Brooke E. Wickman

Gestational diabetes mellitus (GDM) affects up to 15% of pregnant individuals and heightens risk for chronic type 2 diabetes by 10-fold. Postpartum screening after GDM is the standard of care to initiate type 2 diabetes prevention or treatment; yet rates remain low. We describe the rationale and design of SUNRISE, a 24 factorial optimization trial testing components of a digital health intervention that targets understudied, patient-centered barriers to postpartum diabetes screening—a paradigm shift beyond implementing health system operational strategies alone. Participants with GDM (target N=2,000) across 13 medical facilities receive the intervention during pregnancy and postpartum. The intervention includes standard health information plus up to four interactive, theory-driven components that are brief, self-directed, and feasible for health systems: 1) values affirmation (addressing the distressing nature of disease-focused health information); 2) personalized risk information (addressing low perceived risk for type 2 diabetes); 3) a motivational interviewing-based component (addressing ambivalence about screening); and 4) action planning (addressing logistical barriers). The primary outcome is completing a recommended 2-hour, 75-gram oral glucose tolerance test (OGTT) within 4-12 weeks postpartum, assessed objectively via electronic health records. Secondary outcomes are completing any type of screening within a) 4-12 weeks, or b) 4-52 weeks postpartum; and c) enrollment in a lifestyle program for diabetes prevention by 1 year postpartum. The trial is powered to detect clinically meaningful effects that may impact public health if applied in large patient populations. Findings will inform selection of promising intervention components to promote postpartum diabetes screening in health system settings.

Background: Cardiovascular health is affected by health behaviors, but postpartum behavioral influences are not well understood. We examined whether intrinsic motivation (IM) is longitudinally associated with long-term postpartum health behaviors (healthy eating, physical activity, self-weighing) and cardiovascular health (Life's Essential 8 [LE8] scores). Methods: The prospective Pregnancy, Lifestyle and Environment Study-2 (PETALS-2) followed women enrolled in the PETALS study at Kaiser Permanente Northern California during pregnancy (N=311). Data were collected via validated self-report surveys and objective measurements during pregnancy and 6-24 months postpartum (2017-2021). Health behaviors were dichotomized by sample-specific 75th percentiles (P75) or pre-specified thresholds (attaining guideline-recommended moderate-to-vigorous physical activity [MVPA, {greater than or equal to}150 minutes/week]; self-weighing regularly [{greater than or equal to}once/week]). Separate analyses lagged IM by timepoint to assess longitudinal associations between behavior-specific IM and immediate subsequent health behaviors; and between an IM composite and immediate subsequent LE8 scores. Results: Each one-unit higher IM score was associated with greater likelihood of Healthy Eating Index-2015 scores {greater than or equal to}P75 at 24 months postpartum (RR=1.42; 95% CI=1.07, 1.88); attaining MVPA guidelines at 6 (1.48; 1.03, 2.12), 12 (1.85; 1.26, 2.71), and 24 months postpartum (1.66; 1.22, 2.27); and regular self-weighing at 6 (1.53; 1.03, 2.27) and 12 months postpartum (1.65; 1.15, 2.36). Each one-unit higher composite IM score was associated with higher LE8 scores at 6, 18, and 24 months postpartum (18-month mean estimate=2.34; 95% CI=0.67, 4.02). Conclusions: Greater IM was associated with healthier behaviors and cardiovascular health through 24 months postpartum. Future research should test whether interventions targeting IM improve health behaviors and long-term maternal cardiovascular health.

Heart failure (HF) is a major health care burden increasing in prevalence over time. Effective, evidence-based interventions for HF prevention and management are needed to improve patient longevity, symptom control, and quality of life. Dietary Approaches to Stop Hypertension (DASH) diet interventions can have a positive impact for HF patients. However, the absence of a consensus for comprehensive dietary guidelines and for pragmatic evidence limits the ability of health care providers to implement clinical recommendations. The refinement of medical nutrition therapy through precision nutrition approaches has the potential to reduce the burden of HF, improve clinical care, and meet the needs of diverse patients. The aim of this review is to summarize current evidence related to HF dietary recommendations including DASH diet nutritional interventions and to develop initial recommendations for DASH diet implementation in outpatient HF management. Articles involving human studies were obtained using the following search terms: Dietary Approaches to Stop Hypertension (DASH diet), diet pattern, diet, metabolism, and heart failure. Only full-text articles written in English were included in this review. As DASH nutritional interventions have been proposed, limitations of these studies are the small sample size and non-randomization of interventions, leading to less reliable evidence. Randomized controlled interventions are needed to offer definitive evidence related to the use of the DASH diet in HF management.