The Problem: Gestational Diabetes Risk & Cultural Gaps in Care
Gestational diabetes is a condition that develops during pregnancy, leading to elevated blood sugar levels that can impact both maternal and infant health.
It is associated with increased risks, including:
- High blood pressure and birth complications
- Larger birth weight and delivery complications
- Increased likelihood of developing type 2 diabetes for both mother and child
Up to 50% of women with gestational diabetes develop type 2 diabetes within 5 years of giving birth.
Certain populations are disproportionately affected. South Asian women have up to twice the risk of developing gestational diabetes, with 1 in 3 pregnant South Asian women in Ontario affected.
Despite available nutritional guidance, adherence remains low due to:
- Lack of culturally relevant dietary recommendations
- Difficulty sustaining behavior change during pregnancy
- Limited personalized support
The challenge is delivering culturally appropriate, personalized interventions that drive sustained behavior change.
What is DESI?
DESI is a randomized controlled trial evaluating a culturally tailored health coaching intervention to improve diet and physical activity during pregnancy.
The program targets South Asian women at risk of gestational diabetes and combines health coaching, SMS support, and digital tracking tools to promote sustainable lifestyle changes.
Participants are enrolled in one of two groups:
- Control group: Weekly SMS messages encouraging physical activity
- Intervention group:
- Bi-weekly coaching sessions (phone or virtual)
- Weekly SMS messages reinforcing dietary and activity goals
During coaching sessions, participants select 2-4 personalized dietary goals from a structured list, including:
- Reducing high-fat or highly refined foods
- Increasing protein, fruits, and vegetables
- Improving meal planning and mindful eating
- Reducing sugary foods and beverages
Participants are supported through:
- Personalized goal setting and coaching
- SMS-based reinforcement and reminders
- Digital tracking tools (e.g., Fitbit for activity, Bitesnap for nutrition)
A dedicated platform enables health coaches to:
- Track participant progress and adherence
- Schedule coaching sessions
- Manage messaging and goals
- Monitor clinical milestones (e.g., glucose assessments)
DESI delivers culturally relevant, structured support to improve adherence and health outcomes during pregnancy.
Outcomes
DESI is designed to:
- Improve blood glucose outcomes during pregnancy
- Evaluating whether culturally tailored coaching leads to better glycemic control
- Reduce incidence of gestational diabetes in high-risk populations
- Assessing impact compared to standard nutritional guidance
- Increase adherence to dietary and physical activity recommendations
- Supporting sustained behavior change through personalized coaching and SMS reinforcement
- Deliver culturally relevant care interventions
- Tailoring recommendations to align with cultural foods, practices, and preferences
- Enable scalable, coach-supported digital interventions
- Combining human coaching with digital tools to support ongoing engagement
- Positive usability feedback from health coaches
- Coaches reported the platform to be intuitive, supportive of goal tracking, and effective for participant engagement
The Team
DESI is led in collaboration with:
- Population Health Research Institute (PHRI)
- A global leader in large clinical trials and population health research
- Dr. Russell de Souza
- Registered Dietitian and Associate Professor, McMaster University
- Expert in nutrition, cardiovascular health, and population-level dietary research