A wanted pregnancy is among life’s most joyful events. But for about 7 percent of expectant mothers in the United States pregnancy brings the unexpected diagnosis of gestational diabetes.
While the exact cause of gestational diabetes, a temporary condition, remains unknown, what is known is that hormones from the placenta — which help the fetus develop — prevent the mother-to-be’s insulin from processing blood sugar as efficiently as it did before her pregnancy.
This is called insulin resistance and it’s a scary indicator of potential diabetes. In the years after the affected pregnancy, 15 to 50 percent percent of women with gestational diabetes will develop permanent type 2 diabetes.
But help is on the way from a Kaiser Permanente Northern California collaboration. Assiamira Ferrara, MD, PhD; her team at the Division of Research; and Yvonne Crites, MD, medical director of the Regional Perinatal Service Center have received a three-year $8.5 million National Institutes of Health grant to help women with gestational diabetes learn how to avoid type 2 diabetes.
“This study is the biggest, most serious thing Kaiser Permanente is doing to get in the way of the locomotive of increasing diabetes incidence,” said Joe Selby, MD, MPH, director of the Division since 1998. “It translates the evidence from three big international trials that have shown you can prevent type 2 diabetes with a behavioral intervention, including that you can do it among women who had gestational diabetes several years before.”
Healthier behaviors can cut risk of type 2 diabetes by half
The three studies were completed in China, Sweden and the United States. The U.S. study, like others before it, found that helping people at risk of diabetes — including women who have had gestational diabetes — change their behavior by being more physically active and watching their weight cut their risk of developing type 2 diabetes by more than 50 percent.
During the U.S. study, more than 1,000 people received a lifestyle intervention including 16 weekly sessions with a dietitian, physical trainer or psychologist. This effective but expensive treatment reduced the study group’s diabetes risk. But could what was learned in this intensive clinical study be applied at a reasonable cost in a conventional medical facility?
That’s the question Dr. Ferrara, a Division scientist since 1996, has been wrestling with for six years. To test a possible answer, her team ran a small pilot study in 2006 that showed a similar, but less intensive approach could still be effective.
Her team’s big innovation: proposing a diabetes prevention program similar to that cited above, but delivered by telephone. Delivering aid over the phone helps as many busy new mothers as possible to participate, as quickly as possible after they’ve received a gestational diabetes diagnosis.
In March, Division researchers will begin asking 2,500 Kaiser Permanente members who are pregnant women with gestational diabetes to join the newly funded study. Half of them, the control group, will receive the usual help: they will be given written information about how exercise and watching their weight helps reduce their risk of developing type 2 diabetes.
Innovation: “lifestyle coaches” on phone with new moms
But the intervention-group women will receive the new approach. In addition to the information, they will talk regularly by phone with “lifestyle coaches” trained in “motivational interviewing.” This is a way to help people explore and resolve barriers to healthy eating and physical activity, encouraging a healthy way of life that has been found to reduce the risk of type 2 diabetes.
“Our lifestyle coaches will help the mothers identify barriers, how to overcome them, and how to exercise more and eat less fat,” said Dr. Ferrara. It’s a personalized approach to helping the moms see for themselves what’s getting in their way and what they might do to reach their goals.
The outcome goal for these women is safe weight loss. Women with normal weight before pregnancy will be asked to return to their pre-pregnancy weight within one year. Women who were overweight or obese will be asked to lose an additional 5 percent of their pre-pregnancy weight.
As with others at risk of diabetes, pregnant or not, overweight is a major risk factor. Safely losing weight by eating less fat and adding physical activity has been shown to be protective.
Dr. Ferrara is also excited about the possibility that what intervention-group women learn about how to live more healthy lives will be passed on to their families.
“Usually if the behavior of the mother is changed, then the behavior of the kids can be positively influenced, and eventually the whole family does better,” said Dr. Ferrara. “Prevention is the key; otherwise we will never stop diabetes.”