A feasibility randomised controlled trial of a postnatal diabetes prevention program: Mothers after gestational diabetes in Hong Kong

Dr Lok, Yuet Wan Kris   (Principal Investigator (PI))

Dr Chau Pui Hing   (Co-Investigator)

Dr Wong Janet Yuen Ha   (Co-Investigator)

Dr Ho Man Mandy   (Co-Investigator)

30

2019-06-30

2021-12-29

79890

A feasibility randomised controlled trial of a postnatal diabetes prevention program: Mothers after gestational diabetes in Hong Kong

Gestational diabetes, randomised controlled trial

Diabetes/Metabolism,Nutrition

201811159224

Seed Fund for PI Research – Basic Research

2018

Completed

In pregnant women, the normal blood glucose level is slightly higher to accommodate for foetal development [1, 2], but when coupled with hormonal changes that leads to insulin resistance, some might develop hyperglycaemia, a condition known as gestational diabetes mellitus (GDM) [3]. According to the Hong Kong College of Obstetricians and Gynaecologists, Gestational Diabetes Mellitus (GDM) is defined as ""hyperglycemia first detected in pregnancy"" that meets at least one of these criteria after a 75 gram glucose load - fasting plasma glucose (FPG) 5.1-6.9 mmol/L, 1-hour PG ≥ 10.0 mmol/L, and 2-hour PG 8.5-11.0 mmol/L [2]. GDM is a common medical condition that women encounter during pregnancy, the prevalence approximately 10.1% in Eastern and Southeastern Asia populations, and the percentage is larger in higher income regions such as Hong Kong, ranging from 0.6% to 27.5% [4]. Obstetric statistics in 2016 indicated that at least 20% of mothers were affected locally in Hong Kong [5], and the number was estimated to be rising still [4, 6]. GDM is associated with many adverse maternal and foetal outcomes such as macrosomia, shoulder dystocia, caesarean delivery, preterm birth, stillbirth, hypoglycaemia, and jaundice [7]. Overall, women with GDM have a 7-fold higher risk of developing type 2 diabetes mellitus (T2DM) compared to normoglycemic pregnancies [8]. Nonetheless, it has been found that interventions in lifestyle modification such as in diet controls and increasing physical activities, can effectively reduce risk of T2DM incidence by as much as 58% in high-risk population [9-11], some show impacts of those interventions are long-lasting as well, given that compliance rate is high throughout [12]. Although there is no evidence for offering prevention earlier being beneficial, it has been proven that diet and exercise program is more effective in patients taking no medication than those taking insulin, hence the need for early emphasis on lifestyle intervention in such treatment [13]. A number of studies on lifestyle modification program have been conducted on the GDM population, and a number of obstacles have been identified, such as fatigue, lack of time, cultural expectations which affect the engagement of these mothers for behaviour changes [14-24]. The intervention itself tends to lead to significant decrease in fasting blood glucose, but the challenge is to ensure participants’ commitment to the modifications. Therefore we propose a group based lifestyle intervention on the diabetes prevention program (DPP) based in Australia that have yielded positive outcomes [25]. The program aim to promote changes, relative to usual care, in anthropometric, behavioural, and biomedical outcomes [25]. Therefore we would like to adapt this group based lifestyle intervention in Hong Kong since individual lifestyle intervention failed to show any significant difference in outcomes or risk of GDM [26]. However, a feasibility randomised controlled trial of a postnatal diabetes prevention program for GDM mothers is needed first in Hong Kong to enable cultural comparisons as well as identify the barriers to lifestyle modification interventions and to determine if a future definitive RCT could be conducted at a national scale to improve fasting blood plasma glucose among new mothers with gestational diabetes in Hong Kong.