Postnatal Lifestyle Intervention for Overweight Women With Previous Gestational Diabetes: A Randomized Controlled Trial

Holmes, Valerie; Draffin, Claire R; Patterson, Chris; Francis, Loraine; Irwin, Jo-anne; McConnell, Mae; Farrell, Brid; Brennan, Sarah; McSorley, Oonagh; Wotherspoon, Amy; Davies, Mark; McCance, David R.

doi:10.1210/jc.2017-02654

Cited by 48 publications

(54 citation statements)

References 40 publications

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“…In this regard, a few RCTs of intensive interventions (lifestyle and insulin if needed) during pregnancy among women with GDM had been conducted to examine the effects of such interventions on postpartum diabetes risk, but none of them observed that interventions of GDM during pregnancy were effective in reducing the risk of diabetes after delivery 6–8 . Many RCTs had also been conducted to test the efficacy and effectiveness of postpartum lifestyle intervention for the prevention of diabetes among women with prior GDM, but most of them did not show that lifestyle modification was effective in reducing the long‐term risk of diabetes, presumably due to small sample size, relative short duration of follow‐up and hence inadequate statistical power 9–13 . Meta‐analyses may be a way to overcome the limitation of statistical power in individual studies.…”

Section: Introductionmentioning

confidence: 99%

Effects of lifestyle intervention on long‐term risk of diabetes in women with prior gestational diabetes: A systematic review and meta‐analysis of randomized controlled trials

Yang

Cui

et al. 2020

Obesity Reviews

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Summary We performed two meta‐analyses to estimate the effects of lifestyle intervention during pregnancy and after delivery on the risk of postpartum diabetes among women with gestational diabetes mellitus (GDM). We searched the major databases to retrieve articles published in English or Chinese before 15 December 2019. The inclusion criteria were randomized controlled trials (RCTs) of diet, physical activity or both, conducted during or after pregnancy among women with GDM. The exclusion criteria were (1) having type 1 or type 2 diabetes before the intervention and (2) without postpartum diabetes documented. Fixed‐effects model analysis was used to obtain the pooled relative risks (RRs) and 95% confidence intervals (CIs) of lifestyle intervention for diabetes in women with GDM. Four RCTs were identified to have implemented the intervention during pregnancy (n = 2883) and 10 to have conducted it within 3 years after delivery (n = 1733). Lifestyle intervention during pregnancy was not effective at reducing the risk of postpartum diabetes (RR: 0.91, 95%CI: 0.66–1.25). However, lifestyle intervention initiated within 3 years after delivery was highly effective in reducing the risk of postpartum diabetes (pooled RR: 0.57, 95% CI: 0.42–0.78). In conclusion, our findings support the early initiation of lifestyle intervention in women with GDM for the prevention of diabetes.

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Section: Introductionmentioning

confidence: 99%

Effects of lifestyle intervention on long‐term risk of diabetes in women with prior gestational diabetes: A systematic review and meta‐analysis of randomized controlled trials

Yang

Cui

et al. 2020

Obesity Reviews

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“…[8][9][10][11][12][13] Studies have also shown that postpartum behavioural weight loss interventions after delivery can help women reduce postpartum weight retention (PPWR) and risk for future obesity. [14][15][16][17] Because adults face multiple demands on their time, remote delivery (i.e. phone) of behavioural counselling and integration of such counselling within the prenatal care setting where women receive usual care has the potential to enhance patient engagement and satisfaction and to promote dissemination.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and acceptability of a remotely‐delivered behavioural health coaching intervention to limit gestational weight gain

Coughlin

Martin

Henderson

et al. 2020

Obesity Science & Practice

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Introduction: Gestational weight gain (GWG) and postpartum weight retention (PPWR) are significant, potentially modifiable, contributors to women's future weight and health trajectories. There is a need for feasible and patient-centered (i.e., convenient, remotely-delivered, technology-enhanced, and accessible through the prenatal care setting) behavioural interventions that limit GWG and PPWR. This study tests the feasibility and acceptability of a remotely-delivered behavioural health coaching intervention to limit gestational weight gain and postpartum weight retention. Methods: Pregnant women (11-16 weeks gestation) were recruited from two prenatal clinics and randomized to the active intervention or health education comparison group. Completion of the program was monitored and perceived helpfulness was rated (0-100). Results: Twenty-six women were randomized (n = 13 per arm; mean age = 31.6 years, SD = 3.6; mean BMI = 26.7 kg/m 2 , SD = 7.4). Participants completed a median of 18 coaching calls and 16/19 learning activities during pregnancy, and a median of 6 calls and 5/6 learning activities postpartum. They logged weights at least once/week for a median of 36/38 expected weeks and tracked daily calories and exercise for a median of 154/266 days and 72/266 days, respectively. Median (Q1, Q3) helpfulness ratings of the program during pregnancy were 80 (64, 91) and 62 (50, 81) postpartum; helpfulness ratings of coaching calls were 85 (58, 98). At 37 weeks gestation, 77% of participants achieved IOM weight gain recommendations compared to 54% in the comparison group. Conclusions: This study provides evidence for the feasibility and acceptability of a remotely-delivered behavioural weight control intervention in pregnancy and postpartum.

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“…Twenty‐three studies had a low risk of bias in the randomization process, most studies (>90%) had a high risk of bias in deviations from intended interventions and more than half of the studies (29/36 studies) had a low risk of bias from missing outcome data, of which 10 studies reported intention‐to‐treat analyses . Three studies were at high risk of bias from missing outcome data with a higher drop‐out rate in the intervention group and less than one‐third of the studies (11/36) had a low risk of bias from the measurement of outcome . All of the studies had a low risk of bias from selective reporting apart for two studies that analyzed the same outcomes through different methods .…”

Section: Resultsmentioning

confidence: 98%

“…The postpartum phase for recruitment ranged from 3 weeks to 12 months. 24,[28][29][30][31] Twelve studies recruited participants with overweight or obesity at baseline (i.e., in the postpartum period), 28,[31][32][33][34][35][36][37][38][39][40][41] five studies recruited women with overweight or obesity according to prepregnancy BMI, 40,[42][43][44][45] one study recruited women with excessive gestational weight gain of more than 6Á8 kg, 46 three recruited only those with postnatal depression, 24,47,48 four recruited only women with a history of gestational diabetes, 27,39,41,49 and one recruited only those with type 2 diabetes. 50 The remaining studies recruited from the general postpartum population.…”

Section: Systematic Review and Meta-analysismentioning

confidence: 99%

“…25,29,31,36,39,44,46,47,[51][52][53] Three studies were at high risk of bias from missing outcome data with a higher drop-out rate in the intervention group and less than one-third of the studies (11/36) had a low risk of bias from the measurement of outcome. 37,38,41 All of the studies had a low risk of bias from selective reporting apart for two studies that analyzed the same outcomes through different methods. 27,54 Funnel plots of body weight, BMI, and energy intake were largely symmetrical, which suggested a low risk of publication bias ( Figure S1).…”

Section: Systematic Review and Meta-analysismentioning

confidence: 99%

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An evaluation of the impact of lifestyle interventions on body weight in postpartum women: A systematic review and meta‐analysis

et al. 2020

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Summary The established efficacy in postpartum lifestyle interventions has not been translated into better outcomes. This systematic review and meta‐analysis assess the penetration (the proportion of women invited within the target population), implementation (fidelity), participation (the proportion of those invited who enrolled), and effect (weight loss compared to controls) (PIPE) of randomized controlled trials of lifestyle interventions in postpartum women (within two years after birth). MEDLINE, EMBASE, Pubmed, and other databases and clinical trial registries were searched up to the 3rd of May 2019. Data was extracted from published reports and missing data was obtained from study authors. The quality of the studies was appraised using the Cochrane Risk of Bias tool (2·0). Main outcomes were the PIPE impact metrics and changes in body weight. Thirty‐six trials (49 publications) were included (n=5,315 women). One study provided sufficient information to calculate the population penetration rate (2·5%). All studies provided implementation (fidelity) information, but over half had low program fidelity. The participation rate was calculated for nine studies (0·94% to 86%). There was significant change in body weight (mean difference (MD) (95% confidence interval, CI) of ‐2·33 (‐3·10 to ‐1·56). This highlights the inadequacy of conventional RCTs to inform implementation. Future research should broaden methods to pragmatic trials.

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Postnatal Lifestyle Intervention for Overweight Women With Previous Gestational Diabetes: A Randomized Controlled Trial

Cited by 48 publications

References 40 publications

Effects of lifestyle intervention on long‐term risk of diabetes in women with prior gestational diabetes: A systematic review and meta‐analysis of randomized controlled trials

Effects of lifestyle intervention on long‐term risk of diabetes in women with prior gestational diabetes: A systematic review and meta‐analysis of randomized controlled trials

Feasibility and acceptability of a remotely‐delivered behavioural health coaching intervention to limit gestational weight gain

An evaluation of the impact of lifestyle interventions on body weight in postpartum women: A systematic review and meta‐analysis

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