NDPP-MAP: A Lifestyle Intervention to Manage Health Risks After Pregnancy with Gestational Diabetes - PROJECT SUMMARY Gestational diabetes (GDM) affects approximately 8% of pregnancies and substantially increases long-term risk for type 2 diabetes (T2D) and cardiovascular disease (CVD). By 10 years postpartum, 1 in 5 women with prior GDM develop T2D, rising to 60% by 30 years. Women who had GDM are also twice as likely as other women to develop CVD within 10 years. Clinical guidelines recommend intensive preventive care for women who have had GDM, including lifestyle intervention and metformin, but in practice, these women receive little healthcare. The National Diabetes Prevention Program (NDPP) is the leading lifestyle intervention for adults with prediabetes but has shown limited effectiveness among women with prior GDM, who face unique metabolic risks, have many competing priorities, and receive suboptimal clinical care. Our preliminary studies identified key barriers and opportunities for improving the effectiveness of the NDPP in this population. Women with prior GDM value the convenience of online delivery but report a need for tailored education, individualized coaching, and greater flexibility in both modality and content. Hybrid online-telehealth models and person-centered goal setting have shown strong promise for improving engagement and outcomes, and access to metformin can be improved by prompting providers to prescribe it upon participant request. The proposed study will test the NDPP to Manage Risk After Pregnancy (NDPP-MAP), which is a tailored, hybrid version of the NDPP emphasizing glycemic improvement, flexible delivery, and GDM-specific education, as well as facilitated access to metformin. In a randomized controlled trial of 378 women with prior GDM identified from Kaiser Permanente Northwest records, participants will be randomized to NDPP-MAP or the standard NDPP. Outcomes will be assessed remotely using validated methods for measuring A1c, lipids, blood pressure, weight, and physical activity. Primary aims are to (1) determine the effects of NDPP-MAP versus standard NDPP on A1c (primary outcome) and CVD risk factors at 12 months; (2) test moderators of treatment effects (e.g., time since GDM, baseline weight, and baseline A1c); (3) examine within-arm variation by use of intervention components and metformin; and (4) assess cost and projected reimbursement relative to Medicare benchmarks. NDPP-MAP integrates evidence-based digital and behavioral strategies into an established infrastructure for national dissemination, addressing a critical gap in postpartum preventive care. If effective, NDPP-MAP will offer a scalable, sustainable model to prevent chronic disease in millions of women after GDM.
