Josh New, Virginia Landrum, Lindsay Clifton, & Taylor Lile

1. A Pilot Program for:Activity, Nutrition, and Diabetes in Pregnant Oklahoma City WomenANDPOW Josh New, Virginia Landrum, Lindsay Clifton, & Taylor Lile

2. What’s Needed • OKC has ~21,000 American Indians (AI) • 28.4% in poverty (state-wide) • Needs assessment of adults in OK: • 6th most obese state (67.8%) • 8th worst in diabetes (11.5%) • 9th worst in hypertension (35.5%) • AIs highest prevalence in: • Hypertension (36.2%) • Diabetes (17.5%) Robert Wood Johnson Foundation, 2013; National Health Statistics Reports, 2010 ;

3. What’s Needed • Needs assessment (con’t.) • 18% of pregnancies affected by diabetes • 16.3% of AI women have gestational diabetes • Brief survey provided to participants • Day/time • Background/family • Education level National Health Statistics Reports, 2010 ; Thompson et al., 2008;

4. What’s Needed • Nutrition therapy is an effective treatment • Providing easy, affordable options for preventing complications and risk factors associated with gestational diabetes is needed for American Indian women. Buchanan, 2012

5. Target Population • Pregnant, American Indian women ages 18-49 years in the Oklahoma City area attending the Oklahoma City Indian Clinic

6. Program Plan • Classes will be at the OKC Indian Clinic • Thursday nights from 7-8 p.m. (tentative) • Initial 15 minutes to eat and confab • 30-35 minutes for the education session • 5-10 minutes for wrap-up & Q/A • Incentives: • Provide dinner each week through catered food platters • Provide childcare during the session

7. Recruitment • Participants recruited/informed • In-person at OKC Indian Clinic • 8-10 a.m. & 4:30-5:30 p.m. on alternating days for one week

8. Oklahoma City Indian Clinic • Reserved classroom • No cost – approval required • Proposal placed in advance • Allow time for planning • Submit in writing

9. The Chain of Command • Place a request with Clinic Supervisor • Must include: • Purpose • Goals/Objectives • Proposed dates/times • Covered topics • Tentative agenda • Method of recruitment • Funding

10. Program Goals • Measure specific components related to gestational diabetes mellitus with a brief survey assessing a 3-day diet recall (for caloric intake, fruit intake, & vegetable intake), fasting blood glucose, blood pressure, body mass index (BMI), and weekly physical activity habits in each woman attending the education program.

11. Program Goals • Measure specific components related to gestational diabetes mellitus with a brief self-administered questionnaire assessing participants’ knowledge of specific dietary and exercise recommendations. • The dietitian will have one assistant for each education session, whom is a student pursuing a nutrition degree.

12. Program Goals • Educate participants by conducting individual nutrition/exercise information sessions on the following topics (5 total classes) -

13. Objectives & Sessions

14. Gestational Nutrition What is gestational diabetes?

15. Gestational Nutrition • 1st trimester needs • 2 cups of fruit • 2½ cups Vegetables • 6 oz Grains • 5 ½ oz Meat & Beans • 3 cups Dairy • 2nd and 3rd trimester needs • 2 cups Fruit • 3 cups Vegetables • 8 oz Grains • 6 ½ oz Meat & Beans • 3 cups Dairy

16. Serving Size Comparisons • 3 oz cooked meat = deck of cards • 1 c cooked rice or pasta = tennis ball • 1 oz cheese = 4 dice or 1 domino • Medium piece of fruit = baseball • 1 tsp butter/margarine = 1 die • 1 small baked potato = computer mouse • 2 tbsp (PB, salad dressing…) = golf ball • 1 oz chocolate = packet of floss

22. Label Reading: The breakdown Calories reference serving sizes and not the entire package Serving sizes are not “typical” food portion sizes Daily Value (DV) is for a 2,000 calorie diet reference The food profile: How things break down Use the 5-20 rule!

23. Logic Model

24. Program Goals • Measure specific components related to gestational diabetes mellitus with a brief survey assessing a 3-day diet recall (for caloric intake, fruit intake, & vegetable intake), fasting blood glucose, blood pressure, body mass index (BMI), and weekly physical activity habits in each woman attending the education program. • Measure specific components related to gestational diabetes mellitus with a brief self-administered questionnaire assessing participants’ knowledge of specific dietary and exercise recommendations.

25. Tools • Screening instruments: • Height/weight and BMI • Glucometer • Electronic blood pressure cuff • Physical activity in the last 3 days: amount of physical activity in minutes, type of physical activity, and number of times engaged in physical activity • 3 day dietary recall: • Caloric intake/macro- and micronutrient breakdown in FoodWorks software • Number of fruits/vegetables eaten daily

26. Questionnaire • 1. What is gestational diabetes? • a) A form of diabetes mellitus that results from autoimmune destruction of insulin-producing beta cells of the pancreas • b) A metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency • c) Pregnant women who have never had diabetes before but who have high blood glucose (sugar) levels during pregnancy • 2. What are the five food groups? • a) Grains, fruits, vegetables, dairy, protein • b) Grains, fruits, vegetables, dairy, meat • c) Bread, fruits, vegetables, milk, meat • d) Bread, fruits, vegetables, dairy, protein • 3. What is the recommended serving of vegetables throughout pregnancy that should be consumed each day? • a) 2-3 servings • b) 3-4 servings • c) 4-5 servings • d) 5-6 servings • 4. A woman of average weight should gain how many pounds during her pregnancy? • a) 10-20 lbs • b) 15-25 lbs • c) 25-35 lbs • d) 35-45 lb • 5. Folic acid, a key nutrient to the growth of your baby, can be found in which foods? • a) Dark, leafy greens • b) Peas and beans • c) Citrus fruits and juices • d) Whole-grain breads and cereals • e) All of the above

27. Questionnaire • 6. What is a normal fasting blood glucose during pregnancy? • a) <130 mg/dL • b) 130-145 mg/dL • c) >145 mg/dL • 7. Which food is considered not safe to consume during pregnancy? • a) Hard-boiled eggs • b) Caesar salad made with raw eggs • c) Pasteurized egg products • 8.  How many extra calories should a woman consume during each trimester? • a) 1st trimester: 350 calories per day, 2nd trimester: 350 calories per day, 3rd trimester: 350 calories per day • b) 1st trimester: no additional calories, 2nd trimester: 350 calories per day, 3rd trimester: 500 calories per day • c) 1st trimester: no additional calories, 2nd trimester: 200 calories per day, 3rd trimester: 350 calories per day • d) 1st trimester: 200 calories per day, 2nd trimester: 350 calories per day, 3rd trimester: 500 calories per day • 9. Fish highest in mercury should be avoided during pregnancy. Which of the following fish below are highest in mercury? • a) Marlin, tuna, swordfish, mackerel • b) Catfish, crab, oysters, tilapia • c) Shrimp, snapper, sea trout, lobster • d) Tilapia, shrimp, lobster, crab • 10. What is a normal blood pressure? • a) 110/90 mmHg • b) 130/70 mmHg • c) <140/90 mmHg • d) <120/80 mmHg

28. Outcome Variables

29. Pre- & Post Measures

30. Managing • Lead Dietitian - Michelle Denison RD/LD, BC/ • ADM, CDE (Harold Hamm Diabetes Center) • Researcher - Gina Herbert, RN • Maternal Fetal Medicine (OU College of Medicine, OBGYN) • Exercise Physiologist - Josh New, CI-CPT

31. The Cost of Intervention

32. How do we Fund it? • NIH – NIDDK - Translational Research to Improve Diabetes and Obesity-related Outcomes; PA-13-352 - (R01) Research Project Grant • Eligibility for the grant: • Research for “practical, sustainable, and cost-efficient strategies or approaches…” • Research focused on the “prevention or reversal…” • Research that focuses on “prevention or delay of the complications of these conditions…” • “Approaches must have potential for wide dissemination/implementation in communities at-risk”

33. Proposed Timeline • Step 1: Evaluate needs assessment and determine goals/objectives • Step 2: Obtain funds and supporting partnerships with local agency • Step 3: Develop program materials • Step 4: Implement education program • Step 5: Begin evaluation of program • Step 6: Final evaluation of impact/effectiveness