Supporting American Indian/Alaska Native Mothers and Daughters in Reducing Gestational Diabetes Risk
Condition: Gestational Diabetes Mellitus
MeSH terms: Diabetes, Gestational; Diabetes Mellitus
Study type: Interventional

Summary: 
      The purpose of this study is to modify an existing Reproductive Health intervention for
      adolescents with diabetes for Gestational Diabetes and make it culturally appropriate
      American Indian/Alaska Native adolescents. The intervention will then be evaluated for
      effectiveness in AI/AN female teens at risk for GDM.
    

Detailed description: 
      Gestational diabetes mellitus (GDM) has escalated to epidemic proportion and can cause
      maternal and child complications. GDM is a significant maternal risk factor for subsequent
      development of type 2 diabetes (T2D) and places the fetus at increased risk for congenital
      morbidity/mortality and for future onset of diabetes. American Indian and Alaska Native
      (AI/AN) women are twice as likely to develop GDM and T2D; mostly due to healthcare
      disparities (e.g., limited access to resources, lack of culturally relevant programs). The
      need for an inexpensive accessible GDM intervention in this population is compelling. The
      intervention should be delivered during adolescence and prior to sexual debut. Preconception
      counseling (PC) prevents unplanned pregnancies and significantly reduces risks of
      complications. If GDM in a previous pregnancy is an indicator of high risk in subsequent
      pregnancies, then preventing GDM in a first pregnancy is imperative. For a significant and
      innovative shift in paradigm, the Investigators propose a primary prevention PC intervention
      for AI/AN adolescent females at risk for GDM to enhance healthy lifestyle behaviors and
      family planning vigilance prior to this first pregnancy. The Investigators will target girls
      starting at the age of 12 to coincide with both the "Coming-of-Age" rituals for AI/AN girls
      during which many receive womanly advice from elder female family members, and the American
      Diabetes Association recommendation that PC in all females should start at puberty. This new
      directive will require support from the teens' mothers (or their female caregiver) and
      well-informed community health care professionals (HCP). Our objective is to adapt our
      current PC intervention (validated for teens with diabetes) using a sequential mixed-method
      design with a multi-tribal AI/AN community-based participatory research (CBPR) approach
      (e.g., Navajo, Cherokee, 40 Oklahoma tribes; 8 project members are AI/AN) by first using
      focus groups of teens, mothers, HCP, and Tribal leaders; and then testing this culturally
      appropriate PC theory-based intervention named Stopping GDM in AI/AN adolescent females 12 to
      <20yrs at risk for GDM (e.g., pre-diabetes or BMI> 85%). Teens and their mothers will receive
      the Stopping GDM to raise their awareness of the risks of GDM and benefits of healthy
      lifestyle to reduce these risks. By also providing mothers with PC knowledge and skills they
      can naturally weave cultural/social influences into their communications with their
      daughters. The multi-level intervention will be directed at the individual, familial and
      institutional levels simultaneously. AI/AN community-researcher partnerships have been
      established. A randomized controlled trial with a 15mos follow-up will test the effects of
      receiving online Stopping GDM on mother-daughter (M-D) cognitive/psychosocial and behavioral
      outcomes, and daughter family planning vigilance. The final online Stopping GDM program will
      be provided at no cost to the Indian Health Service (IHS) for dissemination to all their
      sites. HCPs at each clinical facility will be given free access to a continuing education
      program for PC training. This proposal provides a unique opportunity for a broad
      dissemination to significantly impact all IHS AI/AN female teens at risk for GDM, and help to
      prevent them and their future children from developing T2D.
    

Intervention name(s): STOPPING-GDM
Intervention type(s): Behavioral
Intervention description(s): Educational counseling and skills building Intervention
Intervention MeSH terms: Tin Fluorides
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: American Indian, Alaska Native Adolescents; Preconception Counseling; Reproductive Health; Gestational Diabetes Mellitus