Fit After Baby: Increasing Postpartum Weight Loss in Women at Increased Risk for Cardiometabolic Disease

Inclusion criteria

• Age 18-45
• Postpartum Body Mass Index (BMI): 26- 45 kg/m2 (≥24 for Asians)
• Positive history of one or more of the following complications in most recent singleton or twin pregnancy:

• Gestational diabetes mellitus (by Carpenter-Coustan criteria, IADPSG (International Association of the Diabetes and Pregnancy Study Groups) criteria, or a documented clinical diagnosis). Women with a glucose value >200 mg/dL after a 50-g glucose challenge test at >12 weeks gestation will also be included.
• Preeclampsia (high blood pressure and proteinuria diagnosed after 20 weeks gestation)
• Gestational hypertension (new hypertension diagnosed after 20 weeks without proteinuria)
• Pre-term delivery (32-37 weeks)
• Small for gestational age (<10th percentile for gestational age)
• Access to and be willing to use a wi-fi enabled iPhone (5 or higher) or iPod (5 or higher).
• Capable of providing informed consent
• Between 4 weeks and 16 weeks after delivery

Exclusion criteria

include:

• Personal history of Type 1 or 2 diabetes
• Personal history of breast cancer or any other type of cancer other than a basal cell skin cancer;
• Personal history of major chronic illness all to be assessed by the study physician for ability to participate, including:

• cardiovascular disease (coronary artery disease, congestive heart failure, valvular heart disease, stroke, transient ischemic attack, or intermittent claudication),
• kidney disease affecting kidney function severe enough to affect participation,
• liver disease affecting liver function severely enough to affect participation,
• venous or arterial thromboembolic disease,
• untreated adrenal insufficiency,
• depression requiring hospitalization within the past 6 months, or
• non-pregnancy related illness requiring overnight hospitalization in the past 6 months;
• Underlying disease/treatment that might interfere with participation in/completion of the study (e.g. significant gastrointestinal conditions, major psychiatric disorders affecting the ability to participate, and others at the discretion of the study clinician);
• Re-current pregnancy;
• Diagnosis of diseases associated with glucose metabolism;
• Current or planned participation in a commercial weight loss program (i.e. Jenny Craig) over the duration of the study;
• Previous or planned bariatric surgery;
• Taking certain prescription medications including

• high dose glucocorticoids,
• atypical antipsychotics associated with weight gain (such as risperdal (risperidone), clozapine (clozaril), olanzapine (zyprexa), quetiapine (seroquel), etc.) or
• weight loss medications including prescription (Qsymia, phentermine, topiramate, Belviq, Contrave, Saxenda, Orlistat), or non-prescription (Alli) medications;
• Taking metformin or other medications known to affect glucose metabolism;
• Other active medical problems detected by examination or laboratory testing, at the discretion of the physician;
• Any fasting blood glucose > 126 mg/dl, any HbA1c at or above 6.5%, or any plasma glucose >200 mg/dl during the first trimester.