Preterm Birth Clinical Trial
Official title:
Quantitative Activity Levels and Gestational Age at Delivery: A Prospective Cohort Study Among Nulliparous Women
Almost half of all deliveries in the United States are of nulliparous patients. They have been identified as an at-risk population for preterm birth. Historically, the most significant risk factor for preterm birth is a prior history of preterm birth, which cannot be applied to a nulliparous population. Forecasting adverse outcomes in first time moms is difficult to predict and prevent. Historically, physicians have prescribed a restriction in activity level for those at risk for preterm delivery. The utility of this intervention has yet to be prospectively and quantitatively studied. The Fitbit activity tracker is a wearable device that has been extensively used in medical research, in an attempt to quantitatively identify how patient activity levels can improve medical outcomes. The study uses the Fitbit device in nulliparous patients, remotely track their activity levels throughout pregnancy, and assess pregnancy outcomes. Because of the significant and long-standing health disparity in the incidence of preterm delivery, the investigators will use the "Everyday Discrimination Scale", a validated battery of racism and health to see how a patient's stress related to perceived discrimination may modify the risk of preterm delivery.
Preterm birth (PTB) remains one of the leading causes of neonatal morbidity and mortality,
with a variety of modifiable and non-modifiable risk factors. In an attempt to prevent PTB,
activity restriction is one of the most commonly prescribed interventions in obstetrics, with
the idea that decreasing activity will mitigate the risk of a preterm delivery (PTD).
However, there has been a lack of evidence in the literature to support this theory. In fact,
multiple studies have demonstrated that decreased activity levels have decreased time to
delivery in both women with a short cervix, as well as nulliparous patients at increased risk
for PTB.
Approximately 40% of deliveries in the United States are nulliparous. For this overwhelming
large portion of women, a knowledge gap exists in assessing their risk for PTB. The most
powerful risk factor for PTB, a previous PTB, is not applicable to this cohort of women. The
precise etiology of PTB in nulliparous women remains unknown but factors found to be
associated have included health behaviors , as well as being part of disadvantaged
populations. Studies have demonstrated a significant racial disparity in PTB, contributing to
the disproportionally worse fetal outcomes in minority populations. Institutional racism,
reported stress levels and discrimination have all been identified as risk factors for PTB.
Interventions to prevent PTB have thus far found to be ineffective, and therein likes an
opportunity to identify risk factors in this largely unstudied population and create
measures, focusing on behavior modification and acknowledging related risks of health
disparities to impact maternal and neonatal outcomes.
Currently there are no published prospective studies using quantitative measures to evaluate
physical activity in relation to gestational age at delivery. Based on a cohort design, our
objective is to use a Fitbit activity tracking device, and assess nulliparous patients. Our
hypothesis is that higher physical activity measured in steps per day will be associated with
a later gestational age at delivery.
Each participant will be given a Fitbit, complementary of participating in the study. Women
will be instructed to wear the Fitbit to measure physical activity throughout the duration of
the entire pregnancy, 24 hours a day. The Fitbit has been shown to be valid measure of steps
under laboratory conditions. Also, the Fitbit provides estimates of "sedentary", "light",
"fairly active" and "very active" minutes as daily accumulated totals. All data from the
Fitbit device will be acquired using the Fitabase software system. Fitabase is a research
software platform that collects data from devices remotely in near real time as devices sync
and update to the Fitabase dashboard. It creates spreadsheet exports of reported data, which
can be retrieved remotely by investigators. Fitabase stores the data collected in high
security data centers, and only permitted research personnel can access the data.
Upon enrollment in the study, researchers will administer the Fitbit device to each study
participant. Researchers will register participants with the Fitabase software system, giving
them a unique anonymous patient identifier, which will link each patient and their Fitbit to
the Fitabase software system. User accounts will be created by the enrolling researcher for
each participant account authorizing access to the Fitbit data for study personnel only. The
data collected from the Fitbit is continuously uploaded remotely from the wearable device to
the Fitabase software; new information is uploaded every 20 minutes. The device only holds a
total of 7 days of patient activity information, so the participant will be required to sync
their device to the software system every 7 days. This is done by an app, which is downloaded
on the participants' phone at the enrollment of the study. Of note, Fitbit data (ie: steps,
activity monitoring) will be blinded to the participants; the Fitbit device has no visible
monitoring screen. Research assistants will monitor compliance of participants to syncing
their Fitbit and will be sent an email reminder if they do not sync the Fitbit within the
last five days. Days with '0' minutes of registered activity will be considered non-valid and
set to missing.
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