Healthy Habits During and After Gestational Diabetes (VALID III)

Healthy Habits During and After Gestational Diabetes: A Cluster Randomised Family Intervention Controlled Trial in Northern Vietnam (VALID III)

Gestational diabetes mellitus (GDM) is associated with an increased risk of childhood obesity and other adverse health outcomes. Early-life nutrition, particularly exclusive breastfeeding, plays an important role in reducing this risk. In Vietnam, infant feeding and childcare practices are strongly influenced by family members, including husbands, grandparents, and parents-in-law.

The Healthy Habits During and After Gestational Diabetes (VALID III) trial aims to evaluate the effect of a co-created family-based health intervention on improving infant feeding practices and childhood body composition among children born to women with GDM. The intervention includes counseling, peer support, digital health components, educational materials, and follow-up support for nutrition, infant feeding practices, physical activity, and GDM management from pregnancy through 24 months after birth. Participants in the control group will receive standard care together with access to a GDM management website.

The primary objective is to evaluate the effect of the intervention on the duration of exclusive breastfeeding during the first 180 days after birth. Secondary objectives include evaluating exclusive breastfeeding at 6 months, child fat mass index at 24 months, and broader maternal and child health and wellbeing outcomes.

Study Overview

• Status: Not yet recruiting
• Conditions: GDM
• Intervention / Treatment: Behavioral: Hybrid intervention; Behavioral: Standard Care with Passive Web Access

Detailed Description

Background

Childhood obesity is a major global health burden, with increasing prevalence in many Asian countries, including Vietnam. However, health policies and programs in low- and middle-income countries (LMICs) often rely on evidence generated in settings that may not be directly applicable, limiting the effectiveness of interventions. Exposure to gestational diabetes mellitus (GDM) is associated with an increased risk of childhood obesity, while optimal early-life nutrition, particularly exclusive breastfeeding, may reduce this risk. In Vietnam, family members, including husbands, grandparents, and parents-in-law, have a substantial influence on infant feeding and childcare practices. These contextual factors highlight the need for family-based interventions to support healthy maternal and child behaviors following a pregnancy complicated by GDM.

Objectives

The Healthy Habits During and After Gestational Diabetes (VALID III) trial aims to evaluate the effect of the "Healthy Habits" family-based health intervention on improving infant feeding practices and childhood body composition among children born to women with GDM. The study will also assess the broader effects of the intervention on maternal and child health and wellbeing.

Study Design

This is a two-arm, parallel-group, superiority cluster randomised controlled trial with a 1:1 allocation of communes to either the intervention group (standard care plus the "Healthy Habits" intervention) or the control group (standard care plus access to a GDM management website). Pregnant women diagnosed with GDM between 24 and 28 weeks of gestation and their families will be recruited. Participants will be followed from pregnancy until 24 months after birth.

Intervention

The "Healthy Habits" intervention is a co-created family-based program delivered during pregnancy and continuing until 24 months postpartum. It includes counseling, peer support, digital health components, educational materials, and follow-up support focused on nutrition, infant feeding practices, physical activity, and GDM management, alongside routine clinical care.

Outcome Assessment

The primary outcome is the duration of exclusive breastfeeding during the first 180 days after birth. Secondary outcomes include the proportion of infants exclusively breastfed at 6 months, child fat mass index at 24 months after birth, process outcomes, and broader maternal and child health and wellbeing outcomes.

• Study Type: Interventional
• Enrollment (Estimated): 2546
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Thanh Duc Nguyen, Assoc. Prof; Phone Number: +84 91 235 7575; Email: bsthanh@hotmail.com

Study Locations

• Vietnam
  • Hưng Yên Province
    • Thái Bình, Hưng Yên Province, Vietnam
      • Thai Binh University of Medicine and Pharmacy
      • Contact: Thanh Duc Nguyen, Phd; Phone Number: +84 91 235 7575; Email: bsthanh@hotmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Confirmed GDM diagnosis in the current pregnancy according to WHO criteria and enrolled no longer than seven days after diagnosis.
• Gestational age at enrolment ≤ 28+0 weeks of pregnancy.
• Maternal age ≥18 years at consent.
• Pregnancy with singleton gestation
• Residence within the study catchment area.
• Language proficiency sufficient to complete consent and study procedures in Vietnamese.
• Capacity to provide informed consent and willingness to participate in all trial procedures, including randomisation

Exclusion Criteria:

• Pregestational diabetes (type 1 or type 2) diagnosed prior to this pregnancy.
• Severe chronic medical conditions and chronic severe mental health conditions likely to interfere with participation, safety, or outcome assessment (e.g., advanced cardiac, renal, hepatic disease; active malignancy; severe uncontrolled endocrine disease other than GDM, schizophrenia, active psychosis).
• Inability to provide informed consent .
• Pregnant women with multiple gestations.
• Pregnant women where it is biologically impossible for the woman to breastfeed, e.g., the woman has undergone bilateral mastectomy.
• Any other condition that, in the judgment of the investigators, makes participation inappropriate or infeasible, e.g., surrogate mother.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Healthy Habits; A co-created intervention delivered during pregnancy and up to two years after birth that includes counselling, peer support, digital health elements, educational materials, and follow-up support on nutrition, infant feeding practices, physical activity, and GDM management provided according to routine clinical practice in the Hung Yen province, Vietnam	Behavioral: Hybrid intervention; The VALID III "Healthy Habits" intervention is a culturally tailored, gender-sensitive, intergenerational complex intervention for women with gestational diabetes mellitus (GDM), delivered from diagnosis to 24 months postpartum. It differs from standard care through its extended duration and integrated family- and digital-based approach. It includes five components: (1) nutrition and infant feeding support (diet, breastfeeding, complementary feeding, household practices); (2) physical activity guidance for pregnancy/postpartum and family active play; (3) intergenerational family engagement involving partners and grandparents; (4) self-care and GDM management including diet advice, blood glucose monitoring, and free clinic testing; and (5) digital support via messaging and educational content. Compared with usual care, the intervention integrates co-created materials, family involvement, and continuous digital engagement to support sustained behavioural change
Active Comparator: Standard Care + Web Access; Access to a website with GDM management + standard care	Behavioral: Standard Care with Passive Web Access; Participants in this control group receive standard care for GDM according to routine clinical practice in Vietnam (antenatal care, dietary advice, glucose monitoring). In addition, they are provided with a website link (https://www.babaukhoemanh.com/en) for passive access to basic GDM management guidance. They do not receive any proactive messaging, peer support, or family engagement

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Duration of exclusive breastfeeding	Exclusive breastfeeding is defined as feeding with no other food or drink, except prescribed medicines, oral rehydration solution, vitamins, and minerals, following the first week of birth. Measured as a continuous variable representing the total number of days each infant was exclusively breastfed during the first 6 months of life. Data will be prospectively recorded by mothers on a weekly basis using a structured hard-copy Infant Feeding Diary kept at home. Research assistants will verify the diaries and capture content in photographs during home visits at 3 and 6 months after birth	Day 1-180 after birth

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Secondary outcome: Proportion of exclusive breastfeeding at 180 days (6 months) after birth	Proportion of exclusive breastfeeding (as defined above) at 180 days after birth.	180 days (6 months) after birth
Child fat mass index (FMI) at 24 months after birth	Fat Mass Index (FMI)= Fat mass (kg)/height (m2)	24 months after birth

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Maternal long-term metabolic health	Maternal metabolic health biomarkers comprise measures of glycaemic control (HbA1c, fasting glucose), insulin metabolism (fasting insulin and C-peptide), and lipid metabolism (LDL cholesterol, HDL cholesterol, triglycerides, and total cholesterol).	24 months after birth.
Maternal Informal social support	Maternal perceived availability and adequacy of informal social support from family, friends, and significant others, reflecting the mother's access to emotional, informational, and practical support.	Baseline (24-28 weeks' gestation, at the time of the oral glucose tolerance test [OGTT]), 6, 12, and 24 months after birth
Maternal quality of life	Maternal quality of life, including health-related quality of life, family health, and maternal mental health, reflecting physical, psychological, and social well-being after childbirth	Baseline (at the time of the oral glucose tolerance test, performed between 24 and 28 weeks of gestation), 6, 12, and 24 months after birth
Child socio-emotional development	Child feeding patterns, behaviours, illness patterns, and environmental factors related to obesity risk, including dietary intake and diet quality, sedentary behaviour and screen time, physical activity, sleep duration, parenting practices (feeding, activity, sleep), and household food environment	At 6, 12 and 24 months after birth
Child fat mass	Child fat mass and fat-free mass	At 6, 12, and 24 months after birth
Maternal glycaemic control in pregnancy	HbA1c (glycated haemoglobin) reflects the average blood glucose concentration over the past ~8-12 weeks and is measured from a blood sample	Baseline (at diagnosis of gestational diabetes mellitus during 24-28 weeks of gestation) and at delivery

Collaborators and Investigators

• Sponsor: Thai Binh University of Medicine and Pharmacy

Study record dates

Study Major Dates

• Study Start (Estimated): November 15, 2026
• Primary Completion (Estimated): May 15, 2028
• Study Completion (Estimated): August 30, 2030

Study Registration Dates

• First Submitted: July 2, 2026
• First Submitted That Met QC Criteria: July 15, 2026
• First Posted (Actual): July 21, 2026

Study Record Updates

• Last Update Posted (Actual): July 22, 2026
• Last Update Submitted That Met QC Criteria: July 20, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: physical activity; childhood obesity; lifestyle intervention; Vietnam; infant feeding; Gestational diabetes mellitus; low- and middle-income countries; exclusive breastfeeding; complementary feeding; caregiver involvement; maternal nutrition; behavioural intervention; family-based intervention; postpartum health; pregnancy hyperglycaemia; early-life nutrition; child adiposity; fat mass index
• Additional Relevant MeSH Terms: Urogenital Diseases; Endocrine System Diseases; Nutrition Disorders; Female Urogenital Diseases and Pregnancy Complications; Metabolic Diseases; Overnutrition; Body Weight; Pregnancy Complications; Glucose Metabolism Disorders; Diabetes Mellitus; Overweight; Obesity; Pathological Conditions, Signs and Symptoms; Behavior; Nutritional and Metabolic Diseases; Signs and Symptoms; Feeding Behavior; Diabetes, Gestational; Pediatric Obesity; Motor Activity; Breast Feeding; Health Services Administration; Health Care Quality, Access, and Evaluation; Quality of Health Care; Quality Indicators, Health Care; Standard of Care
• Other Study ID Numbers: VALID III; 26-12-KU (Other Identifier: Ministry of Foreign Affairs of Denmark (DANIDA))

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared due to strict data privacy agreements with partnering hospitals and project data ownership policies. Only aggregated, summary-level data will be made available through project reports and publications

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No