIP by behavior modification and education (the FBBT) about good food choices and activity to reduce the trend of adult and childhood obesity. We will be one step closer to changing health policy and practice by developing prevention-based programs that are supported by robust evidence-based data to reduce health care costs.
Healthy women = healthy babies = healthy families = healthy futures!!
Past Funding Sources
Molly Towell Perinatal Research Foundation
Canadian Armed Forces
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