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

妊娠期糖尿病(GDM)与母亲和孩子的重大妊娠相关并发症有关，并构成发展为2型糖尿病(T2D)和心血管疾病(CVD)的长期风险。肥胖、T2D和心血管疾病的日益流行是低收入和中等收入国家(LMIC)的主要公共卫生问题，将给有限的卫生保健资源带来压力。对于妊娠期糖尿病来说，随着女性肥胖率的增加，全球的发病率预计会上升。预防妊娠期糖尿病将减轻社区中T2D的负担，并对孕产妇和儿童到成人的终身健康有直接和终生的好处。妊娠期糖尿病的诊断通常在妊娠晚期进行，重点关注已经患上妊娠期糖尿病的妇女。然而，一些既定的风险因素将一群妇女置于患妊娠期糖尿病的“高危”状态。怀孕前或怀孕期间超重或肥胖，怀孕期间体重增加过多，怀孕时年龄提前，与T2D有一级亲属关系，怀孕期间高血压，既往堕胎都被认为是发生妊娠期糖尿病的高危因素。因此，对与行为改变和促进健康生活方式有关的因素的研究将找到预防妊娠期糖尿病的新方法。英国最近的一项研究表明，在怀孕后期开始改变生活方式不太可能有助于预防妊娠期糖尿病。因此，及早预防妊娠期糖尿病有可能降低母亲和儿童的风险。早期筛查、优化产妇营养和倡导从怀孕早期开始进行适度的体力活动是高危母亲产科管理的支柱。然而，在妊娠期实施生活方式改变的主要挑战涉及遵守拟议的干预措施。关于限制卡路里的饮食建议和孕期一系列锻炼的建议通常不成功，主要是因为参与者的依从性较差。因此，重要的是要了解社会文化障碍，然后设计适当、可接受和具有成本效益的干预措施，以改善对任何干预方案的遵守情况。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。发酵酸奶和体育锻炼都被证明可以通过肠道微生物的作用和提高组织对胰岛素的敏感性来降低患糖尿病的风险。建议的研究将以这些证据为基础，采用黄金标准的干预性研究设计。该项目汇集了英国、印度和冈比亚的领先研究人员，研究生活方式干预的效果，即发酵酸奶和日常步行对患有妊娠期糖尿病的高危女性的影响。总体目标是在印度和冈比亚建立改善产前保健的能力。该项目将使人们更好地了解怀孕期间简单生活方式的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.