Effect of an Educational Intervention for the Prevention and Management of Overweight and Obesity During the First 18 Months of Life Children and Mothers With Gestational Diabetes in Insured of the Instituto Mexicano Del Seguro Social.

Effect of an education intervention for the prevention and management of overweight and obesity during the first 18 months of life of offspring and mother with gestational diabetes among insured of the Instituto Mexicano del Seguro Social.

ABSTRACT BACKGROUND: According to ENSANUT 2012, 9.7% of children <5 years already are overweight or obese. Recently, an increase was reported in the frequency of overweight and obesity worldwide, beginning at earlier ages, especially in Mexico. The predisposition to chronic diseases in adults may be programmed in the womb ("fetal programming"). Also, women that suffer diabetes during pregnancy have a very high risk (6.4 times more) of developing diabetes in a middle range. The challenge for health personnel dedicated to the care of mother-child pairs is to achieve glycemic control from conception and to identify all the maternal-fetal secondary complications. To carry out compliance with adherence to medical management and/or healthy eating habits would allow us to reduce future overweight, obesity and the incidence of type 2 diabetes in mother-child pairs. Approaching the mother-child pair is a great opportunity to study the intervention, which would allow us not only have a new, useful awareness in the evaluation of educational strategies, but also to apply good practices of healthy habits for the prevention of obesity and to avoid progression to diabetes. For the aforementioned reasons, the objective is: to implement and evaluate the effect of an education intervention for the prevention and management of overweight and obesity during the first 18 months of life of child and in mothers with and without gestational diabetes in insured members of the Instituto Mexicano del Seguro Social.

MATERIAL AND METHODS. Pregnant women will be invited to participate, who receive their prenatal and/or birth care in the Unidad Médica de Alta Especialidad (UMAE) Gineco-Obstretric Hospital No. 4 (HGO #4) and UMAE HGO #3 of Centro Médico "La Raza" of IMSS. After acceptance and signing an informed consent to participate in the study, 645 mother-child pairs will be included, with and without gestational diabetes mellitus (GDM), which will be diagnosed according to the criteria of the American Diabetes Association; all mothers with be between 18 and 40 years old. There will be 3 groups of binomials: 1) with GDM, 2) without GDM who will received the education intervention, and 3) without GDM who will receive the conventional care IMSS offers to mothers and nursing infants, during the first 18 months post-partum.

At the time of canalization before delivery or cesarean, a blood sample (15 mL) will be taken from the mother for measurement of glucose, glucosylated hemoglobin (A1c) and lipid profile. After birth, blood (15 mL) will be extracted directly from the umbilical cord for measurement of the child's glucose and lipid profile. Once the pediatric doctor has carried out reanimation of the newborn, previously-standardized health staff will take anthropometric measurements. During the 18 months of follow-up from birth, the mother-child pair will be given appointments at 0, 1, 2, 3, 6, 9, 12, 15 and 18 months, in which health care personnel involved in the study (nutritionist, social worker, pediatrician and family doctor) will perform activities to promote health and prevent disease, directed towards the mother-child pair and planned within the education intervention strategy based on the First 1000 Days program, or the conventional care that mothers and nursing infants receive in IMSS, according to the study group. Weekly, the mothers will be sent, by digital media and social networks, educational material to promote healthy diet and physical activity; for the child material will include the promotion of exclusive breastfeeding until 6 months, at which time promotion will be of adequate complementary foods, in addition to early stimulation activities; educational material will be handed out: posters and brochures will serve to reinforce and remind of the information given during appointments. Also, characteristics of the diet consumed by mother and child will be recorded monthly, along with the physical activity performed by the mother.

The education intervention has as objective the acquiring of knowledge, motivation, creation of an awareness of disease, adoption of healthy diet and physical activity; its components will be individual sessions, group sessions, electronic messages, etc.