Research Description
As rates of obesity increase in reproductive-age women, so do the associated adverse sequelae in pregnancy including gestational diabetes, hypertensive disorders of pregnancy, fetal macrosomia, and preterm birth. Most interventions addressing obesity and/or gestational diabetes in pregnancy occur in addition to prenatal care or late in the second trimester after gestational diabetes has been diagnosed. I propose a pragmatic, innovative intervention that is integrated in routine prenatal care and spans all three trimesters. Specifically, this project will determine whether Targeted Lifestyle Change Group Prenatal Care (TLC) improves birthweight and neonatal adiposity—markers for both antepartum maternal status and future childhood adverse outcomes. The study will take place at Washington University Medical Center, a tertiary referral center caring for predominantly African-American women with high rates of obesity, and will employ a randomized controlled design with a rigorous, systematic approach. The expected outcome of this study is high-quality data assessing the efficacy of group prenatal care in obese women at high risk for gestational diabetes. If the trial provides evidence that TLC group prenatal care is effective, data and experience from this study will support the development of an R01 application to test TLC in a multi-center randomized trial. In addition to providing evidence for a new, innovative way of providing prenatal care to women with obesity at high risk for developing gestational diabetes, this work ultimately has the potential to improve long-term maternal health, delay or prevent type 2 diabetes, and positively impact the health of their offspring.Research Profile
What area of diabetes research does your project cover? What role will this particular project play in preventing, treating and/or curing diabetes?Targeted Lifestyle Change (TLC) Group prenatal care focuses on pregnant women who are at high risk for developing gestational diabetes. Pregnancy serves as a window through which we can see a woman's future chronic disease risk. Women who develop diabetes in pregnancy are at significantly increased risk for developing type 2 diabetes after delivery. TLC Group Care embeds a fun, innovative, group-based curriculum into a woman's routine prenatal care. The intervention provides knowledge, tools, and the support of the obstetric provider and 5-9 other pregnant women, who are also at high risk for developing gestational diabetes, to actively apply diabetes prevention strategies throughout pregnancy and beyond. This Pathway project seeks to determine whether TLC reduces pregnancy complications associated with insulin resistance for mothers (gestational diabetes, lifestyle measures, pregnancy weight gain) and their babies (birthweight, fat distribution) compared to routine prenatal care.
If a person with diabetes were to ask you how your project will help them in the future, how would you respond?The diagnosis of gestational diabetes in pregnancy is scary and requires lifestyle changes that can be difficult and overwhelming to achieve. The silver lining in receiving this diagnosis is that, while the risk of developing type 2 diabetes is high, it is not a foregone conclusion and steps can be taken to delay or prevent this long-term diagnosis all together. TLC Group Care focuses on a cohort of women who are at high risk for developing gestational diabetes (and therefore, type 2 diabetes) and provides tools and support for diabetes prevention during pregnancy. The prenatal period tends to represent a time when women are highly motivated to engage in behavior change. Hopefully, with the help of TLC, these changes can be carried forward after delivering the infant with the potential to impact diet, nutrition, and exercise choices for mom, baby and the entire family.
Why important for you, personally, to become involved in diabetes research? What role will this award play?As a high-risk obstetrician, I know that women who have adverse pregnancy outcomes, such as gestational diabetes, hypertensive disorders in pregnancy, preterm birth and low birthweight, are more likely to develop cardiovascular disease later in life than women without these complications. I discuss these risks with my patients, but I love diabetes research because it also allows me to share a message of hope. Cardiovascular disease risk after one of these pregnancy complications can be modified. My research program up to this point has focused on improving pregnancy and postpartum outcomes in women with Type 2 and gestational diabetes. I'm excited to be joining the Pathway program because it will allow me to apply a promising intervention to women who have not yet developed diabetes with the potential to prevent/delay the onset of diabetes and associated complications.
In what direction do you see the future of diabetes research going?I believe the future of diabetes research is in prevention. We've made great strides in treating diabetes in recent years, but this is a largely preventable disease. I'm excited to move my research program from secondary prevention strategies to control diabetes during pregnancy to primary prevention strategies that address insulin resistance before the disease threshold is met.