Prevention of Type 2 diabetes after gestational diabetes directed at the family context: a narrative review from the Danish Diabetes Academy symposium

Abstract

In this review, we aim to summarize knowledge about gestational diabetes mellitus (GDM) after delivery; with special focus on the potential of preventing Type 2 diabetes in a family context. The review expands on the key messages from a symposium held in Copenhagen in May 2017 and highlights avenues for future research. A narrative review of the symposium presentations and related literature is given. GDM is associated with increased short- and long-term adverse outcomes including Type 2 diabetes for both mother and offspring. Interestingly, GDM in mothers also predicts diabetes in the fathers. Thus, although GDM is diagnosed in pregnant women, the implications seem to affect the whole family. Structured lifestyle intervention can prevent or delay the onset of Type 2 diabetes. In this review, we show how numerous challenges are present in the target group, when such interventions are sought and implemented in real-world settings. Although interlinked and interacting, barriers to maintaining a healthy lifestyle post-partum can be grouped into those pertaining to diabetes beliefs, the family context and the healthcare system. Health literacy level and perceptions of health and disease risk may modify these barriers. There is a need to identify effective approaches to health promotion and health service delivery for women with prior GDM and their families. Future efforts may benefit from involving the target group in the development and execution of such initiatives as one way of ensuring that approaches are tailored to the needs of individual women and their families.

Barriers and facilitators to a healthy lifestyle in postpartum women: A systematic review of qualitative and quantitative studies in postpartum women and healthcare providers

“…Feeling unmotivated, lack of enjoyment of exercise or healthy food, low self‐worth, perception of ability and unwillingness to change were barriers relating to motivation identified in this review and have been similarly reported in previous literature 61,65 . Motivational interviewing techniques and patient‐centred approaches could be useful in improving motivation to engage in physical activity and healthy eating 67 .…”

“…Because of the strong influence of the family on women's lifestyle choices and the reliance on family for social support, lifestyle interventions for postpartum women should take a family‐focused approach 49,64 . Considering that the child's health and well‐being is a priority for postpartum mothers, proposing the need to be role models for their children may be an effective strategy to facilitate long‐term lifestyle change 17,65 . Changes at the community and policy level such as provision of childcare at exercise facilities and safe walking paths for mothers with pram may also be effective in promoting physical activity 66…”

Exploring the effectiveness of physical activity interventions in women with previous gestational diabetes: A systematic review of quantitative and qualitative studies

“…A recent review by Nielsen and colleagues highlighted the importance of family-contextualised interventions to increase physical activity in women with a history of GDM (Nielsen et al, 2018). Their narrative review highlighted that “much remains to be understood about what such strategies should involve if they are to be effective” (p. 717), and emphasised the need for multiple avenues of intervention, from psychological to social approaches (Nielsen et al, 2018). This review aimed to fill that gap in understanding by exploring what factors women with previous GDM say is important to them when considering physical activity and how well these factors are represented in previous trials of physical activity interventions.…”

Diabetes after pregnancy prevention trials: Systematic review for core outcome set development

“…The diabetes prevention programme participants had already developed impaired glucose tolerance, and women were enrolled an average of 12 years after their first GDM pregnancy. These women were much further along the trajectory to develop DAP and at a different life stage compared with women within 5 years of GDM pregnancy (Kragelund Nielsen, Groth Grunnet, & Terkildsen Maindal, ; Nielsen, Kapur, Damm, de Courten, & Bygbjerg, ). Importantly, at least half of women with a GDM history who develop DAP do so within 5 years of a GDM pregnancy (Kim, Newton, & Knopp, ; Pace, Brazeau, Meltzer, Rahme, & Dasgupta, ).…”