Project 461671

Gestational diabetes mellitus (GDM), defined as high blood sugar that is first recognized during pregnancy, affects up to 1 in 6 pregnant women worldwide and carries risks for both mother and child. It arises in women who have chronic abnormalities in the production and action of insulin. These abnormalities are actually present before the pregnancy and could be improved by lifestyle intervention to reduce weight. Indeed, it is widely believed that lifestyle intervention to lower weight and improve these abnormalities before pregnancy could reduce the likelihood of a woman developing GDM when she becomes pregnant. However, the direct evaluation of such pre-pregnancy intervention has not been achieved to date because of the practical difficulty of recruiting a sufficient number of women who plan to complete a pregnancy within the limited time frame of research funding. Importantly, we now have an opportunity to address this important question. Specifically, we have established a funded trial in South Africa in which 6800 non-pregnant young women who are planning to conceive within 18 months are being randomized to receive either (i) a preconception lifestyle intervention delivered by community health workers or (ii) standard care. While the objective of this funded trial is to reduce the risk of obesity in the child resulting from the pregnancy, embedding the current study within this trial can address the critical clinical question of whether lifestyle intervention before pregnancy can reduce the incidence of GDM. In doing so, we will leverage the existing funded study to determine whether lifestyle intervention before pregnancy delivered by community health workers can provide a means of preventing GDM. Thus, this proposal offers an opportunity for the coupling of cost-effective allocation of research funding with the potential for societal benefit for both mother and child.