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Author ORCID Identifier

https://orcid.org/0000-0002-6955-6993

AccessType

Open Access Dissertation

Document Type

dissertation

Degree Name

Doctor of Philosophy (PhD)

Degree Program

Public Health

Year Degree Awarded

2022

Month Degree Awarded

May

First Advisor

Lisa Chasan-Taber

Second Advisor

Brian Whitcomb

Third Advisor

Penelope Pekow

Fourth Advisor

Lynnette Sievert

Subject Categories

Epidemiology | Maternal and Child Health | Women's Health

Abstract

Cardiovascular disease and type 2 diabetes are global epidemics affecting approximately 127 and 21 million people in the U.S., respectively. Women who are overweight, obese or who develop glucose intolerance during pregnancy represent high-risk groups for the development of cardiovascular disease and type 2 diabetes. Hispanic women are both more likely to begin their pregnancies as overweight or obese and have a higher prevalence of type 2 diabetes, compared to non-Hispanic whites. However, prior lifestyle interventions have largely been limited to non-Hispanic whites. Therefore, this research assessed how culturally tailored lifestyle modification may affect cardiovascular disease and type 2 diabetes risk factors among at-risk Hispanic women using data from Estudió PARTO and Proyecto Mamá, two randomized controlled trials of pregnant Hispanic women in western Massachusetts. Chapter 1 examined the impact of a lifestyle intervention on postpartum cardiovascular disease risk and insulin resistance biomarkers among Hispanic women with abnormal glucose tolerance. The Lifestyle Intervention (LI) arm experienced clinically significant lower levels of insulin than the comparison Health and Wellness arm (HW), statistically lower levels of HDL cholesterol and TNF-a, and no differences in all other cardiovascular disease risk and insulin resistance biomarkers. Chapter 2 examined the impact of a lifestyle intervention on pregnancy and postpartum cardiovascular disease risk and insulin resistance biomarkers among overweight and obese Hispanic women. The lifestyle intervention did not lead to a significant difference in change over the pregnancy and postpartum follow-up time in most cardiovascular disease risk and insulin resistance biomarkers, with the exception of higher LDL cholesterol concentrations among the LI arm compared to the HW arm. Lastly, Chapter 3 examined the impact of a lifestyle intervention on postpartum weight retention among overweight and obese Hispanic women. The LI arm had a clinically significant 5.5-fold higher odds of meeting postpartum weight reduction goals, at 12 months postpartum and a 5 kg smaller increase in weight at 6 months postpartum, compared to the HW arm. In conclusion, a lifestyle intervention had beneficial impacts on numerous cardiovascular disease risk and insulin resistance biomarkers, including insulin, and postpartum weight retention in this high-risk Hispanic population.

DOI

https://doi.org/10.7275/28616566

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