Monitoring Movement and Health Study
| Status: | Active, not recruiting |
|---|---|
| Conditions: | High Blood Pressure (Hypertension), Obesity Weight Loss, Women's Studies |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Endocrinology, Reproductive |
| Healthy: | No |
| Age Range: | 18 - 45 |
| Updated: | 4/6/2019 |
| Start Date: | March 1, 2017 |
| End Date: | June 30, 2020 |
Sedentary Behavior in Pregnancy and Cardiovascular Health: the Monitoring Movement and Health (MoM Health) Study
The investigators will study sedentary behavior (SED) across pregnancy in young women. We
hypothesize that SED will increase across pregnancy and that higher SED will be related to
worse cardiovascular health, specifically elevated blood pressure (BP) and excessive
gestational weight gain (GWG). Pregnancy is a biologically relevant period during which CVD
risk factors may develop or worsen, contributing to future CVD. Pregnant women also spend
most of their day sedentary, which is defined as too much sitting as distinct from too little
exercise. SED has emerged as a risk factor, independent from moderate-to-vigorous physical
activity (e.g., exercise), for elevated BP, obesity, diabetes, CVD, and mortality in general
populations, but there are no recommendations for SED during pregnancy and few studies
evaluate SED across pregnancy. These few studies are limited by small sample size, lack of
repeated measures across trimesters, suboptimal SED assessment methodology, and a failure to
link with clinical outcomes (e.g., BP, GWG). The investigators will address these gaps in a
prospective study that will measure SED in 130 pregnant women across three trimesters using
state-of-the-art objective activity monitors capable of measuring min-by-min activity by both
intensity and posture. We will also measure BP and GWG during each trimester and, further,
will link to and abstract all prenatal clinic weights and BPs, glucose screening results,
gestational diabetes, preeclampsia, and adverse birth outcomes. Lastly, with the long-term
goal of identifying women at high risk of SED during pregnancy and designing effective
interventions, the investigators will efficiently evaluate correlates and determinants of SED
which have never been studied during pregnancy.
hypothesize that SED will increase across pregnancy and that higher SED will be related to
worse cardiovascular health, specifically elevated blood pressure (BP) and excessive
gestational weight gain (GWG). Pregnancy is a biologically relevant period during which CVD
risk factors may develop or worsen, contributing to future CVD. Pregnant women also spend
most of their day sedentary, which is defined as too much sitting as distinct from too little
exercise. SED has emerged as a risk factor, independent from moderate-to-vigorous physical
activity (e.g., exercise), for elevated BP, obesity, diabetes, CVD, and mortality in general
populations, but there are no recommendations for SED during pregnancy and few studies
evaluate SED across pregnancy. These few studies are limited by small sample size, lack of
repeated measures across trimesters, suboptimal SED assessment methodology, and a failure to
link with clinical outcomes (e.g., BP, GWG). The investigators will address these gaps in a
prospective study that will measure SED in 130 pregnant women across three trimesters using
state-of-the-art objective activity monitors capable of measuring min-by-min activity by both
intensity and posture. We will also measure BP and GWG during each trimester and, further,
will link to and abstract all prenatal clinic weights and BPs, glucose screening results,
gestational diabetes, preeclampsia, and adverse birth outcomes. Lastly, with the long-term
goal of identifying women at high risk of SED during pregnancy and designing effective
interventions, the investigators will efficiently evaluate correlates and determinants of SED
which have never been studied during pregnancy.
Objective: The investigators aim to conduct a prospective cohort study using
state-of-the-art, noninvasive measurement of sedentary behavior in n=130 pregnant women
during each trimester of their first pregnancy. We will link sedentary behavior to
gestational weight gain, blood pressure, and potential determinants such as demographics,
health conditions and behaviors, psychosocial factors, perceptions/beliefs, and the
environment.
Specific Aims:
Aim 1: Objectively measure sedentary behavior across pregnancy trimesters Aim 2: Relate
objectively-measured sedentary behavior to blood pressure and gestational weight gain across
pregnancy Aim 3: Characterize correlates and determinants of sedentary behavior during
pregnancy
1.3 Background: Cardiovacular disease (CVD) remains the leading cause of death in women with
minimal declines over the past 30 years among women <55 years old. Stagnant rates of CVD
mortality in younger women have occurred alongside notable declines in men and older adults
and are thought to be due, in part, to high rates of obesity and elevated blood pressure
(BP). Related to this, the American Heart Association (AHA) recently identified primordial
prevention, a population-level approach that targets preventing rather than treating CVD risk
factors, as a necessary strategy to reduce the CVD burden. To achieve primordial prevention,
the target must be populations at risk for developing CVD risk factors (vs. those with
existing risk factors), such as younger women.
Pregnancy is a biologically unique period for young women during which CVD risk factors such
as obesity and high blood pressure (BP) can develop or worsen, contributing to future CVD.
Pregnant women also spend most of their time in sedentary behavior (SED). SED is any behavior
that occurs in a seated/reclining position with low energy expenditure and is now recognized
as a behavior that is distinct from inactivity, or a lack of moderate-vigorous physical
activity (MVPA). Though MVPA has known benefits, SED is an emerging, independent risk factor
for obesity, CVD, and mortality. Importantly, prolonged bouts of SED (accumulated in bouts
lasting 30 min or more) in non-pregnant persons are more strongly related to obesity and
induce unfavorable hemodynamic responses, such as increased BP. We hypothesize that too much
SED across pregnancy is an important contributor to excess gestational weight gain (GWG) and
elevated BP, two important CVD risk factors in young women.
Remarkably, a dearth of studies evaluates SED across pregnancy. In cross-sectional studies,
pregnant women spend 50-60% of their day in SED and SED is highest in the 3rd trimester. Yet,
no study has evaluated if SED increases across pregnancy (repeated measurements) using best
practice SED assessment methodology (objective device capable of capturing posture and
intensity). Moreover, no study has evaluated whether greater SED is associated with increased
GWG and BP in pregnant women, which in turn are known to impact pregnancy health and later
maternal CVD risk. Current guidelines only advise MVPA for pregnant women with no
recommendations about SED, highlighting the research gaps about SED and its consequences
during pregnancy. Moreover, clarifying the role of SED in pregnancy is important because
lowering SED might be a feasible strategy for pregnant women, who have low participation in9
and unique barriers to MVPA. Lastly, little is known about correlates and determinants of SED
in pregnancy. Such data are critical for identifying women at risk for high SED during
pregnancy and for developing effective interventions.
1.4 Significance: Sedentary behavior is a novel risk factor for weight gain, high BP, and
CVD, yet patterns, correlates, determinants and consequences of sedentary behavior are poorly
understood in pregnant women. Sedentary behavior is the most common behavior in pregnant
women, but the dearth of research studies applying state-of-the-art sedentary behavior
assessment methods and with repeated measures across pregnancy is a major research gap that
we intend to address with this proposal. To the investigators' knowledge, no studies with
optimal sedentary behavior measurement, assessing both posture and intensity while awake
(i.e., activPAL), have been conducted in pregnant women. Beyond this, few studies have
evaluated temporal trends in sedentary time across gestation. There is no research examining
bouts of extended, uninterrupted sedentary time which have particularly deleterious effects
on BP and are more strongly related to high BMI. Lastly, correlates and determinants of
sedentary behavior are poorly understood overall and, in particular, among pregnant women.
Before effective interventions can be designed to reduce sedentary behavior in pregnancy,
nonmodifiable and modifiable factors associated with sedentary behavior must be better
understood. Thus, the objective, longitudinal measurement of sedentary behavior in pregnancy
proposed in this application will determine patterns, correlates, determinants, and
consequences of sedentary behavior in pregnancy to move toward future goals of 1) clarifying
risks and whether sedentary behavior recommendations are appropriate for pregnant women, 2)
identifying groups at risk for high sedentary behavior, and 3) informing intervention
targets. Further, this research addresses the AHA's mission to reduce the burden of CVD by
investigating a novel strategy for primordial prevention of cardiovascular disease in young
women.
state-of-the-art, noninvasive measurement of sedentary behavior in n=130 pregnant women
during each trimester of their first pregnancy. We will link sedentary behavior to
gestational weight gain, blood pressure, and potential determinants such as demographics,
health conditions and behaviors, psychosocial factors, perceptions/beliefs, and the
environment.
Specific Aims:
Aim 1: Objectively measure sedentary behavior across pregnancy trimesters Aim 2: Relate
objectively-measured sedentary behavior to blood pressure and gestational weight gain across
pregnancy Aim 3: Characterize correlates and determinants of sedentary behavior during
pregnancy
1.3 Background: Cardiovacular disease (CVD) remains the leading cause of death in women with
minimal declines over the past 30 years among women <55 years old. Stagnant rates of CVD
mortality in younger women have occurred alongside notable declines in men and older adults
and are thought to be due, in part, to high rates of obesity and elevated blood pressure
(BP). Related to this, the American Heart Association (AHA) recently identified primordial
prevention, a population-level approach that targets preventing rather than treating CVD risk
factors, as a necessary strategy to reduce the CVD burden. To achieve primordial prevention,
the target must be populations at risk for developing CVD risk factors (vs. those with
existing risk factors), such as younger women.
Pregnancy is a biologically unique period for young women during which CVD risk factors such
as obesity and high blood pressure (BP) can develop or worsen, contributing to future CVD.
Pregnant women also spend most of their time in sedentary behavior (SED). SED is any behavior
that occurs in a seated/reclining position with low energy expenditure and is now recognized
as a behavior that is distinct from inactivity, or a lack of moderate-vigorous physical
activity (MVPA). Though MVPA has known benefits, SED is an emerging, independent risk factor
for obesity, CVD, and mortality. Importantly, prolonged bouts of SED (accumulated in bouts
lasting 30 min or more) in non-pregnant persons are more strongly related to obesity and
induce unfavorable hemodynamic responses, such as increased BP. We hypothesize that too much
SED across pregnancy is an important contributor to excess gestational weight gain (GWG) and
elevated BP, two important CVD risk factors in young women.
Remarkably, a dearth of studies evaluates SED across pregnancy. In cross-sectional studies,
pregnant women spend 50-60% of their day in SED and SED is highest in the 3rd trimester. Yet,
no study has evaluated if SED increases across pregnancy (repeated measurements) using best
practice SED assessment methodology (objective device capable of capturing posture and
intensity). Moreover, no study has evaluated whether greater SED is associated with increased
GWG and BP in pregnant women, which in turn are known to impact pregnancy health and later
maternal CVD risk. Current guidelines only advise MVPA for pregnant women with no
recommendations about SED, highlighting the research gaps about SED and its consequences
during pregnancy. Moreover, clarifying the role of SED in pregnancy is important because
lowering SED might be a feasible strategy for pregnant women, who have low participation in9
and unique barriers to MVPA. Lastly, little is known about correlates and determinants of SED
in pregnancy. Such data are critical for identifying women at risk for high SED during
pregnancy and for developing effective interventions.
1.4 Significance: Sedentary behavior is a novel risk factor for weight gain, high BP, and
CVD, yet patterns, correlates, determinants and consequences of sedentary behavior are poorly
understood in pregnant women. Sedentary behavior is the most common behavior in pregnant
women, but the dearth of research studies applying state-of-the-art sedentary behavior
assessment methods and with repeated measures across pregnancy is a major research gap that
we intend to address with this proposal. To the investigators' knowledge, no studies with
optimal sedentary behavior measurement, assessing both posture and intensity while awake
(i.e., activPAL), have been conducted in pregnant women. Beyond this, few studies have
evaluated temporal trends in sedentary time across gestation. There is no research examining
bouts of extended, uninterrupted sedentary time which have particularly deleterious effects
on BP and are more strongly related to high BMI. Lastly, correlates and determinants of
sedentary behavior are poorly understood overall and, in particular, among pregnant women.
Before effective interventions can be designed to reduce sedentary behavior in pregnancy,
nonmodifiable and modifiable factors associated with sedentary behavior must be better
understood. Thus, the objective, longitudinal measurement of sedentary behavior in pregnancy
proposed in this application will determine patterns, correlates, determinants, and
consequences of sedentary behavior in pregnancy to move toward future goals of 1) clarifying
risks and whether sedentary behavior recommendations are appropriate for pregnant women, 2)
identifying groups at risk for high sedentary behavior, and 3) informing intervention
targets. Further, this research addresses the AHA's mission to reduce the burden of CVD by
investigating a novel strategy for primordial prevention of cardiovascular disease in young
women.
Inclusion Criteria:
- 8-12 weeks pregnant
- 18-45 years old
- plan to receive prenatal care and deliver with University of Pittsburgh Medical Center
providers
Exclusion Criteria:
- use of medication to treat diabetes or hypertension
- medical condition that severely limits physical activity (e.g., cannot walk 2 blocks)
- other serious medical condition that could affect outcomes (such as systemic lupus,
chronic renal disease, or hepatitis)
We found this trial at
1
site
Pittsburgh, Pennsylvania 15261
Phone: 412-383-4020
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