Project 461931

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 pre-pregnancy lifestyle intervention to lower weight and improve these abnormalities could reduce the likelihood of a woman developing GDM when she becomes pregnant. However, to date, the direct evaluation of such intervention has not been achieved in Canada 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 Ontario and Alberta in which 5230 non-pregnant young women who are planning to conceive within 3 years are being randomized to receive either (i) a preconception health intervention delivered by public health nurses 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, we propose to embed the current study within this trial to 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 public health nurses 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.