Pregnancy Interventions In Mothers Relating to Diabetes In Asian India and Low-income countries (The PRIMORDIAL Study)

妊娠糖尿病 (GDM) 与母亲和孩子的严重妊娠相关并发症有关，并构成患 2 型糖尿病 (T2D) 和心血管疾病 (CVD) 的长期风险。肥胖、T2D 和 CVD 患病率的上升是低收入和中等收入国家 (LMIC) 的主要公共卫生问题，并将给有限的医疗保健资源带来压力。对于 GDM，预计全球范围内的发病率将随着女性肥胖的增加而上升。预防 GDM 将减轻社区 T2D 的负担，并对孕产妇、儿童乃至成人的一生健康产生直接和终生的益处。 GDM 诊断通常在怀孕后期进行，重点关注已经患有 GDM 的女性。然而，一些已确定的风险因素使一群女性处于患 GDM 的“高风险”之中。怀孕前或怀孕期间超重或肥胖、怀孕期间体重过度增加、怀孕时年龄增长、一级亲属患有 T2D、怀孕期间高血压、既往堕胎都被认为是发生 GDM 的“高风险”。因此，对与行为改变和促进更健康生活方式相关的因素的研究将确定预防 GDM 的新疗法。英国最近的研究表明，在怀孕后期开始改变生活方式不太可能有助于预防 GDM。因此，早期预防 GDM 有可能降低母亲和孩子的风险。早期筛查、优化孕产妇营养、提倡从孕早期开始适度体力活动是高危妈妈产科管理的重点。然而，在怀孕期间改变生活方式的主要挑战与坚持建议的干预措施有关。关于限制热量的饮食建议和怀孕期间一系列运动的建议通常不会成功，主要是因为参与者依从性差。因此，重要的是要了解社会文化障碍，然后设计合适、可接受且具有成本效益的干预措施，以提高对任何干预计划的依从性。有证据表明，怀孕前或怀孕期间生活方式的任何行为变化都会对健康产生重要影响。发酵酸奶和体力活动均已被证明可以通过肠道微生物发挥作用，并提高组织对胰岛素的敏感性，从而降低患糖尿病的风险。拟议的研究将基于这些证据，采用黄金标准干预研究设计。该项目汇集了英国、印度和冈比亚团队的顶尖研究人员，研究生活方式干预（即发酵酸奶和日常步行）对罹患 GDM 高风险女性的影响。首要目标是建设改善印度和冈比亚产前护理的能力。该项目将帮助人们更好地了解怀孕期间简单的生活方式改变如何对孕产妇和儿童健康产生深远的有益影响，并最终为怀孕期间的母亲设计改进的干预措施。

Gestational diabetes (GDM) is associated with significant pregnancy-related complications to the mother and the child and poses a long-term risk of developing type 2 diabetes (T2D) and cardiovascular disease (CVD). Increasing prevalence of obesity, T2D and CVD are major public health concerns in the low- and middle- income countries (LMICs) and will put strain on limited health care resources. For GDM, the incidence is expected to rise across the globe in parallel with increasing adiposity among women. Prevention of GDM will reduce the burden of T2D in the community and has both immediate and life-long benefits on maternal and the child to adult lifespan health. GDM diagnosis is usually made late in pregnancy and focus is given to women who have already developed GDM. However, a number of established risk factors place a group of women at 'high-risk' for developing GDM. Being overweight or obese prior to, or during pregnancy, excessive weight gain during pregnancy, advancing age at pregnancy, first degree relative with T2D, high blood pressure during pregnancy, previous abortions are all considered 'high-risk' for developing GDM. Therefore, research into factors that are linked to behavioural change and promotion of healthier lifestyle will identify new treatments to prevent GDM. Recent research from the UK have suggested that initiating lifestyle changes late in pregnancy is unlikely to be helpful in preventing GDM. Therefore, early prevention of GDM has the potential of reducing the risk in both the mother as well as the child. Early screening, optimising maternal nutrition and advocating moderate physical activity beginning from early pregnancy are the mainstays of obstetric management of high-risk mothers. However, the major challenge in implementing lifestyle changes during pregnancy relates to adherence to proposed interventions. Dietary advice on calorie restriction and proposal of set of exercises during pregnancy is usually not successful mainly because poor participant compliance. It is therefore important to understand the socio-cultural barriers and then designing interventions that are suitable, acceptable and cost-effective to improve adherence to any intervention programme. There are evidences to suggest that any behavioural change in life-style before or during pregnancy has important health implications. Both fermented yoghurt and physical activity have been shown to reduce the risk of diabetes by acting through the gut micro-organisms and also improving the sensitivity of the tissues to insulin. The proposed study will build on these evidences using a gold-standard interventional study design. The project brings together leading researchers in the UK, Indian and Gambian groups to study the effect of lifestyle intervention namely fermented yoghurt and daily walking in women who are high-risk for developing GDM. An overarching objective is to build capacity for improved antenatal care in India and The Gambia. The project will lead to a better understanding how simple lifestyle changes during pregnancy has profound beneficial effects on the maternal and child health, and ultimately to the design of improved interventions for mothers during for pregnancy.