Identifying postpartum intervention approaches to prevent type 2 diabetes in women with a history of gestational diabetes

Abstract

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

Evaluation of the Effect of Corrected Nutrition on Reduction of Stress in Gestational Diabetes

“…In one of the related studies, most participants changed their life style based on information available on the Internet. The authors suggested the low cost of acquiring information via the Internet and the difficulties of attending classes and receiving face-toface training, as the causes of inclination towards the use of the Internet as an information source (23). All these studies are somehow consistent with the present study and reflect the strong role of training in creating motivation for self-care and for making lifestyle changes.…”

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

“…It has been shown, for example, that only 16% of women with previous GDM believed themselves to be at high risk for T2D, and women with greater perceptions of risk intended more often to change their lifestyle in a healthier direction. 19 Common barriers to lifestyle changes in women with GDM have been child care duties, fatigue, work-related obstacles, and lack of time and motivation 18 and-for example, in a behavioral intervention study among women with GDM-an increase in physical activity targets was not attained. 14 Our result of the effect of lifestyle intervention on the incidence of T2D between women with and without GDM is in line with the results of the DPP trial.…”

“…We cannot analyze in detail the true effectiveness of our intervention due to the lack of counselling data collected. We suggest that novel approaches, such as Internet-based lifestyle interventions, 18 may also be useful in order to benefit more from lifestyle interventions in women with GDM. An interesting finding was also that a high number of women at risk did not participate in the program at all after the baseline, reflecting the situation ''in real life.''…”

“…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. 12 It has been suggested that women with GDM may have many barriers to lifestyle changes, such as lack of motivation, financial and time constraints, childcare duties, fatigue, and work-related obstacles, 18 and they may not perceive themselves as being at high risk for T2D after delivery. 19 Some studies have already shown that favorable outcomes are difficult to achieve by lifestyle interventions in this population.…”

Procrastination as a Key Factor in Postpartum Screening for Diabetes: A Qualitative Study of Iranian Women with Recent Gestational Diabetes

“…In previous studies, there was controversy about the relationship between using insulin in GDM and doing the screening. Some studies reported a positive relationship between insulin use in GDM and screening (15,21). Another study reported a negative relationship (22), and some studies reported no relationship (19,23).…”