The American Congress of Obstetrics and Gynecology recommends that exercise should be encouraged in women with uncomplicated pregnancies. Potential benefits of exercise include a decreased incidence of medical complications of pregnancy, including gestational diabetes and preterm labor. Additional benefits include decreased incidence of excessive maternal weight gain, cesarean sections and low birthweight of the newborn. The Massachusetts' rate of gestational diabetes was 4.7% in 2015 with 7.8% babies being born at low birth weight and 8.6% born preterm statewide. The aim of this project was to evaluate the availability of structured exercise programs tailored specifically to pregnant women, as a lack of options may limit a woman's ability to benefit from the health-protective effects of exercise during pregnancy. A telephone survey was conducted in 2017 to gather information about exercise programs available to pregnant women at YMCAs across Massachusetts. YMCAs were chosen because of their accessibility, affordability and history of health-centered initiatives. Our analysis revealed that of the 73 Massachusetts YMCA facilities contacted; only three indicated a specific class for prenatal exercise. Two offered prenatal yoga and the other a stretching class. This study revealed that easily accessible options for exercise tailored to pregnant women are currently limited at YMCA facilities in Massachusetts. This may reflect an overall limitation of exercise options for pregnant women. Further investigation regarding the specific barriers women face when attempting to exercise during pregnancy may provide valuable insight into how community organizations can help maximize the number of women who partake in exercise during pregnancy.

Background: Previous evidence suggests that soy containing foods may have beneficial effects on lipid and glycemic metabolism. Pregnancy is associated with a progressive deterioration in glucose and lipid metabolism, partially attributable to elevated estrogen concentrations. Little is known about the effects of soy intake on cardiometabolic risk factors in pregnant women. Methods: A pilot RCT was conducted in 30 pregnant women who were randomized to receive counseling to consume a high-soy or low-soy foods containing diet. Assessments (physical measurements, food frequency questionnaires, fasting blood samples) were conducted at 14 and 28 weeks of pregnancy, and 6 weeks’ postpartum. Monthly follow-up calls were conducted to assess safety and encourage adherence. Results: Both the high-soy and low-soy groups demonstrated high adherence (80-90%), defined as consuming soy foods ≥ 15 days in the past four weeks for high-soy group and ≤ 5 days for low-soy group. Five adverse events possibly associated with soy intake were reported (nausea, vomiting, diarrhea, itchy mouth); all were transient and resolved without sequelae. The high-soy group lost body fat between baseline and postpartum while the low-soy group gained body fat, as reflected by change in triceps skinfold thickness (-4.8 mm vs +3.6 mm, p=0.04). There was a trend towards an improvement in BMI in the high-soy group, both at 28 weeks (+1.4 vs. +3.6 kg/m2, p=0.15) and postpartum (-1.2 vs. +0.6 kg/m2, p=0.14). There were no differences between groups in fasting glucose, HDL-C, LDL-C, TG, or VLDL levels. Conclusion: Initial results from this pilot RCT support the acceptability and safety of consuming soy-based whole foods during pregnancy. A larger-scale RCT is needed to further elucidate the effects of soy diet on cardiometabolic risk among pregnant women.

Background: Diet plays an important role in the prevention and management of gestational diabetes mellitus (GDM). Previous studies suggest that soy protein and isoflavones may have beneficial effects on lipid and glucose metabolism. Little is known regarding the cardiometabolic effects of soy intake during pregnancy. This pilot study assessed the feasibility, safety and acceptability of daily consumption of soy foods during pregnancy in women at high risk for GDM, and participant adherence to their assigned treatment. Methods: A randomized controlled trial (RCT) was conducted among pregnant women at high risk for GDM. The Soy group were counseled to consume a combination of foods designed to contain ~25 grams of soy protein and 60-75 mg of isoflavones daily from 14 weeks until birth. They were provided with recipes and contents of different soy foods. The Control group maintained their regular diet while minimizing intake of soy containing foods. Assessments, conducted at 14 and 28 weeks of pregnancy, and 6 week postpartum, included physical measurement, questionnaire, and fasting blood samples for lipid, glucose and isoflavone metabolism biomarkers. Monthly follow-up calls were conducted to assess safety and encourage adherence. Results: Twenty-nine subjects were recruited over a 10 month period. Both Soy and Control groups demonstrated high adherence (80-90%), defined as ≥ 15 days consuming soy foods in the past four weeks for soy group and ≤ 5 days for controls. Only five adverse events were reported possibly associated with soy intake, including nausea, vomiting, diarrhea, and itchy mouth. They were all transient and resolved without sequelae. Conclusion: Although adherence can be challenging in such a trial, this study used a variety of approaches such as recommended recipes, dietician consultation, and monthly follow-up calls to enhance feasibility and compliance. Results indicated feasibility and adherence to treatment assignment, including the soy-based diet intervention.