The STAR-MAMA RCT: Bilingual Mobile Health Coaching for Postpartum Weight Loss

Overview

Journal Am J Prev Med

Specialty Public Health

Date 2023 Apr 7

PMID 37028566

Authors

Mara E Murray Horwitz

Camille V Edwards

Priyanka Athavale

Lois McCloskey

Howard J Cabral

Emelia J Benjamin

Margaret A Handley

Affiliations

Soon will be listed here.

Abstract

Introduction: Gestational diabetes and overweight during pregnancy are associated with future type 2 diabetes. Postpartum weight loss can reduce diabetes risk. However, effective interventions for postpartum weight loss are lacking, in particular for Latina populations, despite their disproportionate burdens of gestational diabetes, overweight, and diabetes.

Study Design: This was a community-based RCT.

Setting/participants: Researchers recruited pregnant individuals with gestational diabetes or BMI>25 kg/m from safety-net health care settings and Women, Infants, and Children offices in Northern California in 2014-2018. Of 180 individuals randomized to intervention (n=89) or control (n=91), 78% identified as Latina, 61% were primarily Spanish speaking, and 76% perceived their diabetes risk to be low.

Intervention: The intervention consisted of a 5-month postpartum telephone-based health coaching intervention delivered in English or Spanish.

Main Outcome Measures: Data were collected through surveys at enrollment and 9-12 months after delivery and chart review up to 12 months after delivery. The primary outcome, weight change from prepregnancy to 9-12 months after delivery, was compared between the groups, overall and within strata defined a priori according to language (Spanish or English) and diabetes risk perception (none/slight or moderate/high).

Results: The intent-to-treat estimated intervention effect was +0.7 kg (95% CI= -2.4 kg, +3.8 kg; p=0.67). In stratified analyses, intervention effects remained nonsignificant but varied in direction: effects were favorable among English speakers and those with higher perceived diabetes risk, and unfavorable among Spanish speakers and those with lower perceived risk. Analyses were conducted in 2021-2022.

Conclusions: A postpartum health coaching intervention, designed for low-income Latina women at increased risk for diabetes, did not reduce postpartum weight gain. Intervention effects were nonsignificantly more favorable among English speakers versus Spanish speakers, and among those who perceived their diabetes risk to be high versus low.

Trial Registration: This study is registered at www.

Clinicaltrials: gov NCT02240420.

References

Ferrara A, Hedderson M, Brown S, Albright C, Ehrlich S, Tsai A . The Comparative Effectiveness of Diabetes Prevention Strategies to Reduce Postpartum Weight Retention in Women With Gestational Diabetes Mellitus: The Gestational Diabetes' Effects on Moms (GEM) Cluster Randomized Controlled Trial. Diabetes Care. 2015; 39(1):65-74. PMC: 4686847. DOI: 10.2337/dc15-1254. View

Handley M, Landeros J, Wu C, Najmabadi A, Vargas D, Athavale P . What matters when exploring fidelity when using health IT to reduce disparities?. BMC Med Inform Decis Mak. 2021; 21(1):119. PMC: 8028253. DOI: 10.1186/s12911-021-01476-z. View

Fortmann A, Savin K, Clark T, Philis-Tsimikas A, Gallo L . Innovative Diabetes Interventions in the U.S. Hispanic Population. Diabetes Spectr. 2019; 32(4):295-301. PMC: 6858072. DOI: 10.2337/ds19-0006. View

Nicholson W, Beckham A, Hatley K, Diamond M, Johnson L, Green S . The Gestational Diabetes Management System (GooDMomS): development, feasibility and lessons learned from a patient-informed, web-based pregnancy and postpartum lifestyle intervention. BMC Pregnancy Childbirth. 2016; 16(1):277. PMC: 5031324. DOI: 10.1186/s12884-016-1064-z. View

Hedrick V, Comber D, Estabrooks P, Savla J, Davy B . The beverage intake questionnaire: determining initial validity and reliability. J Am Diet Assoc. 2010; 110(8):1227-32. PMC: 2911642. DOI: 10.1016/j.jada.2010.05.005. View

Burkart S, Marcus B, Pekow P, Rosal M, Manson J, Braun B . The impact of a randomized controlled trial of a lifestyle intervention on postpartum physical activity among at-risk hispanic women: Estudio PARTO. PLoS One. 2020; 15(7):e0236408. PMC: 7380594. DOI: 10.1371/journal.pone.0236408. View

Burner E, Lam C, DeRoss R, Kagawa-Singer M, Menchine M, Arora S . Using Mobile Health to Improve Social Support for Low-Income Latino Patients with Diabetes: A Mixed-Methods Analysis of the Feasibility Trial of TExT-MED + FANS. Diabetes Technol Ther. 2017; 20(1):39-48. PMC: 5770080. DOI: 10.1089/dia.2017.0198. View

Diamond L, Izquierdo K, Canfield D, Matsoukas K, Gany F . A Systematic Review of the Impact of Patient-Physician Non-English Language Concordance on Quality of Care and Outcomes. J Gen Intern Med. 2019; 34(8):1591-1606. PMC: 6667611. DOI: 10.1007/s11606-019-04847-5. View

Abebe D, von Soest T, Holle A, Zerwas S, Torgersen L, Bulik C . Developmental trajectories of postpartum weight 3 years after birth: Norwegian Mother And Child Cohort study. Matern Child Health J. 2014; 19(4):917-25. PMC: 4482124. DOI: 10.1007/s10995-014-1593-x. View

10.

Shin D, Chung H, Weatherspoon L, Song W . Validity of prepregnancy weight status estimated from self-reported height and weight. Matern Child Health J. 2013; 18(7):1667-74. DOI: 10.1007/s10995-013-1407-6. View

11.

Fischer A, Conigliaro J, Allicock S, Kim E . Examination of social determinants of health among patients with limited English proficiency. BMC Res Notes. 2021; 14(1):299. PMC: 8340469. DOI: 10.1186/s13104-021-05720-7. View

12.

Hedrick V, Savla J, Comber D, Flack K, Estabrooks P, Nsiah-Kumi P . Development of a brief questionnaire to assess habitual beverage intake (BEVQ-15): sugar-sweetened beverages and total beverage energy intake. J Acad Nutr Diet. 2012; 112(6):840-9. PMC: 3379009. DOI: 10.1016/j.jand.2012.01.023. View

13.

Eggleston E, LeCates R, Zhang F, Wharam J, Ross-Degnan D, Oken E . Variation in Postpartum Glycemic Screening in Women With a History of Gestational Diabetes Mellitus. Obstet Gynecol. 2016; 128(1):159-167. PMC: 5049505. DOI: 10.1097/AOG.0000000000001467. View

14.

Vercammen K, Moran A, Soto M, Kennedy-Shaffer L, Bleich S . Decreasing Trends in Heavy Sugar-Sweetened Beverage Consumption in the United States, 2003 to 2016. J Acad Nutr Diet. 2020; 120(12):1974-1985.e5. DOI: 10.1016/j.jand.2020.07.012. View

15.

Bengtson A, Ramos S, Savitz D, Werner E . Risk Factors for Progression From Gestational Diabetes to Postpartum Type 2 Diabetes: A Review. Clin Obstet Gynecol. 2020; 64(1):234-243. PMC: 7855576. DOI: 10.1097/GRF.0000000000000585. View

16.

Martin J, Hure A, MacDonald-Wicks L, Smith R, Collins C . Predictors of post-partum weight retention in a prospective longitudinal study. Matern Child Nutr. 2012; 10(4):496-509. PMC: 6860352. DOI: 10.1111/j.1740-8709.2012.00437.x. View

17.

Malik V, Popkin B, Bray G, Despres J, Hu F . Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation. 2010; 121(11):1356-64. PMC: 2862465. DOI: 10.1161/CIRCULATIONAHA.109.876185. View

18.

Kjos S, Peters R, Xiang A, Henry O, Montoro M, Buchanan T . Predicting future diabetes in Latino women with gestational diabetes. Utility of early postpartum glucose tolerance testing. Diabetes. 1995; 44(5):586-91. DOI: 10.2337/diab.44.5.586. View

19.

Han E, Powell L . Consumption patterns of sugar-sweetened beverages in the United States. J Acad Nutr Diet. 2012; 113(1):43-53. PMC: 3662243. DOI: 10.1016/j.jand.2012.09.016. View

20.

Athavale P, Thomas M, Delgadillo-Duenas A, Leong K, Najmabadi A, Harleman E . Linking High Risk Postpartum Women with a Technology Enabled Health Coaching Program to Reduce Diabetes Risk and Improve Wellbeing: Program Description, Case Studies, and Recommendations for Community Health Coaching Programs. J Diabetes Res. 2016; 2016:4353956. PMC: 5088315. DOI: 10.1155/2016/4353956. View