The Jom Mama project aims to help young couples planning to get pregnant lower both their own and their future children’s diabetes risk.
OUR lives start in our mothers’ wombs. That is where our parents’ genetic material combines and mixes up to produce the unique individual that is us.
It is also where all the complex and complicated cells, tissues, organs and systems that make up our body start to form and develop.
So, it makes sense that this can also be the place where it all starts to go wrong.
According to the Developmental Origins of Health and Disease hypothesis, the environment in the womb can induce changes in the development of the fetus, impacting on their long-term health and risk of disease, particularly non-communicable diseases.
The physical or social stresses experienced by a pregnant woman – like stress, a poor or unhealthy diet, exposure to tobacco smoke and obesity, among others – can affect the way her baby’s genes are expressed, resulting in an increased vulnerability to developing chronic diseases like cardiovascular disease and type 2 diabetes when they are older.
This is the scientific basis behind Danish pharmaceutical company Novo Nordisk’s Jom Mama project – the first in the world under its Changing Future Health initiative.
According to the company’s vice-president for Corporate Sustainability Susanne Stormer, the pilot project was initially developed to understand the factors and risks leading to gestational diabetes mellitus (GDM).
As suggested by the name, GDM is when blood sugar levels rise to diabetic levels during pregnancy due to the impaired production of insulin.
This condition usually resolves itself after the baby is delivered; however, having had GDM is a risk factor for developing type 2 diabetes later on.
In addition, babies of GDM mothers, especially if they weigh 4kg or more during birth, are also at risk of both becoming obese and developing type 2 diabetes when they are older.
Novo Nordisk Malaysia, Singapore, Philippines and Brunei Government Affairs head Priya Matzen notes that the 2011 National Health and Morbidity Survey (NHMS) has already shown a threefold increase in the number of women of reproductive age (18-35 years old) with diabetes.
These women also have the lowest level of physical activity, while one-third of women overall have abdominal or central obesity, according to the survey.
“There is no established study for the prevalence of gestational diabetes in Malaysia, but if you go out there and talk to the clinicians and the family medicine specialists, they all agree there is an increase in gestational diabetes,” she says.
The Jom Mama project coordinator adds: “There are enough studies to show that in gestational diabetes, the mother has an 80% likelihood of getting diabetes later in life, and the child has a 50% likelihood of getting diabetes later in life.
“And this means that you would have a huge proportion of the population ending up with diabetes.”
With these numbers in mind, the Jom Mama project aims to nip the problem right in the bud.
In fact, it aims to tackle the problem before it even becomes a problem by targeting young couples who are planning to have their first child in the near future.
At the heart of this strategy is the belief that all prospective parents want a healthy child.
Says Matzen: “If you can educate them and make them understand the importance of leading a healthy lifestyle prior to pregnancy, that would definitely have an impact on them, and also, their children.
“So, it has a double benefit, if you like.”
She notes that the motivation for change would also be high, as the couple are already planning to make such a huge change in their lives (i.e. having a baby).
Partnering with the Health Ministry and working with the Steno Diabetes Centre in Denmark, the University of Southhampton, United Kingdom, and the University of Witwatersrand, South Africa, the idea is to develop a set of practical pre-pregnancy interventions and test their efficacy in improving a woman’s health status during pregnancy, as well as reducing the risks of developing both diabetes and diabetic risk factors like obesity in both mother and child later on.
The project started with its first phase in November 2012.
“What we did initially was to conduct some research among young couples, where we met up with them, visited their homes, interviewed them about their habits, took pictures of their refrigerators to see what sort of food they were eating, etc,” shares Stormer over a phone interview from Copenhagen, Denmark.
The point of this qualitative study, according to Matzen, was to enable them to develop interventions based on what is realistic and feasible within the local context, rather than theoretical.
Among the questions put to the 20 couples involved were what motivates them, what prevents them from making healthy choices and what would excite them about making a lifestyle change.
Advice and motivation
This data collection phase ended in August 2013, and those involved in the project have been developing and refining their intervention processes and materials since then.
These basically involve introducing and maintaining healthy dietary changes, increased exercise time and stress management into the lives of young couples via community nurses (also called community health promoters) and an app.
Matzen explains that the idea is to make use of the ministry’s community nurses around the country to deliver personalised pre-pregnancy care. (While these nurses do visit and check up on expecting mothers, they do not currently deliver pre-pregnancy care as part of their duties.)
“They go in and counsel the couple; they’ll be like the friend, the guide, who will help these couples make the transition to a healthy lifestyle,” she says.
“We’re working a lot with the idea of behavioural motivation, making sure that the couple not only understands the subject, but is really motivated to take action after understanding the concept.
“The idea is that we help the couples internalise these changes.”
In addition, there will be an e-health app to help these couples make and maintain their lifestyle changes.
“This e-health app is personalised and interacts with the community health promoter. Every time the community health promoter visits you or when you’ve decided what tasks and goals you want to accomplish, this app helps you achieve these goals through reminders and motivational messages.”
Matzen adds that the app will also play on the couple’s competitive spirits to motivate them as it is designed to keep tabs on who is doing better at achieving their lifestyle goals.
The next step for the project is a short test run of the processes that have been developed, scheduled to take place within the next few months and involving another 20 couples.
Then, it is on to recruiting for the randomised clinical trial proper, with a target of about 1,000 couples and the quantitative outcome being measured by the female participants’ waist-to-height ratio.
“We hope to start the trial by the middle of next year in Seremban,” says Matzen, who explains that the Negri Sembilan capital has one of the highest occurrences of diabetes in the country.
Stormer shares that if successful in Malaysia, the Jom Mama concept will be scaled up and introduced to other countries.
“This whole area of prevention is one that Novo Nordisk is going to focus on more as we proceed,” she says.
“Jom Mama is one among several initiatives that will all be addressing diabetes before the patient comes to the clinic and needs treatment.
“And of course, if we are successful in this, we hope to be able to build on this knowledge to scale it up for other pilot projects or run it on a wider scale.”
See next Sunday’s Fit for life for an article on the Steno Diabetes Centre expanding to Malaysia.