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Between navigating the health care system, adhering to a medication regimen, monitoring blood sugar levels, improving one’s diet, and maintaining an exercise routine, managing diabetes is a challenge for any adult.

If that adult happens to be a pregnant woman, that challenge can become even more difficult, whether the woman had diabetes before her pregnancy or develops it during the course of pregnancy (i.e., gestational diabetes). Diabetes doesn’t just affect an expecting mother, after all; it affects her child as well.

But two ���ӽ紫ý researchers, nursing professor Patricia Gatlin and registered dietician and nutrition sciences professor Arpita Basu, have found that a couple surprising items — goal-setting and fruit — can do a lot to lower the risks associated with having or developing diabetes for mothers and children alike.

A Helping Hand

Gatlin found her way to gestational diabetes research through a local nurse practitioner she met over the course of creating a self-care support group for vulnerable populations with diabetes at a local federally qualified health care center.

The nurse practitioner reached out to Gatlin months later to see if she would be willing to start a similar group at the nurse practitioner’s clinic working specifically with pregnant women struggling to avoid gestational diabetes.

“This was my first time working to support diabetes self-care dedicated to pregnant women, who I quickly discovered are highly motivated because they want the best for their babies,” Gatlin said. “Now I can’t imagine working with a different population.”

Gatlin developed a research study focused on women who either had type 2 diabetes and became pregnant or were at a higher risk for developing gestational diabetes. The goal was to help each woman have a healthy pregnancy by achieving and maintaining healthy weight gain during pregnancy as well as regulating optimal blood glucose levels.

Gatlin’s Healthy Pregnancy through Exercise and Nutrition (H-PEN) study explores how to mitigate diabetes effects or risks through diet and exercise from a perinatal perspective that spans the entire pregnancy and postpartum period. Participants are between 18 to 40 years old and have a body mass index (BMI) greater than 25. The study seeks to help participants reduce excessive weight gain, thereby reducing the risk for developing gestational diabetes or complicating existing diabetes symptoms.

Participants in the H-PEN study receive a scale for daily weigh-ins as well as an assortment of nutrition tools such as a portion plate, measuring cups, and a 2,200-calorie meal plan for expecting mothers.

Gatlin interacts with participants twice a month—once via phone or text to ask about the expecting mother’s diet and exercise goals, the second in person during the perinatal appointment to discuss both the participant’s goals and any perceived challenges to achieving those goals in the prior month.

“For some women of different cultures, writing goals is not a comfortable act, so we talked in detail more about what they wanted to achieve,” Gatlin said. “This helps them to realize and recognize what they wanted to do regarding diet and exercise and how they could set small goals to accomplish bigger ones.”

The technique paid off. Fifty-eight women have already delivered their babies (the study concludes in December 2018). While some participants gained more than the recommended amount of weight or developed gestational diabetes, overall, the preliminary results are positive, and the women have expressed appreciation for the support they’ve been provided throughout their pregnancies to help them maintain proper glucose levels and minimize weight gain.

“To be working with an expecting mom and helping her achieve goals for a healthy pregnancy is very rewarding,” Gatlin said. “And I must say, it is pretty awesome to hold a new baby at the end!”

A ‘Berry’ Promising Prevention Strategy

Prior to joining ���ӽ紫ý in fall 2017, Basu’s research focused on supplementing the diets of men and women within minority populations with dark-colored fruits and berries, especially blueberries. The fruit helped them control glucose levels, blood pressure, and inflammation, which lower the risk for diabetes.

Then Basu learned an alarming fact that inspired her to refine her target population further.

“A woman who suffers from gestational diabetes has a 70 percent chance of developing type 2 diabetes within five to 10 years after delivery,” Basu said. “And children born to moms who had gestational diabetes have greater risks for cardiovascular diseases, obesity, and diabetes as adults.”

Basu realized she needed to start at the beginning.

“Pregnancy begins the human lifespan,” she said. “Everything the mother does, all her lifestyle factors — including dietary factors — have a very profound effect on the baby’s growth and development.”

Knowing gestational diabetes is a persistent problem among minority populations, Basu teamed up with ���ӽ紫ý School of Medicine’s Dr. Petar Planinic, acting chair and assistant professor in the Department of Obstetrics and Gynecology, to launch a cross-sectional study and address the issue. The two are gathering data from 300-400 obese, pregnant mothers in minority groups about their dietary habits and examining whether adding specific foods, including dark-colored fruits and berries, can lower the risks for developing gestational diabetes as they lowered the risk of developing diabetes in non-pregnant adults.

Basu and Planinic are also providing dietary guidance to the expecting women.

“We give the participants a food-based alternative instead of telling them to make changes in their whole diet,” Dr. Planinic said—an approach backed by science.

“Current literature concludes that simply telling someone to improve his or her diet and increase physical activity doesn’t really work,” Basu said. “We want to understand the mindsets of the participants. If a woman doesn’t see a problem with her diet, current weight, or weight gain during pregnancy, then why would she change? No one wants to be told to do anything, so our approach is not to tell someone to stop eating a certain food, but to encourage them to try something else.”

The researchers take participants’ cultural dietary norms into consideration while making recommendations as well. For instance, Basu said, women in certain cultures increase their intake of fruit juices during pregnancy for various reasons, but in doing so, they end up increasing their consumption of processed sugars as well.

“We need to determine strategies for adding fruits and vegetables to our participants’ diets without taxing their budgets,” Basu said. “For example, instead of drinking two glasses of juice each day, which increases glucose loads, we recommend replacing one glass of juice with one cup of blueberries.”

Dr. Planinic sees several prospective positive outcomes of the study that could span current and future generations. “If the participating women accept Basu’s dietary suggestions and other interventions that help prevent gestational diabetes, then we will have healthier moms, healthier pregnancies, and, ultimately, healthier adults,” he said.