The JOM MAMA project addresses diabetes prevention in a life-course perspective. Gestational diabetes is known to affect pregnancy outcomes as well as the risk of T2D of the women as well as their off-spring. The project is one of the first to explore whether an intervention prior to pregnancy (pre-conception) has any positive impact. Based a very thorough process of intervention mapping and a number of baseline studies, an intervention has been developed by a unique consortium of MOH Malaysia, Novo Nordisk Inc. and research institutions including SDCC. The intervention which focuses on young couples in Malaysia is presently evaluated in an on-going randomised controlled trial.
In recent decades, the life course perspective and the Developmental Origins of Health and Disease (DOHaD) principle (Hanson and Gluckmann 2011) has drawn the attention to the crucial importance of fetal life and early infancy for later development of NCDs. This has a bearing for prevention of type 2 diabetes (T2D) as well in relation to gestational diabetes (GDM).
Low and middle-income countries face a double burden of disease: a high prevalence of both communicable- and non-communicable diseases (NCDs). This poses a special challenge to prevention and constitutes a unique field of research. During the past decades, Malaysia has undergone rapid socio-economic development, and lifestyle-related NCDs have emerged as a serious public health challenge. Changes in dietary habits and sedentary lifestyles have led to a dramatic increase in the prevalence of obesity and type 2 diabetes (T2D).
Pregnancy and pre-conception factors play an important part in this scenario. Thus, maternal lifestyle and conditions such as GDM affect pregnancy outcomes as well as the risk of T2D of the women as well as their off-spring. Thus, interventions during these periods could have a powerful influence in reducing the incidence of NCDs.
The Malaysian JOM MAMA research and development project takes the pre-conceptual period as a window of opportunity for prevention. The project aims at developing, implementing and evaluating a prevention programme addressing risk factors such as obesity among young couples.
The overall aim is to optimise women’s health literacy and health status prior to and during pregnancy, in order to improve birth outcomes and reduce risk of the next generation to develop T2D. The effects on the next generation is caused by epigenetic mechanisms, i.e. influences on the foetus in utero for instance due to GDM that have long term effects such as increased risk of later developing T2D.
JOM MAMA is funded by Novo Nordisk Inc. The Malaysian Ministry of Health provides substantial resources in terms of human resources and running costs. In addition, the other partners involved contribute with their own resources.
Malaysian Ministry of Health (www.moh.gov.my)
University of Southampton (www.southampton.ac.uk)
University of Witwatersrand (www.wits.ac.za)
Royal College of Surgeons in Ireland RCSI) (www.rcsi.ie)
Novo Nordisk A/S.
Links Mohammed, Hamid Jan B. Jan & Yap, Roseline Wai Kuan & Loy, See Ling & Norris, Shane A. & Biesma, Regien & Aagaard-Hansen, Jens: Prevalence and Determinants of Overweight, Obesity, and Type 2 Diabetes Mellitus in Adults in Malaysia. Asia-Pacific Journal of Public Health, 2015, vol.27, no.2, pp.123-135. DOI: 10.1177/1010539514562447.
Skau, Jutta KH & Nordin, Awatef Binti Amer & Cheah, Julius CH & Ali, Roslinah & Zainal, Ramli & Aris, Tahir & Ali, Zainudin Mohd & Matzen, Priya & Biesma, Regien & Aagaard-Hansen, Jens & Hanson, Mark A & Norris, Shane A: A complex behavioural change intervention to reduce the risk of diabetes and prediabetes in the pre-conception period in Malaysia: study protocol for a randomised controlled trial. Trials, 2016, vol.17, no.215, pp.1-12. DOI 10.1186/s13063-016-1345-x.
Norris, Shane A. & Ho, Julius C.C. & Rashed, A.A. & Vinding, Vibeke & Skau, Jutta K.H. & Biesma, Regien & Aagaard-Hansen, Jens & Hanson, Mark & Matzen, Priya: Pre-pregnancy community-based intervention for couples in Malaysia: application of intervention mapping. BMC Public Health, 2016, vol.16, p.1167. DOI 10.1186/s12889-016-3827-x.