ABSTRACT
BACKGROUND: Excessive gestational weight gain (GWG) is associated with adverse health outcomes in both the mother and child. Many previous lifestyle interventions in women with excess weight during pregnancy encouraging appropriate GWG have been unsuccessful, and there remains no consensus about the content, format, or theoretical framework of GWG interventions. We assessed the feasibility and acceptability of a remote health coach intervention to promote healthful lifestyle behaviors and appropriate GWG among overweight pregnant women. METHODS: At one northeastern US clinic, we enrolled 30 overweight (pre-pregnancy BMI ≥ 25 kg/m2) pregnant women at a median gestation of 12.5 weeks (IQR: 11-15) into a one-arm trial. We connected participants with a health coach to provide behavioral support to help participants adopt healthful lifestyles during pregnancy. Health coaches contacted participants by phone every 2-3 weeks to monitor goals, and sent emails and text messages between calls. Participants completed baseline (N = 30) and follow-up (N = 26) surveys at the end of the intervention (36 weeks gestation), as well as follow-up phone interviews (N = 18). RESULTS: Among 30 participants, median age was 32 years (IQR: 28-33), median self-reported pre-pregnancy BMI was 27.3 kg/m2 (IQR: 25.7-31.1), and 17/30 were white, 9/30 African-American, and 3/30 Asian. Three-quarters (22/29) of participants completed at least a college degree. Although 25/30 participants reported in baseline surveys that they worried about being able to lose the weight postpartum that they expected to gain during pregnancy, just 12/26 participants reported the same at follow-up (P < 0.001). In follow-up surveys, 21/26 participants reported that health coaches were helpful in keeping them motivated, and 22/26 thought the phone conversations helped them face problems and find solutions. Based on qualitative assessment, several themes emerged in follow-up interviews about the quality of the intervention including accountability and support from health coaches. Participants also expressed desire for more visual resources and integration with standard clinical care to improve the intervention. CONCLUSIONS: We demonstrated feasibility and high participant satisfaction with our remote health coach intervention during pregnancy. We identified areas in which we could refine the intervention for inclusion in a full-scale RCT, such as integration with clinical care and additional visual resources. TRIAL REGISTRATION: Retrospectively registered at ClinicalTrials.gov ( NCT03080064 , 3/14/2017).
Subject(s)
Healthy Lifestyle , Mentoring/methods , Overweight/therapy , Pregnancy Complications/therapy , Prenatal Care/methods , Adult , Electronic Mail , Feasibility Studies , Female , Humans , Overweight/psychology , Pilot Projects , Pregnancy , Pregnancy Complications/psychology , Prenatal Care/psychology , Social Responsibility , Text Messaging , Weight GainABSTRACT
Hormone therapy (HT) was widely prescribed in the 1980s and 1990s and has been controversial since the initial results of the Women's Health Initiative (WHI) trial in the early 2000s suggested that it increased risk for breast cancer and coronary heart disease and did not prolong life. However, more recent data and reexamination of the WHI results suggest that HT is safe and effective for many women when used around the time of menopause. Two experts debate the 2017 Hormone Therapy Position Statement of The North American Menopause Society, which recommends HT as first-line treatment of vasomotor symptoms, and apply it to the care of Ms. R, a 52-year-old woman with severe hot flashes, sleep disturbance, and irritability.
Subject(s)
Antidepressive Agents, Second-Generation/therapeutic use , Estrogen Replacement Therapy/methods , Hot Flashes/drug therapy , Menopause , Sleep Wake Disorders/drug therapy , Venlafaxine Hydrochloride/therapeutic use , Female , Humans , Middle Aged , Quality of Life , Risk AssessmentABSTRACT
Idiopathic nephrotic syndrome is the most common form of nephrotic syndrome in the pediatric population. Three major histopathological findings have been identified. The most common is that of minimal change nephrotic syndrome. Most of these cases respond well to oral steroids and achieve long-term remission. For those that become steroid dependent, the clinical course can be quite difficult. The case study included demonstrates some of the difficulties that can be encountered and questions that still exist with management of this diagnosis.
