1. Final Presentation Preventing Type 2 diabetes onset among expectant mothers with gestational diabetes mellitus (GDM) Kris, Emily, Kathi, & Yukiha

2. What’s the issue ●Approximately 7 out of 100 pregnant women develop GDM (CDC, 2014) ●Many health complications for GDM mother and baby. o Increased risk of:  preterm delivery  increased likelihood of needing emergency caesarean section  excessive birth weight (babies >9lbs)  babies have a higher risk of developing obesity and type 2 diabetes later in life  maternal high blood pressure  GD in future pregnancies  mothers developing type 2 diabetes

3. Risk Factors Women at risk of gestational diabetes mellitus (GDM) ●Meet one or more of the following risk factors: o Older than 25 years of age o Family or personal health history of diabetes o High blood pressure o Previously delivered a baby weighing >9 lbs, or had an unexplained stillbirth o BMI >30 o From a higher risk ethnic group - Hispanic American, African American, Native American, Southeast Asian, or Pacific Islander

4. Pilot Population Pregnant women with GDM living in Rhode Island (11.7%, CDC, 2014)

5. Goals Prevent onset of type 2 diabetes (prenatal to postpartum) Activity goals ●Healthy, pregnant women in our population get at least 150 minutes per week of moderate-intensity aerobic activity (e.g. brisk walking) during and after pregnancy (target approximately 30 minutes a day) Food Intake Goals ●Track daily food intake Glucose tracking goals ●Track blood glucose levels according to the frequency recommended by their healthcare providers

6. Our Audience

7. Tech in use... *

8. Pilot Details Duration: 9 months ●24-28 weeks of gestation (screening for GDM) + 6 months post-partum Management ○Partnerships between tertiary institutions and healthcare providers ■already going to see doctor (aids compliance; prevent loss-to- follow-up) ○Nurses/PAs as part of the research team ■Nurse part of research team ● know data, collect data, and integrate into care: ○ decrease likelihood of ethical dilemma

9. Pilot Details Marketing and Recruitment ●Recruit via healthcare providers ○Between 24 and 28 weeks of pregnancy ○Diagnosed with GDM ○Living in Rhode Island ○Age: not teenagers; 18 to 35 years old ●Marketing via Facebook ads, prenatal care classes, doctors’ offices

10. Pilot Details Budget and opportunities for funding ●Pay for PI, nurse ●Cost of watches + apps ●Pay for primary investigator, nurse ●Cost of watches + apps ●Project assistant ●NIH - PA-14-180 mHealth Tools for Individuals with Chronic Conditions to Promote Effective Patient-Provider Communication, Adherence to Treatment and Self-Management (R01)

11. Risks & Limitations ●Limited sample size ●Maintaining compliance; loss-to-follow-up ●Closed entry into study ●Patient information obtained by anyone involved in the study must be reviewed by the clinic, as they are ethically responsible for the patient’s well being ●Potential risk of the effect of wearable device on fetus, as this is yet unstudied ●Participation in the study cannot guarantee prevention of the development of type II diabetes after delivery

12. Expected Outcomes ●May lower rates of type 2 diabetes onset ●May begin and maintain healthy physical activity pattern ●Begin and maintain healthy blood glucose ●Maintaining healthy diet

13. ●Survey the pilot about their perceived compliance, ability to follow, and success in managing glucose levels ●Results could enable future studies ●Results would enable investigators to pursue additional funding The Next Steps

14. Evidence-Based Guidelines From the National Institute of Child Health and Human Development: ●Know blood sugar level and keep it under control ●Eat a healthy diet, as recommended by healthcare provider ●Regular, moderate physical activity ●Maintain a healthy weight gain ●Keep daily records of diet, physical activity, and glucose levels ●Adhere to insulin and/or other medication prescriptions ●Test urine for ketones, as per healthcare provider recommendations ●Blood pressure checks, as recommended

15. Evidence-Based Guidelines From the American Congress of Obstetricians and Gynecologists: “Complete postpartum screening following a diagnosis of GDM”: ●at the 38 week prenatal appointment, ●at the birth hospital discharge visit ●at the post-op visit following an operative delivery

16. Theoretical Frameworks Health Belief Model ●Perceived benefits: More stable glucose levels; Increased exercise (data visualized); Peer group of fellow recruits ●Perceived barriers: Limited access to safe walking/exercise areas; Unfamiliarity with tech and monitoring glucose levels (host trainings and weekly check-ins by research team) ●Perceived severity/susceptibility: Information from doctor about current symptoms and potential prenatal/postpartum consequences for mother and fetus ●Self-efficacy: Real-time feedback and access to data trends; Each time you input data, you’ve performed desired action (self reinforcement to increase self-efficacy) ●Cues to action: Push notifications; Text based reminders from research teams

17. Theoretical Frameworks Social Support Theory ●Emotional: Peer group correspondence ●Instrumental: Feedback from apps; Reminders from research teams ●Informational: from HCP and research team ●Appraisal: Data visualization