Motivational Support and Meal Preparation Training to Reduce Vascular Risk After Gestational Diabetes
Combining Motivational Support, Meal Preparation Training, and a Tapering Course of Meal Replacements To Achieve Vascular Risk Reduction in Women With a Gestational Diabetes History (MoMM)
Women with a history of 'diabetes in pregnancy' or Gestational Diabetes (GDM) have a high
risk for type 2 diabetes later in life. This can often be prevented, however, with
improvements in eating habits and higher physical activity levels. However, many women find
it difficult to alter their lifestyle habits, especially if they have young children. In
adults with type 2 diabetes, the investigators have been studying the effects of combining
nutrition education with meal preparation training and pedometer-based self-monitoring to
improve eating habits and increase activity levels. The investigators have shown that such a
strategy can reduce hemoglobin A1C by 0.3% and correlates with small reductions in weight
(Dasgupta et al, International Journal of Behavioural Nutrition and Physical Activity,
2012). In developing the present interventional study, we presented this strategy to women
with a GDM history and asked them how they would modify it to suit their needs. They
expressed strong interest in such an approach but emphasized a need to involve their spouses
and provide childcare support. They did not express interest in use of meal replacements.
Therefore, in MoMM-intervention phase, the investigators will examine the effects of a once
per month (4 session) program combined with Internet/telephone-based support. The four
sessions with include meal preparation training, strategies to limit mindless eating and
improve meal content and portion control. All sessions will offer child care. Two sessions
will involve spouses. The investigators will assess effects on weight, BMI, DXA measures of
fat, and measures of insulin resistance and blood pressure. This single-arm intervention
study may lead ultimately to a randomized controlled trial.
The investigators have adopted a single-arm intervention pilot study to assess the potential
effects of a nutrition/physical activity behavioural intervention in women with a history of
GDM within the past 5 years. The investigators have designed the intervention to include
in-person sessions- but at a feasible frequency for busy mothers- as well as telephone calls
and an on-line discussion forum, to provide an ongoing source of support, information, and
accountability. Further, participants' partners will be invited to some of the in-person
sessions and childcare will be provided on-site. Importantly, there are no meal replacements
included, despite the study title, because focus group discussions indicated that this was
not of interest to the target population.
The investigators will hold in-person sessions at a frequency of once per month over a
4-month period. In addition to the in-person, on-site sessions, we will arrange for
participants to have in a grocery store 'tour' led by a student from the McGill School of
Dietetics and Human Nutrition BSc program. This will allow a review of label reading and
interpretation as well as tips on produce selection. Details of the intervention are
provided under the trial arm section below.
Gestational Diabetes Mellitus With Baby Delivered
behavioural, diabetes prevention, overweight, physical activity, gestational diabetes
McGill University Health Center
McGill University Health Center, Canadian Institutes of Health Research (CIHR)
Dasgupta K, Da Costa D, Pillay S, De Civita M, Gougeon R, Leong A, Bacon S, Stotland S, Chetty VT, Garfield N, Majdan A, Meltzer S. Strategies to optimize participation in diabetes prevention programs following gestational diabetes: a focus group study. PLoS One. 2013 Jul 4;8(7):e67878. doi: 10.1371/journal.pone.0067878.
Leong A, Rahme E, Dasgupta K. Spousal diabetes as a diabetes risk factor: a systematic review and meta-analysis. BMC Med. 2014 Jan 24;12:12. doi: 10.1186/1741-7015-12-12. Review.
Brazeau AS, Leong A, Meltzer SJ, Cruz R, DaCosta D, Hendrickson-Nelson M, Joseph L, Dasgupta K; MoMM study group.. Group-based activities with on-site childcare and online support improve glucose tolerance in women within 5 years of gestational diabetes pregnancy. Cardiovasc Diabetol. 2014 Jun 30;13:104. doi: 10.1186/1475-2840-13-104.