Carter Research Group
About the study
Ideally, women live on the healthy purple line. During pregnancy, women typically suffer from greater insulin resistance, but after pregnancy, they return to normal and don’t reach the threshold for gestational diabetes.
The focus of this study is women who live on the yellow line. They typically are poor, predominantly African American, obese, and at high risk for crossing the diabetes threshold during pregnancy. Happily, even most of those patients return to normal immediately postpartum. Studies have shown they still are at significantly higher risk of developing type 2 diabetes later in life.
In the first five years after delivery, there is a rapid increase in the onset of type 2 diabetes, a trend that doesn’t plateau until about 10 years after pregnancy. The goal is to improve women’s health by modifying risk factors so they live on this green line and never reach the threshold for gestational or type 2 diabetes. Or we at least delay the onset of type 2 diabetes until much later in life.
To this end, I propose a randomized controlled trial that randomizes 416 women at high risk for gestational diabetes to traditional individual care or to a group that receives more focused diabetes prevention, including prenatal care and targeted lifestyle changes, and builds upon our previously tested GDM group care curriculum. I will assess neonatal outcomes, including birthweight, and maternal outcomes including GDM, lifestyle measures, gestational weight gain, and adverse pregnancy outcomes.
The ADA Pathway award would allow me to modify and fine-tune our previously tested GDM curriculum for TLC, and conduct a large, randomized controlled trial to rigorously test if group care can improve outcomes for those at risk of developing gestational diabetes. If my hypothesis is correct, we later would pursue a multicenter study to follow outcomes for five years
My diabetes research would benefit from expertise available through the mentor advisory group and potential, interdisciplinary collaboration with other Pathway scientists. I can combine their expertise with skills I am gaining as a health policy fellow at the National Academy of Medicine. The combination would enable me to conduct rigorous research into the efficacy of targeting diabetes during prenatal care, while also advocating at the national level for pregnant women at risk for diabetes.
Ebony B. Carter, MD, MPH
Assistant Professor, Division of Maternal Fetal Medicine
Interim Chief, Division of Clinical Research
Department of Obstetrics and Gynecology,
Washington University School of Medicine
Dr. Ebony Carter is an Assistant Professor at Washington University School of Medicine and practices Maternal Fetal Medicine in the Department of Obstetrics and Gynecology. Her research focuses on evidence based prenatal care and community based participatory research to reduce economic and racial health disparities. Her research is funded by the Robert Wood Johnson Foundation, National Institute for Child Health and Human Development, and the American Diabetes Association.
Dr. Carter earned her undergraduate degree in human biology with honors from Stanford University, Master of Public Health in health policy from the University of Michigan and medical degree from Duke University. She completed residency in Obstetrics and Gynecology at the Harvard integrated program at Brigham and Women’s/Massachusetts General Hospitals and fellowship training in Maternal Fetal Medicine at Washington University School of Medicine.
She and her husband, Dr. Dedric Carter, are active members of Union Tabernacle Baptist Church and they are the proud parents of 3 little girls
Mission: Targeted Lifestyle Change (TLC) Initiative is dedicated to reducing the risk of Gestational Diabetes Mellitus (GDM) and its complications in high-risk, low-income, African American women in St. Louis and beyond.
TLC values self-efficacy, autonomy, collaboration, relationship, commitment to racial equity and empowerment as our commitment and accountability to accelerate change:
- Self-efficacy: We support a woman’s belief in her capacity to execute behaviors necessary to achieve her goals and the ability to exert control over her motivation, behavior, and environment while recognizing the impact of social determinants of health.
- Autonomy: We respect the independence, wisdom and experience of patients.
- Collaboration: We work collaboratively with patients and health care team members to identify empowering, evidence-based and high impact interventions that fit within the context of patient lives.
- Relationship: We believe patient-care is rooted in relationship and strive to be supportive and honest. We will continue to grow by celebrating our successes, learning from our challenges, and having fun in the process.
- Empowerment: We seek empowerment of patients and health care team members.
- Dedicated to racial equity: We are committed to innovation, try new things to challenge the status quo and doing the hard work necessary to address our personal biases and to use our platform to tear down individual, interpersonal, cultural, and structural racism.