Samantha Frances Ehrlich

Background: While there is evidence of the benefits of healthy maternal lifestyle behaviors (eg, physical activity plus a healthy diet) on cardiometabolic health, there are limited data on the independent association between physical activity and cardiometabolic health among women with a history of gestational diabetes mellitus (GDM). Objective: In this study, our aim was to explore the association between device-assessed physical activity and cardiometabolic outcomes in Chinese American women, a group disproportionately affected by GDM and type 2 diabetes. Methods: A cross-sectional study was conducted among 33 Chinese American women (0.5–5 years after delivery) with a history of GDM in New York City in 2023 to 2024, in which we collected their device-assessed physical activity data, online survey data (in Mandarin and English), and cardiometabolic data (via fasting blood samples). Descriptive, unadjusted, and adjusted regression analyses were performed. Results: Participants’ mean age was 38.2 ± 3.3 years (2.6 ± 1.5 years after delivery), and body mass index was 23.5 (interquartile range: 21.7–25.1) kg/m ² . Among the 33 participants, 27.3% had prediabetes, 51.5% had lipid dysregulation, and 21.2% had elevated blood pressure. The duration of moderate-to-vigorous physical activity per week was 132.4 (interquartile range: 90.5–272.0) minutes, and 46.9% of the cohort met the physical activity recommendation of ≥150 minutes moderate-to-vigorous physical activity per week. In regression models, meeting the physical activity recommendations was inversely associated with total cholesterol (−27.6 ± 12.7 mg/dL) and low-density lipoprotein cholesterol (−25.5 ± 10.6 mg/dL) levels (both P < .04). Conclusions: The majority of participants engaged in suboptimal physical activity levels. However, meeting physical activity recommendations was associated with better total and low-density lipoprotein cholesterol levels. Targeting physical activity may be a key strategy for improving cardiometabolic health in Chinese American women recently diagnosed with GDM.

Background: For most patients with pregnancy hyperglycemia, treatment includes lifestyle behavioral counseling for a healthy diet and physical activity (PA). Outside of pregnancy, emerging evidence suggests that the timing of PA (e.g., in the morning vs. evening) may modify its glucose-lowering effects. PA is an evidence-based, non-pharmacological strategy for managing glucose levels, and recommendations for PA timing could improve glucose levels in individuals with pregnancy hyperglycemia. Objective: To describe the rationale and protocol of the Time to Move Randomized Crossover Trial, which evaluates the effects of morning vs. evening PA on glucose levels across the 24-hour cycle. Methods: The eligibility criteria include singleton pregnancies in patients aged 18–40 years, identified as having gestational glucose intolerance [(GGI), a non-fasted, 50-g glucose challenge test, 1-hour value ≥130 mg/dl] or gestational diabetes mellitus [(GDM), by the one- or two-step procedure, at ≥24 weeks]. Participants who provide consent are randomized to first perform either morning PA (between 5 a.m. and 9 a.m., within 30 min–40 min of starting breakfast) or evening PA (between 4 p.m. and 8 p.m., within 30 min–40 min of starting dinner). All PA episodes consist of 30 min of moderate-intensity walking or stepping. Participants ultimately contribute 2 days in each of the three treatment conditions: morning PA, evening PA, and no PA, with one washout day between treatment conditions. Timestamped glucose measurements are obtained using Dexcom G6 or G7 continuous glucose monitors (CGM). The primary analysis will be intention-to-treat; per-protocol associations will also be explored. PA adherence is assessed using ActiGraph PA monitoring devices (i.e., the CentrePoint Insight Watch, worn on the non-dominant wrist), which provide continuous timestamped estimates of movement. Participants upload photos (i.e., in real time) of all foods and beverages consumed throughout the study period, and the timestamps of these photos are used to identify postprandial periods. One 24-hour dietary recall, aided by photo uploads, is also completed for each treatment condition. Conclusions: The Time to Move Randomized Crossover Trial addresses the gap in scientific knowledge regarding whether the timing of PA may be leveraged to maximize glucose control in individuals with pregnancy hyperglycemia. Clinical trial registration: ClinicalTrials.gov , identifier NCT06125704.

Introduction: Continuous glucose monitoring (CGM) offers a unique opportunity to assess Q6 glucose patterns across the 24-hour day, including nighttime. In individuals with pregnancy hyperglycemia, evidence suggests that optimizing nocturnal glucose levels reduces the risk of large-for-gestational-age births and future metabolic dysfunction. However, the behavioral correlates of nocturnal glucose levels remain poorly understood. Continuous movement devices assess physical activity (PA) and sedentary behavior (SED) across 24-hour days, and to the best of our knowledge, have not been paired with CGM data in individuals with pregnancy hyperglycemia. This secondary analysis of a feasibility trial explored the association of day-time PA and SED with nighttime (i.e., 12–6 AM) interstitial glucose levels in individuals with gestational diabetes mellitus (GDM) or gestational glucose intolerance (GGI).Methods: Participants (N = 13; ~31 weeks gestation) wore a Dexcom G6 CGM and ActiGraph Insight Watch for 7 days. Mixed effects models examined associations between daytime moderate-tovigorous physical activity (MVPA), light physical activity (LPA), and sedentary behavior (SED) with nocturnal glucose metrics, including mean glucose, time in range (TIR; 60–99 mg/dL), and area under the curve (AUC).Results: Adjusted models revealed that each 10-minute increase in MVPA was associated with 0.86 mg/dL [95% confidence interval (CI) 0.002, 1.73] higher mean glucose and 313 mg/ dL*min (CI 0.98, 624.55) higher AUC. No associations were observed for total activity, LPA, or SED.Discussion: These findings illustrate the feasibility and potential of combining CGM with activity monitor data, and the need to further integrate dietary intake data. Improvements in glucose and activity monitoring technology hold great promise for improving scientific and clinical understanding and supporting the development of personalized, data-driven glucose management tools during pregnancy.

Introduction: This randomized controlled pilot trial evaluated a behavioral physical activity (PA) intervention for individuals with pregnancy hyperglycemia and explored the feasibility of a fully powered efficacy trial. Materials and Methods: The pilot trial sought to enroll and randomize participants to a 5‐week‐long behavioral PA intervention that promoted walking or stepping (i.e., in place or around a small area) versus a general wellness intervention (that provided no information on PA, diet, or metabolism), both delivered remotely via weekly, 10–20‐min‐long counseling sessions with a lifestyle coach. Participants ( N = 20) completed surveys, including the Pregnancy Physical Activity Questionnaire, and wore ActiGraph CentrePoint watches for 7 days at baseline and at follow‐up. Nineteen participants (95%) completed follow‐up study visits. A subset (85%) had neonatal anthropometric measurements due to pandemic‐related restrictions. Results: One hundred and twenty individuals were screened, with 54% ( n = 65) meeting eligibility criteria and receiving physician approval to contact; 26% of the eligible enrolled, were randomized, and completed a baseline visit. Ninety percent of those randomized to the PA intervention ( n = 9) completed it, rating the PA intervention as excellent (56%) or very good (44%). The PA intervention mitigated late pregnancy declines in self‐reported walking and running activity (follow‐up minus baseline: 0.22 MET h/week [95% CI −0.41, 0.84] in the PA intervention vs. −0.70 [−1.31, −0.10] in controls), and there was the suggestion of improvements in neonatal birthweight for gestational age Z ‐score and subscapular skinfold. Conclusion: Findings suggest that the behavioral PA intervention promoting unsupervised, moderate‐intensity walking or stepping, which could easily be delivered in conjunction with clinical medical nutrition therapy, was acceptable. The intervention may mitigate late pregnancy declines in moderate‐intensity PA and remains to be investigated in a full‐scale randomized controlled efficacy trial. Trial Registration: ClinicalTrials.gov identifier: NCT06125704

Background: Despite evidence-based recommendations for HPV vaccination, uptake among young adults is suboptimal. Limited research has explored factors that may influence HPV vaccination among young adults, as well as associated promotion and informational preferences in this group. This study aimed to examine factors associated with HPV vaccination among young adults and preferences for HPV vaccine information and promotion. Methodology: This study utilized a cross-sectional design to examine factors related to HPV vaccination among young adults on a university campus in Tennessee. Data were collected via an online survey administered to students, aged 18–26 years, from March–May 2023. Study measures included sociodemographic characteristics, health/healthcare-related factors, and perception-related measures. Data analysis included descriptive statistics and multivariable logistic regression analysis. Results: Out of 402 participants that completed the survey, 209 reported being vaccinated against HPV. In the adjusted model, variables associated with HPV vaccination were perceived risk (adjusted OR [aOR] = 1.12; 95% confidence interval [CI]:1.05, 1.20), perceived barriers (aOR = 0.73; 95% CI: 0.66, 0.81), higher HPV knowledge (aOR = 1.17; 95% CI: 1.03, 1.33), and receipt of healthcare provider recommendations (aOR = 12.90; 95% CI: 7.08, 23.51). Conclusions: Study findings suggest that those who are vaccinated were more likely to report receiving healthcare provider recommendations, low perceived barriers, higher HPV knowledge and perceived risk. Future HPV vaccination promotion efforts for young adults may consider increasing HPV vaccine knowledge and awareness, addressing barriers, and strengthening provider recommendations.

Objective: Coronavirus disease 2019 (COVID‐19) infection during pregnancy increases the risk of severe illness and death. This study describes individual‐level determinants of COVID‐19 vaccination among pregnant people in East Tennessee.Methods: Advertisements for the online Moms and Vaccines survey were placed in prenatal clinics in Knoxville, Tennessee. Determinants were compared between unvaccinated individuals and those partially or fully vaccinated for COVID‐19.Results: Wave 1 of the Moms and Vaccines study included 99 pregnant people: 21 (21.2%) were unvaccinated and 78 (78.8%) were partially or fully vaccinated. Compared with the unvaccinated individuals, the partially or fully vaccinated patients more often obtained information about COVID‐19 from their prenatal care provider (8 [38.1%] vs. 55 [70.5%], P = 0.006) and indicated higher levels of trust in that information (4 [19.1] vs. 69 [88.5%], P < 0.0001). Misinformation was higher in the unvaccinated group overall, although there was no difference in concern for the severity of COVID‐19 infection during pregnancy by vaccination status (1 [5.0%] of the unvaccinated vs. 16 [20.8%] of the partially or fully vaccinated, P = 0.183).Conclusion: Strategies to counter misinformation are of the utmost importance, particularly pregnancy‐ and reproductive health–related misinformation, because of the increased risk of severe disease faced by unvaccinated pregnant individuals.

Purpose of Review Evolutionary hypotheses on the ratio of males to females at birth posit that women terminate pregnancies with low likelihood of surviving and producing grandchildren. Thus, females are preferred to males under unfavorable conditions. Much of this literature has focused on catastrophic disruptions that induce maternal stress and result in fewer males. Diabetes may similarly affect the sex ratio. Recent Findings A male bias at birth among infants born to women with GDM is widely recognized; mild hyperglycemia experienced early in pregnancy may signal favorable conditions and warrant investment in males. There are sparse data on women with pregestational diabetes, but some evidence for a female bias born to those with type 1 diabetes and severe hyperglycemia (i.e., requiring insulin). Disease-related maternal stress in these women may lead to the selective termination of male fetuses. Summary Further examination of pregestational diabetes stands to contribute to scientific understanding of the sex ratio.

Background: Activity monitoring devices may be used to facilitate goal-setting, self-monitoring, and feedback towards a step-based physical activity (PA) goal. This study examined the performance of the wrist-worn Fitbit Charge 3™ (FC3) and sought opinions on walking and stepping-in-place from women with gestational diabetes (GDM). Methods: Participants completed six 2-min metronome-assisted over ground bouts that varied by cadence (67, 84, or 100 steps per minute) and mode (walking or stepping-in-place; N = 15), with the sequence randomized. Steps were estimated by FC3 and measured, in duplicate, by direct observation (hand-tally device, criterion). Equivalence testing by the two one-sided tests (TOST) method assessed agreement within ± 15%. Mean absolute percent error (MAPE) of steps were compared to 10%, the accuracy standard of the Consumer Technology Association (CTA)™. A subset (n = 10) completed a timed, 200-m self-paced walk to assess natural walking pace and cadence. All participants completed semi-structured interviews, which were transcribed and analyzed using descriptive and interpretive coding. Results: Mean age was 27.0 years (SD 4.2), prepregnancy BMI 29.4 kg/m² (8.3), and gestational age 32.8 weeks (SD 2.6). The FC3 was equivalent to hand-tally for bouts of metronome-assisted walking and stepping-in-place at 84 and 100 steps per minute (i.e., P < .05), although walking at 100 steps per minute (P = .01) was no longer equivalent upon adjustment for multiple comparisons (i.e., at P < .007). The FC3 was equivalent to hand-tally during the 200-m walk (i.e., P < .001), in which mean pace was 68.2 m per minute (SD 10.7), or 2.5 miles per hour, and mean cadence 108.5 steps per minute (SD 6.5). For walking at 84 and 100 steps per minute, stepping-in-place at 100 steps per minute, and the 200-m walk, MAPE was within 10%, the accuracy standard of the CTA™. Interviews revealed motivation for PA, that stepping-in-place was an acceptable alternative to walking, and competing responsibilities made it difficult to find time for PA. Conclusions: The FC3 appears to be a valid step counter during the third trimester, particularly when walking or stepping-in-place at or close to women’s preferred cadence.