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BackgroundWomen who develop gestational diabetes mellitus (GDM) have an increased risk for the development of type 2 diabetes. Despite this "window of opportunity," few intervention studies have targeted postpartum women with a history of GDM. We sought perspectives of women with a history of GDM to identify a) barriers and facilitators to healthy lifestyle changes postpartum, and b) specific intervention approaches that would facilitate participation in a postpartum lifestyle intervention program.MethodsWe used mixed methods to gather data from women with a prior history of GDM, including focus groups and informant interviews. Analysis of focus groups relied on grounded theory and used open-coding to categorize data by themes, while frequency distributions were used for the informant interviews.ResultsOf 38 women eligible to participate in focus groups, only ten women were able to accommodate their schedules to attend a focus group and 15 completed informant interviews by phone. We analyzed data from 25 women (mean age 35, mean pre-pregnancy BMI 28, 52% Caucasian, 20% African American, 12% Asian, 8% American Indian, 8% refused to specify). Themes from the focus groups included concern about developing type 2 diabetes, barriers to changing diet, and barriers to increasing physical activity. In one focus group, women expressed frustration about feeling judged by their physicians during their GDM pregnancy. Cited barriers to lifestyle change were identified from both methods, and included time and financial constraints, childcare duties, lack of motivation, fatigue, and obstacles at work. Informants suggested facilitators for lifestyle change, including nutrition education, accountability, exercise partners/groups, access to gyms with childcare, and home exercise equipment. All focus group and informant interview participants reported access to the internet, and the majority expressed interest in an intervention program delivered primarily via the internet that would include the opportunity to work with a lifestyle coach.ConclusionTime constraints were a major barrier. Our findings suggest that an internet-based lifestyle intervention program should be tested as a novel approach to prevent type 2 diabetes in postpartum women with a history of GDM.Trial RegistrationClinicalTrials.gov: NCT01102530

Objective To test the feasibility and effectiveness of a web-based lifestyle intervention based on the Diabetes Prevention Program modified for women with recent gestational diabetes mellitus (GDM) to reduce postpartum weight retention. Methods We randomly allocated 75 women with recent GDM to either a web-based lifestyle program (Balance after Baby) delivered over the first postpartum year or to a control group. Primary outcomes were change in body weight at 12 months from 1) first postpartum measured weight, and 2) self-reported prepregnancy weight. Results There were no significant differences in baseline characteristics between groups including age, BMI, race and income status. Women assigned to the Balance after Baby program (n=36, 3 lost to follow-up) lost a mean of 2.8 kgs (95% CI −4.8 to −0.7) from 6 weeks to 12 months postpartum while the control group (n=39, 1 lost to follow-up) gained a mean of 0.5 kgs (−1.4 to +2.4) (p=0.022). Women in the intervention were closer to prepregnancy weight at 12 months postpartum (mean change −0.7 kgs; −3.5 to +2.2), compared to women in the control arm (+4.0 kgs; +1.3 to +6.8) (p=0.035). Conclusion A web-based lifestyle modification program for women with recent GDM decreased postpartum weight retention.