JOM MAMA -Malaysian project explores obesity prevention before birth

The life course perspective and the Developmental Origins of Health and Disease (DOHaD) principle (Hanson & Gluckmann 2011) have drawn the attention to the crucial importance of fetal life and early infancy for later development of NCDs. This has a bearing for prevention of type 2 diabetes (T2D) as well. Gestational diabetes (GDM) also called Hyperglycemia in Pregnancy (HIP) plays an important part by affecting pregnancy outcomes as well as the risk of T2D of the women and their off-spring post-partum. The effects on the next generation is caused by epigenetic mechanisms influencing the foetus in utero. Seen in a life course perspective, pre-conception interventions may reduce the incidence of NCDs.

Low and middle-income countries face a double burden of disease: a high prevalence of both communicable- and non-communicable diseases (NCDs). This poses a special challenge to prevention and constitutes a unique field of research. Malaysia has undergone rapid socio-economic development, and lifestyle-related NCDs have emerged as a serious public health challenge. Changes in dietary habits and sedentary lifestyles have led to a dramatic increase in the prevalence of obesity and type 2 diabetes (T2D). 

Aim
The Malaysian JOM MAMA research and development project takes the pre-conception period as a window of opportunity for prevention of GDM. The overall aim is to optimise women’s health literacy and health status prior to and during pregnancy, in order to improve birth outcomes and reduce risk of the next generation to develop T2D. 

Design and method
We have developed a health education intervention for young couples, based on extensive formative work including intervention mapping (Bartholomew et al. 2011), a DELPHI needs assessment (Norris et al. 2014), literature reviews (Mohamed et al. 2015) and three qualitative studies exploring priorities of the young couples, community leaders, health care professionals and other key stakeholders.

The trial is presently ongoing (Skau et al. 2016). The intervention focuses on health literacy, physical activity, nutrition, psychosocial well-being and pregnancy preparedness to affect behaviour change. The intervention is currently being evaluated to determine whether it has an effect, and if so, how it can be refined, scaled up within Malaysia and disseminated to other settings and populations.

Target group
The primary target group are the young couples planning pregnancies and their off-spring. Secondary target groups are healthcare professionals and managers at local and national levels within the Malaysian health care system.

Expected ending and outcome
We expect the following outcomes from the JOM MAMA project:
- Improved pregnancy outcomes,
- Reduced risk of contracting T2D later in life among mothers,
- Offspring will be less prone to develop T2D later in life due to epigenetic mechanisms,
- Health care professionals will achieve increased competences to carry out effective health interventions,
- National health authorities will gain expertise on health promotion programmes in relation to reproductive health as well as translational research.

Collaborators 
JOM MAMA is funded by Novo Nordisk Inc. The Malaysian Ministry of Health provides substantial resources in terms of human resources. In addition, the other partners involved contribute with their own resources.

Collaborators include:
Malaysian Ministry of Health 
University of Southampton, Southampton, UK 
University of Witwatersrand, Johannesburg, South Africa 
Royal College of Surgeons in Ireland, Dublin, Ireland 
Novo Nordisk Inc.

LINKS
Hanson & Gluckmann (2011) Developmental origins of noncommunicable disease: population and public health implications. The American Journal of Clinical Nutrition, 94(6):1754-1758.

Bartholomew et al. (2011) Planning Health Promotion Programs: An Intervention Mapping Approach. 3rd ed. Jossey-Bass.

Norris et al. (2014) The life and health challenges of young Malaysian couples: Results from a stakeholder consensus and engagement study to support non-communicable disease prevention. BMC Public Health 14(2): 2-6.

Mohamed et al. (2015) Prevalence and determinants of overweight, obesity and type 2 diabetes mellitus in adults in Malaysia. Asia-Pacific Journal of Public Health 27(2):123-135.

Skau et al. (2016) A complex behavioural change intervention to reduce the risk of diabetes and prediabetes in the pre-conception period in Malaysia: study protocol for a randomised controlled trial. Trials 17:215.

Sidst opdateret 20-09-2016

Responsible

Jens Aagaard-Hansen
Senior Researcher
Diabetes Prevention Research