Wanda Nicholson, MD, MPH, MBA - Division of Women's Primary Healthcare
Gestational diabetes, defined as glucose intolerance that first occurs or is first identified in pregnancy, is part of a vicious cycle that contributes to the epidemic of diabetes and obesity across generations. In utero alterations to fetal metabolism due to prolonged glycemic exposure have life-long consequences for the newborn; namely an 8-fold risk of diabetes, obesity and the metabolic syndrome. The expectant mother with gestational diabetes is at greater risk for longterm obesity and overt diabetes. In our pilot study, “Weight Loss Interventions after Delivery” (aka “First WinD”), we tested a postpartum-specific intervention that included face-to-face individual and group sessions. The intervention was successful in achieving weight loss over the study period, but two important issues were raised: 1) attending in-person visits proved challenging for participants, due to the competing demands of parenting and work, and 2) participants verbalized missed opportunities during pregnancy and delivery to learn about the implications of GDM for their own health and the well-being of their infants. Building on our experiences with First WinD, our objective is to develop and pilot-test a novel, theory-driven, multi-modal intervention called e-GDM. E-GDM will address the logistical issues associated with in-person visits by incorporating an alternative delivery model, but may also be an effective way of addressing knowledge gaps of mothers about the downstream consequences of GDM. We propose a transgenerational approach to breaking the cycle of diabetes and obesity in gestational diabetics and their offspring. We propose an intervention that starts during pregnancy and extends seamlessly through the first 6 postpartum months- a critical metabolic period for the mother-child dyad. Our specific aims are to : 1) with input from women with current or recent GDM, develop a theory-driven healthy lifestyle intervention, e-GDM, that is delivered via state of the art computer technologies, coupled with periodic in person group visits; 2) conduct a small pilot RCT of the intervention versus usual care on a) measures of maternal and infant outcomes, b) process outcomes, and 3) conduct a preliminary assessment of intervention effects to calculate effect sizes to design a larger scale trial. Maternal outcomes are A1C, postpartum weight loss (6 months -6 weeks postpartum). Infant outcomes are birth weight and 6 weeks and 6 months weight and length z-scores, and waist circumference. Process outcomes are adherence/participation with protocol, improved eating behaviors and physical activity, postpartum depression symptoms, self-efficacy, social support, acceptability and costs. If effective, our intervention could significantly change how GDM is currently treated in clinical practice.