Preventing Type 2 Diabetes in Women with Previous Gestational Diabetes: Reviewing the Implementation Gaps for Health Behavior Change Programs

Abstract

Gestational diabetes mellitus (GDM) places a woman at high risk of developing subsequent type 2 diabetes mellitus (T2DM), particularly in the first 5 years postpartum. Engaging women in health behavior change during this period is challenging and current diabetes prevention programs were developed for middle-aged adults, all of which have limited the evidence on successful implementation for this high-risk population. In this review, we will first summarize the effects of existing diabetes prevention programs in women with a history of GDM. Second, we suggest that the programs need to be modified according to the facilitators and barriers faced by this population. Third, we propose that improving program penetration, fidelity, and participation is critical for population-level success. Finally, we outline the research priorities to improve the implementation of diabetes prevention programs for postpartum women with a history of GDM.

Implementing weight management during and after pregnancy to reduce diabetes and CVD risk in maternal and child populations

“…The other aspect to this gap is that the interventions all focus on behaviour change in either the woman or the infant but not both, yet there are clear opportunities to leverage the impact of change in this instance by creating a more holistic approach to behaviour change at the family unit level. Research also indicates that the guidance available to inform translating the evidence into practice is lacking in terms of health service implementation or optimal programme delivery (88,96,97) . There is a clear need to use implementation science methods to inform the integration of effective lifestyle interventions into routine antenatal and postpartum care if we are to reduce the burdens of overweight and obesity and its impacts.…”

Acceptability and adoption of the Face‐it health promotion intervention targeting women with prior gestational diabetes and their partners: A qualitative study of the perspectives of healthcare professionals

“…5 One of the explanations may be that interventions do not account for the individual, family, and health system barriers faced by women with recent GDM in adopting healthy behaviours after delivery. 6,7 In Denmark, women with prior GDM are advised to attend yearly consultations with their general practitioners (GPs), but few do. 8 Currently, no other formalised follow-up exists for women with prior GDM, leaving a missed opportunity for diabetes prevention.…”

“…However, when these health behaviour interventions are sought replicated in other settings, the effects on type 2 diabetes risk tend to attenuate 5 . One of the explanations may be that interventions do not account for the individual, family, and health system barriers faced by women with recent GDM in adopting healthy behaviours after delivery 6,7 . In Denmark, women with prior GDM are advised to attend yearly consultations with their general practitioners (GPs), but few do 8 .…”

A Complex mHealth Coaching Intervention to Prevent Overweight, Obesity, and Diabetes in High-Risk Women in Antenatal Care: Protocol for a Hybrid Type 2 Effectiveness-Implementation Study

“…Postpartum and interpregnancy reach, penetration, and participation are all key barriers to both efficacy and implementation, and evidence is not yet strong enough to recommend population-level scale-up. Few studies have engaged women in pregnancy to optimize reach and participation in the face of competing family demands and less contact with the health system [ 28 ]. Again, implementation research in the real world that addresses these barriers is vital to inform population-level strategies and future roll-out and scale-up.…”