Abstract
Introduction
Intrauterine exposure to maternal obesity and hyperglycemia greatly increases offspring health risks. Scalable lifestyle interventions to lower weight and glycemia prior to conception are needed, but have been understudied, especially in diverse and low-income women with disproportionately high risks of negative maternal-child outcomes. The objective of this report is to provide initial evidence of the National Diabetes Prevention Program’s (NDPP) effects on maternal-child outcomes in diverse, low-income women and their offspring.
Methods
The yearlong NDPP was delivered in a safety net healthcare system to 1,569 participants from 2013 to 2019. Using medical records, we evaluated outcomes for women < 40 years who became pregnant and delivered after attending the NDPP for ≥ 1 month (n = 32), as compared to a usual care group of women < 40 years (n = 26) who were initially eligible for the NDPP but were excluded due to pregnancy at enrollment.
Results
Most women in either group were Latinx, had Medicaid or were uninsured, and had obesity at baseline. The mean difference in BMI change from baseline to conception was − 1.8 ± 0.6 kg/m2 (p = 0.002) for NDPP versus usual care. Fewer NDPP participants had obesity at conception (56.7% vs. 88.0%, p = 0.011) and hyperglycemia in early pregnancy (4.0% vs. 25.0%; p = 0.020) than usual care. No other differences were statistically significant, yet nearly all outcomes favored the NDPP. Covariate-adjusted results were consistent, except the difference in frequency of obesity at conception was no longer significant (p = 0.132).
Discussion
Results provide preliminary evidence that the NDPP may support a reduction in peri-conceptional obesity/diabetes risks among diverse and low-income women.
Significance
Scalable lifestyle interventions to lower weight and glycemia prior to conception are needed, especially to support diverse and low-income women with disproportionately high risks of negative maternal-child outcomes. This report presents initial evidence of the National Diabetes Prevention Program?s effects on maternal-child outcomes in diverse, low-income women and their offspring. Results encouragingly suggest that the program can reduce peri-conceptional obesity and glycemia, and may be a resource to help break the cycle of disease across generations.
This is a preview of subscription content, log in via an institution to check access.
Code availability by request
N.D.R. conducted the study, completed the data analysis, and was the primary author. K.A.S. contributed critically to conceiving the study, the analytical approach, results interpretation, and manuscript preparation. M.K. conducted medical chart reviews and assisted with manuscript preparation. All authors read and approved the final submitted version. N.D.R. is the guarantor of this work and, as such, had full access to all the data reported and takes responsibility for the integrity of the data and the accuracy of the report.
References
Boney, C. M., Verma, A., Tucker, R., & Vohr, B. R. (2005, Mar). Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics, 115(3), e290–296. https://doi.org/10.1542/peds.2004-1808.
Branum, A. M., Kirmeyer, S. E., & Gregory, E. C. (2016, Aug). Prepregnancy Body Mass Index by Maternal Characteristics and State: Data From the Birth Certificate, 2014. Natl Vital Stat Rep, 65(6), 1–11. https://www.ncbi.nlm.nih.gov/pubmed/27508894
Campione, J. R., Ritchie, N. D., Fishbein, H. A., Mardon, R. E., Johnson, M. C. Jr., Pace, W., Birch, R. J., Seeholzer, E. L., Zhang, X., Proia, K., Siegel, K. R., & McKeever Bullard, K. (2022). Jun 16). Use and impact of type 2 diabetes Prevention Interventions. American Journal Of Preventive Medicine. https://doi.org/10.1016/j.amepre.2022.04.002.
Cannon, M. J., Masalovich, S., Ng, B. P., Soler, R. E., Jabrah, R., Ely, E. K., & Smith, B. D. (2020). Retention among participants in the National Diabetes Prevention Program Lifestyle Change Program, 2012–2017. Diabetes Care, 43(9), 2042–2049. https://doi.org/10.2337/dc19-2366.
CDC (2015). Diabetes Prevention Recognition Program Standards and Operating Procedures. Retrieved July 1 from https://www.cdc.gov/diabetes/prevention/pdf/DPRP_Standards_09-02-2011.pdf
Chen, L., Pocobelli, G., Yu, O., Shortreed, S. M., Osmundson, S. S., Fuller, S., Wartko, P. D., McCulloch, D., Warwick, S., Newton, K. M., & Dublin, S. (2019). Aug). Early pregnancy hemoglobin A1C and pregnancy outcomes: a Population-Based study. American Journal Of Perinatology, 36(10), 1045–1053. https://doi.org/10.1055/s-0038-1675619.
Cortes, Y. I., Zhang, S., & Hussey, J. M. (2022). Pregnancy loss is related to body mass index and prediabetes in early adulthood: findings from add Health. PLoS One, 17(12), e0277320. https://doi.org/10.1371/journal.pone.0277320.
Dabelea, D., & Crume, T. (2011, Jul). Maternal environment and the transgenerational cycle of obesity and diabetes. Diabetes, 60(7), 1849–1855. https://doi.org/10.2337/db11-0400.
Ely, E. K., Gruss, S. M., Luman, E. T., Gregg, E. W., Ali, M. K., Nhim, K., Rolka, D. B., & Albright, A. L. (2017). Oct). A National Effort to prevent type 2 diabetes: participant-level evaluation of CDC’s National Diabetes Prevention Program. Diabetes Care, 40(10), 1331–1341. https://doi.org/10.2337/dc16-2099.
Glasgow, R. E., Vinson, C., Chambers, D., Khoury, M. J., Kaplan, R. M., & Hunter, C. (2012). Jul). National Institutes of Health approaches to dissemination and implementation science: current and future directions. American Journal Of Public Health, 102(7), 1274–1281. https://doi.org/10.2105/AJPH.2012.300755.
Gruss, S. M., Nhim, K., Gregg, E., Bell, M., Luman, E., & Albright, A. (2019). Aug 5). Public Health Approaches to type 2 diabetes Prevention: the US National Diabetes Prevention Program and Beyond. Current Diabetes Reports, 19(9), 78. https://doi.org/10.1007/s11892-019-1200-z.
Harrison, C. R., Phimphasone-Brady, P., DiOrio, B., Raghuanath, S. G., Bright, R., Ritchie, N. D., & Sauder, K. A. (2020, Jun). Barriers and facilitators of National Diabetes Prevention Program Engagement among Women of Childbearing Age: a qualitative study. The Diabetes Educator, 46(3), 279–288. https://doi.org/10.1177/0145721720920252.
Hughes, R. C., Moore, M. P., Gullam, J. E., Mohamed, K., & Rowan, J. (2014, Nov). An early pregnancy HbA1c >/=5.9% (41 mmol/mol) is optimal for detecting diabetes and identifies women at increased risk of adverse pregnancy outcomes. Diabetes Care, 37(11), 2953–2959. https://doi.org/10.2337/dc14-1312.
LeBlanc, E. S., Smith, N. X., Vesco, K. K., Paul, I. M., & Stevens, V. J. (2021, Jan). Weight loss prior to pregnancy and subsequent gestational weight gain: Prepare, a randomized clinical trial. Am J Obstet Gynecol, 224(1), 99 e91-99 e14. https://doi.org/10.1016/j.ajog.2020.07.027
Martin, J. A., Hamilton, B. E., Osterman, M. J. K., & Driscoll, A. K. (2021, Apr). Births: final data for 2019. National Vital Statistics Reports : From The Centers For Disease Control And Prevention, National Center For Health Statistics, National Vital Statistics System, 70(2), 1–51. https://www.ncbi.nlm.nih.gov/pubmed/33814033.
Najafi, F., Hasani, J., Izadi, N., Hashemi-Nazari, S. S., Namvar, Z., Mohammadi, S., & Sadeghi, M. (2019, Mar). The effect of prepregnancy body mass index on the risk of gestational diabetes mellitus: a systematic review and dose-response meta-analysis. Obesity Reviews, 20(3), 472–486. https://doi.org/10.1111/obr.12803.
Peng, T. Y., Ehrlich, S. F., Crites, Y., Kitzmiller, J. L., Kuzniewicz, M. W., Hedderson, M. M., & Ferrara, A. (2017, Feb). Trends and racial and ethnic disparities in the prevalence of pregestational type 1 and type 2 diabetes in Northern California: 1996–2014. Am J Obstet Gynecol, 216(2), 177 e171-177 e178. https://doi.org/10.1016/j.ajog.2016.10.007
Phelan, S., Jelalian, E., Coustan, D., Caughey, A. B., Castorino, K., Hagobian, T., Munoz-Christian, K., Schaffner, A., Shields, L., Heaney, C., McHugh, A., & Wing, R. R. (2021, Apr 7). Protocol for a randomized controlled trial of pre-pregnancy lifestyle intervention to reduce recurrence of gestational diabetes: Gestational Diabetes Prevention/Prevencion de la Diabetes Gestacional. Trials, 22(1), 256. https://doi.org/10.1186/s13063-021-05204-w
Ritchie, N. D., Sauder, K. A., & Fabbri, S. (2017, Nov). Reach and Effectiveness of the National Diabetes Prevention Program for Young Women. American Journal Of Preventive Medicine, 53(5), 714–718. https://doi.org/10.1016/j.amepre.2017.06.013.
Ritchie, N. D., Sauder, K. A., Kaufmann, P. G., & Perreault, L. (2021). Aug 17). Patient-centered goal-setting in the National Diabetes Prevention Program: a pilot study. Diabetes Care. https://doi.org/10.2337/dc21-0677.
Ritchie, N. D., Sauder, K. A., Phimphasone-Brady, P., & Amura, C. R. (2018). Apr). Rethinking the National Diabetes Prevention Program for Low-Income Whites. Diabetes Care, 41(4), e56–e57. https://doi.org/10.2337/dc17-2230.
Sauder, K. A., & Ritchie, N. D. (2021, Mar). Reducing intergenerational obesity and diabetes risk. Diabetologia, 64(3), 481–490. https://doi.org/10.1007/s00125-020-05341-y.
Shapiro, A. L., Schmiege, S. J., Brinton, J. T., Glueck, D., Crume, T. L., Friedman, J. E., & Dabelea, D. (2015). May). Testing the fuel-mediated hypothesis: maternal insulin resistance and glucose mediate the association between maternal and neonatal adiposity, the healthy start study. Diabetologia, 58(5), 937–941. https://doi.org/10.1007/s00125-015-3505-z.
Simmons, D. (2021). May). Paradigm shifts in the management of diabetes in pregnancy: the importance of type 2 diabetes and early hyperglycemia in pregnancy: the 2020 Norbert Freinkel Award lecture. Diabetes Care, 44(5), 1075–1081. https://doi.org/10.2337/dci20-0055.
Zheng, Y., Manson, J. E., Yuan, C., Liang, M. H., Grodstein, F., Stampfer, M. J., Willett, W. C., & Hu, F. B. (2017). Jul 18). Associations of Weight Gain from Early to Middle Adulthood with Major Health Outcomes later in Life. Journal Of The American Medical Association, 318(3), 255–269. https://doi.org/10.1001/jama.2017.7092.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
The National Diabetes Prevention Program at Denver Health was funded largely by the Amendment 35 Cancer, Cardiovascular Disease and Pulmonary Disease Grant Program administered by the Colorado Department of Public Health and Environment, as well as an award from America’s Health Insurance Plans in partnership with the Centers for Disease Control and Prevention. Additional support was provided by Denver Health. N.D.R. also acknowledges support by grants from the National Institutes of Health (R01DK119478; R01DK130900, UG3HL162967) and American Diabetes Association (7-22-ICTSN-45). The contents of this publication are solely the responsibility of the authors and do not represent official views of funding organizations.
The authors report no conflicts of interest.
The Colorado Multiple Institutional Review Board approved the program evaluation project.
Consent to participate
Not applicable.
Consent for publication
Not applicable.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Ritchie, N.D., Sauder, K.A. & Kostiuk, M. Reducing Maternal Obesity and Diabetes Risks Prior to Conception with the National Diabetes Prevention Program. Matern Child Health J 27, 1133–1139 (2023). https://doi.org/10.1007/s10995-023-03624-5
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-023-03624-5