Motivational Support and Meal Preparation Training to Reduce Vascular Risk After Gestational Diabetes
Condition: Gestational Diabetes Mellitus With Baby Delivered
MeSH terms: Diabetes, Gestational; Diabetes Mellitus
Study type: Interventional

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): Nutrition/Physical Activity Intervention
Intervention type(s): Behavioral
Intervention description(s): Please see Arm description.
Other intervention name(s): Lifestyle Intervention; Diabetes Prevention Intervention
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: behavioural; diabetes prevention; overweight; physical activity; gestational diabetes