What is DESI?
DESI is a two arm parallel randomized controlled trial of health coaching to improve diet and encourage walking during pregnancy.
The goal of the study is to have 95 women in each arm. The controlled group will receive 1 message a week to encourage walking. The intervention group receives biweekly contact with a health coach by phone or zoom, weekly text messages to encourage walking and reinforce dietary changes they decide upon themselves.
During the coaching sessions, women choose and set 2 to 4 dietary goals from a list of 11. These goals can be change at the bi-weekly meetings. The text messages sent are to encourage and support these goals. The 11 dietary goals are:
The trial contains a platform for the health coaches. It stores participant information, sets times for the biweekly coaching sessions, tracks the glucose assessment dates, set up the messaging (goals, times and dates), ability to assess how closely participants are adhering to their goals, reflect on the coaching session and allows the participant to assess how well the coach meets their needs. To help with tracking of goals participants use Fitbit to track steps and Bitesnap to track nutrition targets.
Gestational diabetes is diagnosed during pregnancy. Women with gestational diabetes develop high blood sugar which can affect the health of the mother and baby. The blood sugar usually returns to normal shortly after delivery.
There can be risk of birth complications such as high blood pressure, large birth weight in the baby, a need for c section and macrosomia injury to the baby during delivery.
Women with gestational diabetes are also more at risk to develop type 2 diabetes in the future. Up to half of women with gestational diabetes develop type 2 diabetes within 5 years of giving birth. It also increase the risk of developing type 2 diabetes for the babies.
The trial focuses on South Asian women. South asian women have double the risk of developing gestational diabetes as white European women. 1 in 3 pregnant South Asian women in Ontario have gestational diabetes.
The goal of the trial is to determine if a culturally personalized nutrition intervention delivered by a health coach improves blood sugar levels and reduce the incidence of gestational diabetes in South Asian women to a greater extent than usual nutrition advice.
Most of the nutritional recommendations offered to women are not culturally sensitive and therefore are not followed. The trial seeks to modify risk by personalizing food choices, taking into consideration cultural foods and customs and personal preferences and styles.
Health coaches using the platform have stated it is user friendly, easy to track goals, and encourages interaction with participants.
The Population Health Research Institute (PHRI) is a global leader in large clinical trials and population health observational studies. They support research through statistical methodology, analysis of data, program management, technology infrastructure and more.
Russell de Souza is a registered dietitian and associate professor in the Department of Health Research Methods, Evidence, and Impact at McMaster University. He conducts systematic reviews, randomized trials, observational and qualitative studies to understand how personal nutrition choices and the nutritional environment contribute to cardiovascular disease across the lifespan.