Journal Article

The Impact of a Lifestyle Intervention on Cardiometabolic Risk Factors among Postpartum Hispanic Women with Overweight and Obesity in a Randomized Controlled Trial (Proyecto Mamá)

Rosal, Milagros C, Braun, Barry, Manson, JoAnn E, Pekow, Penelope, Marcus, Bess, Whitcomb, Brian W, Chasan-Taber, Lisa, Wagner, Kathryn A, Sievert, Lynnette Leidy

2024

Overview

IntroductionMaternal 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.MethodsProyecto 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.ResultsIn 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).DiscussionWomen who participated in vigorous activity, regardless of their assigned intervention arm, had more favorable changes in biomarkers of insulin resistance.SignificanceWomen with overweight/obesity during pregnancy are at an increased risk of adverse cardiometabolic profiles and future development of type 2 diabetes and cardiovascular disease. Hispanic women are disproportionately affected by cardiometabolic disorders but have largely been excluded from lifestyle intervention studies. Although providing a lifestyle intervention to Hispanic women with overweight/obesity resulted in no significant differences in postpartum cardiometabolic biomarkers, women who articipated in vigorous activity, regardless of their assigned intervention arm, had favorable changes in insulin resistance biomarkers. These findings suggest that the intensity of physical activity may be important for improving postpartum cardiometabolic biomarkers among high-risk, Hispanic women.

• Publisher: Springer Nature B.V
• Subject: Biomarkers / Cardiovascular diseases / Clinical trials / Health risks / Hispanic people / Insulin resistance / Intervention / Lifestyles / Lipids / Maternal & child health / Metabolic disorders / Obesity / Overweight / Pregnancy / Risk factors / Womens health