Targeted Lifestyle Change Group Prenatal Care

Targeted Lifestyle Change (TLC) Group Prenatal Care for Obese Women at High Risk for Gestational Diabetes: a Randomized Controlled Trial

To conduct a randomized trial to determine the effect of Targeted Lifestyle Change Group Prenatal Care (TLC) on maternal and neonatal outcomes in women at high risk for developing gestational diabetes mellitus (GDM).

Long term, the investigator aims to test the central hypothesis that those in TLC will have better maternal and neonatal outcomes than those in TC. The objective is to conduct a randomized trial to determine the effect of TLC group prenatal care on birthweight and neonatal body composition, maternal healthy lifestyle and diabetes-related outcomes, delivery and neonatal outcomes, and psychosocial stress and depression.

Inclusion Criteria:

• English speaking
• ≤16 weeks gestation
• Two or more of the following GDM risk factors:
• BMI ≥ 25
• Physical inactivity
• First degree relative with diabetes
• High risk race or ethnicity (African American, Latino, Native American, Asian American, Pacific Islander)
• Prior infant weighing ≥ 4,000 g
• Prior GDM
• Hypertension (140/90 mm Hg or receiving treatment)
• High-density lipoprotein cholesterol level <35 mg/dL or triglycerides > 250 mg/dL
• Polycystic ovarian syndrome
• A1c ≥ 5.7%
• Impaired glucose tolerance
• Impaired fasting glucose on previous testing
• History of cardiovascular disease
• Ability to attend group prenatal visits at specified days and times
• Willingness to be randomized
• Ability to give informed consent

Exclusion Criteria:

• Type 2 diabetes (eligible for Diabetes Group Care)
• Positive glucose challenge test during early pregnancy
• Multiple gestation (require extra care)
• Major fetal anomaly (require extra care)
• Serious medical co-morbidity necessitating more care than can be safely provided in group setting, as deemed by medical provider (require extra care)
• Serious psychiatric illness, including schizophrenia, necessitating more care than can be safely provided in group setting, as deemed by medical provider (require extra care)