A Pregnancy and Postpartum Lifestyle Intervention in Women With Gestational Diabetes Mellitus Reduces Diabetes Risk Factors

Abstract

OBJECTIVETo pilot, among women with gestational diabetes mellitus (GDM), the feasibility of a prenatal/postpartum intervention to modify diet and physical activity similar to the Diabetes Prevention Program. The intervention was delivered by telephone, and support for breastfeeding was addressed.RESEARCH DESIGN AND METHODSThe goal was to help women return to their prepregnancy weight, if it was normal, or achieve a 5% reduction from prepregnancy weight if overweight. Eligible participants were identified shortly after a GDM diagnosis; 83.8% consented to be randomly assigned to intervention or usual medical care (96 and 101 women, respectively). The retention was 85.2% at 12 months postpartum.RESULTSThe proportion of women who reached the postpartum weight goal was higher, although not statistically significant, in the intervention condition than among usual care (37.5 vs. 21.4%, absolute difference 16.1%, P = 0.07). The intervention was more effective among women who did not exceed the recommended gestational weight gain (difference in the proportion of women meeting the weight goals: 22.5%, P = 0.04). The intervention condition decreased dietary fat intake more than the usual care (condition difference in the mean change in percent of calories from fat: −3.6%, P = 0.002) and increased breastfeeding, although not significantly (condition difference in proportion: 15.0%, P = 0.09). No differences in postpartum physical activity were observed between conditions.CONCLUSIONSThis study suggests that a lifestyle intervention that starts during pregnancy and continues postpartum is feasible and may prevent pregnancy weight retention and help overweight women lose weight. Strategies to help postpartum women overcome barriers to increasing physical activity are needed.

Gestational diabetes mellitus among Norwegian women with polycystic ovary syndrome: prevalence and risk factors according to the WHO and the modified IADPSG criteria

“…Our data indicate that this association may partly be explained by the lower weight loss post-partum and not so much by the diagnosis of GDM itself. In a pilot randomized trial, Ferrara et al (36) have recently reported that GDM women receiving prenatal/post-partum intervention to modify diet and physical activity show a higher probability of reaching post-partum weight goal (defined as prepregnancy weight if BMI !25 kg/m 2 and K5% of prepregnancy weight if BMI O25 kg/m 2 ) 12 months post-partum. The associations among maternal weight changes, HbA1c levels in PCOS women, GDM, type 2 diabetes, and later cardiovascular disease should be explored further.…”

Dulce Mothers: an intervention to reduce diabetes and cardiovascular risk in Latinas after gestational diabetes

“…A handful of community-based DPP translations have shown promising results over relatively short time frames [11,12]. However, limited efforts have been made to translate the DPP for women with a history of GDM [13,14], especially those with low socioeconomic status (SES). This represents a critically missed opportunity [15] given that a GDM diagnosis identifies individuals at a very high risk for future T2DM [1,16] and that lifestyle intervention is an effective diabetes prevention strategy for women with history of GDM [16].…”

Lifestyle Intervention in Prevention of Type 2 Diabetes in Women With a History of Gestational Diabetes Mellitus: One-Year Results of the FIN-D2D Project

“…8 Lifestyle interventions are a successful means of preventing T2D in high-risk individuals for T2D; 9,10 the effectiveness of lifestyle intervention in women with a history of GDM have also been examined to some extent. [11][12][13][14][15][16][17] In the Tianjin Gestational Diabetes Mellitus Prevention Program, lifestyle intervention yielded beneficial changes in weight, body mass index (BMI), body fat, waist circumference, plasma insulin levels, physical activity and diet in women with prior GDM during the 1-year follow-up. 17 Other studies have also shown that lifestyle intervention reduced weight and BMI, 13,16 and yielded beneficial changes in diet 15,16 and leisure time physical activity 16 in women with GDM.…”

“…[11][12][13][14][15][16][17] In the Tianjin Gestational Diabetes Mellitus Prevention Program, lifestyle intervention yielded beneficial changes in weight, body mass index (BMI), body fat, waist circumference, plasma insulin levels, physical activity and diet in women with prior GDM during the 1-year follow-up. 17 Other studies have also shown that lifestyle intervention reduced weight and BMI, 13,16 and yielded beneficial changes in diet 15,16 and leisure time physical activity 16 in women with GDM. In addition, in the Diabetes Prevention Program (DPP), the effect of lifestyle intervention on T2D risk reduction was similar in women with and without a history of GDM, but women without GDM lost more weight during the follow-up.…”