Diabetes prevention interventions for women after gestational diabetes mellitus: an overview of reviews

Momsen, Anne‐Mette Hedeager; Høtoft, Diana; Ørtenblad, Lisbeth; Lauszus, Finn Friis; Krogh, Rubab Hassan Agha; Lynggaard, Vibeke; Christiansen, Jens Juel; Maindal, Helle Terkildsen; Nielsen, Claus Vinther

doi:10.1002/edm2.230

Cited by 35 publications

(40 citation statements)

References 53 publications

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“…As the first-line treatment, nutritional interventions have made recommendations on intakes of carbohydrate, fat, and protein ( 58 ). Although most of these clinical practice guidelines on nutritional interventions are not being of high quality ( 58 ), the nutritional interventions could significantly reduce the risk of postpartum diabetes ( 59 ). However, evidence is limited regarding diet modification and anti-diabetic pharmacotherapy including metformin treatment during pregnancy and risks of cardiovascular diseases in women with a history of GDM ( 60 ).…”

Section: Discussionmentioning

confidence: 99%

Association Between Gestational Diabetes Mellitus and the Risks of Type-Specific Cardiovascular Diseases

Mao

Hu²,

Xia

et al. 2022

Front. Public Health

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ObjectiveGestational diabetes mellitus (GDM) has been linked to subsequent overall cardiovascular diseases. However, evidence on the associations of GDM with type-specific cardiovascular diseases is lacking, and findings on the potential impact of type 2 diabetes on the associations are not consistent. This study aimed to explore the associations between GDM and the risks of type-specific cardiovascular diseases.MethodsData were from 12,025 women (≥20 years) who had delivered at least one live birth in the National Health and Nutrition Examination Survey, 2007–2018. GDM history and type-specific cardiovascular diseases including coronary heart disease (CHD), heart failure and stroke were defined by self-report. We also combined our results with those from previously related publications on the associations between GDM and risks of type-specific cardiovascular diseases with a random-effect model.ResultsCompared with women without GDM, the multivariable-adjusted odds ratios (95% confidence intervals) were 1.82 (1.21–2.72) for CHD, 1.43 (0.80–2.53) for heart failure, and 1.19 (0.76–1.86) for stroke among women with a history of GDM. Type 2 diabetes was associated with 43.90, 67.44, and 63.16% of the excess odds of CHD, heart failure and stroke associated with GDM, respectively. Combining results from this study with those from previously related studies yielded odds ratios (95% confidence intervals) of 1.81 (1.60–2.05) for CHD (12 studies, 7,615,322 participants, I2= 72.6%), 1.66 (1.25–2.21) for heart failure (5 studies, 4,491,665 participants, I2= 88.6%), and 1.25 (1.07–1.46) for cerebrovascular disease (9 studies, 6,090,848 participants, I2= 77.8%).ConclusionsGDM showed stronger associations with coronary heart diseases and heart failure than cerebrovascular disease, and the excess risks are attributable, in part, to type 2 diabetes.

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Section: Discussionmentioning

confidence: 99%

Association Between Gestational Diabetes Mellitus and the Risks of Type-Specific Cardiovascular Diseases

Mao

Hu²,

Xia

et al. 2022

Front. Public Health

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“…Nevertheless, most women who have had GDM do not attempt or sustain changes to reduce modifiable risk factors but maintain lifestyles that increase their diabetes risk, and many show discrepancy between T2DM risk perception and behaviour [12]. Existing behaviour change interventions have focused on promoting physical activity and a healthy diet, while others have supported breastfeeding after GDM [13]. Intervention modes include group, individual and remote interventions, or a combination of approaches [13].…”

Section: Resultsmentioning

confidence: 99%

“…Existing behaviour change interventions have focused on promoting physical activity and a healthy diet, while others have supported breastfeeding after GDM [13]. Intervention modes include group, individual and remote interventions, or a combination of approaches [13]. Positive effects on preventing T2DM progression are frequently observed but can be limited due to poor engagement, particularly in intensive interventions like the US Diabetes Prevention Programme, in this population [13][14][15][16].…”

Section: Resultsmentioning

confidence: 99%

“Post-GDM support would be really good for mothers”: A qualitative interview study exploring how to support a healthy diet and physical activity after gestational diabetes

et al. 2022

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Background Women with a history of gestational diabetes mellitus (GDM) are at high risk of developing type 2 diabetes mellitus (T2DM). They are therefore recommended to follow a healthy diet and be physically active in order to reduce that risk. However, achieving and maintaining these behaviours in the postpartum period is challenging. This study sought to explore women’s views on suggested practical approaches to achieve and maintain a healthy diet and physical activity to reduce T2DM risk. Methods Semi-structured interviews with 20 participants in Cambridgeshire, UK were conducted at three to 48 months after GDM. The participants’ current diet and physical activity, intentions for any changes, and views on potential interventions to help manage T2DM risk through these behaviours were discussed. Framework analysis was used to analyse the transcripts. The interview schedule, suggested interventions, and thematic framework were based on a recent systematic review. Results Most of the participants wanted to eat more healthily and be more active. A third of the participants considered that postpartum support for these behaviours would be transformative, a third thought it would be beneficial, and a third did not want additional support. The majority agreed that more information about the impact of diet and physical activity on diabetes risk, support to exercise with others, and advice about eating healthily, exercising with a busy schedule, monitoring progress and sustaining changes would facilitate a healthy diet and physical activity. Four other suggested interventions received mixed responses. It would be acceptable for this support to be delivered throughout pregnancy and postpartum through a range of formats. Clinicians were seen to have important roles in giving or signposting to support. Conclusions Many women would appreciate more support to reduce their T2DM risk after GDM and believe that a variety of interventions to integrate changes into their daily lives would help them to sustain healthier lifestyles.

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“…Several randomized clinical trials have studied diabetes prevention with a pharmacologic intervention in women with a history of GDM. 51,[56][57][58][59][60] Troglitazone 59 and pioglitazone 60 have been shown to be more effective than placebo in preventing progression to type 2 diabetes but are not recommended for women of reproductive age.…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

Pregnancy as an opportunity to prevent type 2 diabetes mellitus: FIGO Best Practice Advice

Adam

McIntyre

Tsoi

et al. 2023

Intl J Gynecology & Obste

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Gestational diabetes (GDM) impacts approximately 17 million pregnancies worldwide. Women with a history of GDM have an 8–10‐fold higher risk of developing type 2 diabetes and a 2‐fold higher risk of developing cardiovascular disease (CVD) compared with women without prior GDM. Although it is possible to prevent and/or delay progression of GDM to type 2 diabetes, this is not widely undertaken. Considering the increasing global rates of type 2 diabetes and CVD in women, it is essential to utilize pregnancy as an opportunity to identify women at risk and initiate preventive intervention. This article reviews existing clinical guidelines for postpartum identification and management of women with previous GDM and identifies key recommendations for the prevention and/or delayed progression to type 2 diabetes for global clinical practice.

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Diabetes prevention interventions for women after gestational diabetes mellitus: an overview of reviews

Abstract: Systematic review registration: www.crd.york.ac.uk/ PROSPERO CRD42014013597.

Cited by 35 publications

References 53 publications

Association Between Gestational Diabetes Mellitus and the Risks of Type-Specific Cardiovascular Diseases

Association Between Gestational Diabetes Mellitus and the Risks of Type-Specific Cardiovascular Diseases

“Post-GDM support would be really good for mothers”: A qualitative interview study exploring how to support a healthy diet and physical activity after gestational diabetes

Pregnancy as an opportunity to prevent type 2 diabetes mellitus: FIGO Best Practice Advice

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