Rena Wing is the director of the Weight Control & Diabetes Research Center at The Miriam Hospital, which received a $2.8 million grant from the National Institutes of Health to determine if overweight women who experienced gestational diabetes mellitus during one pregnancy can reduce their risk of GDM in a subsequent pregnancy by losing weight. In partnership with California Polytechnic Institute State University, the Weight Control and Diabetes Center will undertake a five-year clinical trial to evaluate whether losing weight before a subsequent pregnancy can reduce the risk of developing GDM again.
Wing, lead investigator for the study test site at Miriam, is also a professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University and a 2012 recipient of the Lifetime Achievement award from the American Psychological Association for her groundbreaking work in obesity research. She spoke with Providence Business News about this grant and how Miriam will conduct the research.
PBN: How will the $2.8 million NIH grant be allocated between The Miriam Hospital and the California Polytechnic Institute? Do you have concerns that future years’ funding might be halted, with a Republican-controlled White House and U.S. Congress?
WING: The funds are divided almost equally between the two sites and correspond to the tasks that will take place at each site. The grant has been funded for five years and we do not expect any changes to that funding plan.
PBN: How will The Miriam Hospital recruit women for this study, and how many women do you plan to recruit?
WING: The study involves 250 women, half of whom will be recruited at The Miriam Hospital. We will use a variety of different approaches to recruit women, including working with obstetricians to identify women who have gestational diabetes in their current pregnancy to discuss this study as an option to consider before their next pregnancy.
PBN: How overweight must a woman be to be eligible for this study?
WING: Women must have a body mass index of 25 or greater. For example, a 5-foot, 2-inch woman would qualify if she weighed more than 140 pounds and a 5-foot, 6-inch woman weighing more than 155 pounds would qualify.
PBN: What’s involved in participating in the study? How will you follow their health status in any subsequent pregnancies?
WING: Participants will be randomly assigned to Health Promotion, which involves two meetings with a study counselor and regular newsletters, or to Lifestyle Intervention, which involves weekly meetings with a counselor for the first 16 weeks and then meetings every one to four weeks until conception, and receipt of regular newsletters. These meetings will focus on achieving weight loss through healthy eating, physical activity and behavior change.
We will follow all women through their next pregnancy to determine how many develop GDM again. All women will complete an oral glucose tolerance test as part of their routine obstetric care to determine if they meet criteria for GDM.
PBN: What negative health consequences does gestational diabetes have on a pregnant woman and her fetus? Are those consequences short-term or permanent?
WING: GDM affects about 18 percent of pregnancies and increases maternal and fetal health risks. In the mother, GDM has both short-term and long-term consequences. During the pregnancy, GDM increases the risk of preeclampsia, caesarean sections, induced deliveries and pre-term labor; it also increases the long-term risks of type 2 diabetes, metabolic syndrome and cardiovascular disease. GDM also has negative short- and long-term effects on the fetus. GDM increases risk of fetal death, macrosomia (when a newborn baby is significantly larger than average) and birth trauma or damage to a newborn’s tissues and organs; long-term, it increases the risk of obesity and metabolic disease.
Women with GDM in one pregnancy are at high risk of having GDM again in their next pregnancy. Forty to 73 percent of women with GDM in one pregnancy will have it again in their next pregnancy. Women who have recurrence of GDM have three times the risk of prenatal and perinatal complications and future health problems, including diabetes and cardiovascular disease.
Nancy Kirsch is a PBN contributing writer.
