Fitbit Activity Tracker to Predict Risk of Preterm Birth

November 26, 2019 updated by: Cynthia Gyamfi, Columbia University

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.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

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.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Observational

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
150

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • New York
      • New York, New York, United States, 10032
        • Columbia University Medical Center

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

Female

Sampling Method

Non-Probability Sample

Study Population

Patients who are having their first baby, and have a low risk pregnancy

Description

Inclusion Criteria:

  • Documented single viable intrauterine pregnancy at the time of enrollment
  • Nulliparous women
  • At least 18 years of age
  • Access to a smartphone or computer

Exclusion Criteria:

  • Known or suspected major congenital anomalies or aneuploidy
  • Fetal demise
  • Multiple gestation

  • Known maternal medical complications (increasing patient risk for indicated (planned) preterm delivery:

    • Pre-gestational diabetes White's Class D or worse
    • Cancer (undergoing treatment)
    • Current hyperthyroidism if not adequately controlled
    • Renal disease with altered renal function (serum creatinine > 1.5)
    • Systemic lupus, scleroderma, polymyalgia rheumatica
    • Active liver disease (acute hepatitis, chronic active hepatitis, persistently abnormal liver enzymes)
    • Platelet or red blood cell disorder
    • Chronic pulmonary disease (aside from asthma)
    • Structural, functional or ischemic heart disease. Neither mitral valve prolapse nor paroxysmal supraventricular tachycardia are considered exclusions.
    • Known HIV positive with viral load greater than 1,000 copies/ml or cluster of differentiation 4 (CD4) count less than 350/mm3
    • Current or planned cerclage
    • Planned delivery prior to 37 weeks
    • Planned delivery at a non-participating hospital
  • Patients who do not have regular access to a smart phone or computer

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: Cohort
  • Time Perspectives: Prospective

Cohorts and Interventions

Group / Cohort

Group / Cohort

A group or subgroup of participants in an observational study that is assessed for biomedical or health outcomes.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Preterm birth
Data collected using Fitbit activity tracker from women with delivery prior to 37 weeks gestation
Other: Fitbit activity tracker
Wearable device that records the number of steps a person takes throughout the day
Full-term birth
Data collected using Fitbit activity tracker from women with delivery after 37 weeks gestation
Other: Fitbit activity tracker
Wearable device that records the number of steps a person takes throughout the day

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Difference in number of steps
Time Frame: Duration of pregnancy (< 9months)
The difference in steps per day between women that deliver preterm versus those that deliver at term will be analyzed.
Duration of pregnancy (< 9months)

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Average number of steps for those women who deliver prior to 37 weeks gestation
Time Frame: Duration of pregnancy (< 9months)
Average number of steps for those women who deliver prior to 37 weeks gestation
Duration of pregnancy (< 9months)
Average number of steps for those women who delivery prior to 34 weeks gestation
Time Frame: Duration of pregnancy (< 9months)
Average number of steps for those women who delivery prior to 34 weeks gestation
Duration of pregnancy (< 9months)
Change in steps per week
Time Frame: Duration of pregnancy (< 9months)
Change in steps per week over each trimester
Duration of pregnancy (< 9months)
Number of triage visits
Time Frame: Duration of pregnancy (< 9months)
Number of triage visits for threatened preterm labor
Duration of pregnancy (< 9months)
Number of inpatient hospitalizations
Time Frame: Duration of pregnancy (< 9months)
Number of inpatient hospitalizations for threatened preterm labor
Duration of pregnancy (< 9months)
Incidence of adverse maternal outcomes
Time Frame: Duration of pregnancy (<9months)
Incidence of adverse maternal outcomes including pre-eclampsia, diabetes
Duration of pregnancy (<9months)
Incidence of adverse fetal outcomes
Time Frame: Duration of pregnancy (<9months)
Incidence of adverse fetal outcomes including Intrauterine growth restriction (IUGR), oligohydramnios, placental abruption
Duration of pregnancy (<9months)
Incidence of cesarean section
Time Frame: Duration of pregnancy (< 9months)
Incidence of cesarean section
Duration of pregnancy (< 9months)
Pregnancy physical activity questionnaire (PPAQ)
Time Frame: Duration of pregnancy (< 9months)
The PPAQ is a validated, self-administered questionnaire that takes on average 10-15 minutes to complete, and has been used to assess the current physical activity levels of pregnant women. This questionnaire is composed of 32 questions, grouped into different types of activities. an estimated average metabolic equivalent (MET-hr/wk) value will be calculated. Clinical practice guidelines have shown that achieving 8.5 MET-hr/wk is associated with healthy gestational weight gain (GWG).
Duration of pregnancy (< 9months)
Perceived Stress Scale (PSS)
Time Frame: Duration of pregnancy (< 9months)
The PSS is a classic stress assessment instrument. For each question, the answers are ranked as follows: 0 - never, 1 - almost never, 2 - sometimes, 3 - fairly often, 4 - very often. A calculated total score can range from 0 to 40 with higher scores indicating higher perceived stress. Scores ranging from 0-13 - low stress; 14-26 - moderate stress; 27-40 - high perceived stress.
Duration of pregnancy (< 9months)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Columbia University

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Cynthia Gyamfi, M.D., Columbia University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
October 24, 2017

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
July 1, 2019

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
July 1, 2019

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
September 29, 2017

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
October 3, 2017

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
October 9, 2017

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
November 29, 2019

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
November 26, 2019

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
November 1, 2019

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • AAAR3883

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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