A pregnancy and postpartum lifestyle intervention in women with gestational diabetes mellitus reduces diabetes risk factors: a feasibility randomized control trial

Assiamira Ferrara, Monique M Hedderson, Cheryl L Albright, Samantha F Ehrlich, Charles P Quesenberry Jr, Tiffany Peng, Juanran Feng, Jenny Ching, Yvonne Crites, Assiamira Ferrara, Monique M Hedderson, Cheryl L Albright, Samantha F Ehrlich, Charles P Quesenberry Jr, Tiffany Peng, Juanran Feng, Jenny Ching, Yvonne Crites

Abstract

Objective: To pilot, among women with gestational diabetes mellitus (GDM), the feasibility of a prenatal/postpartum intervention to modify diet and physical activity similar to the Diabetes Prevention Program. The intervention was delivered by telephone, and support for breastfeeding was addressed.

Research design and methods: The goal was to help women return to their prepregnancy weight, if it was normal, or achieve a 5% reduction from prepregnancy weight if overweight. Eligible participants were identified shortly after a GDM diagnosis; 83.8% consented to be randomly assigned to intervention or usual medical care (96 and 101 women, respectively). The retention was 85.2% at 12 months postpartum.

Results: The proportion of women who reached the postpartum weight goal was higher, although not statistically significant, in the intervention condition than among usual care (37.5 vs. 21.4%, absolute difference 16.1%, P=0.07). The intervention was more effective among women who did not exceed the recommended gestational weight gain (difference in the proportion of women meeting the weight goals: 22.5%, P=0.04). The intervention condition decreased dietary fat intake more than the usual care (condition difference in the mean change in percent of calories from fat: -3.6%, P=0.002) and increased breastfeeding, although not significantly (condition difference in proportion: 15.0%, P=0.09). No differences in postpartum physical activity were observed between conditions.

Conclusions: This study suggests that a lifestyle intervention that starts during pregnancy and continues postpartum is feasible and may prevent pregnancy weight retention and help overweight women lose weight. Strategies to help postpartum women overcome barriers to increasing physical activity are needed.

Trial registration: ClinicalTrials.gov NCT00460018.

Figures

Figure 1
Figure 1
Flow chart of participant recruitment and retention, Kaiser Permanente Northern California, 2005–2009.

References

    1. Jovanovic L, Pettitt DJ. Gestational diabetes mellitus. JAMA 2001;286:2516–2518
    1. Ferrara A, Kahn HS, Quesenberry CP, Riley C, Hedderson MM. An increase in the incidence of gestational diabetes mellitus: Northern California, 1991-2000. Obstet Gynecol 2004;103:526–533
    1. Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 2009;373:1773–1779
    1. Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care 2002;25:1862–1868
    1. Lee AJ, Hiscock RJ, Wein P, Walker SP, Permezel M. Gestational diabetes mellitus: clinical predictors and long-term risk of developing type 2 diabetes: a retrospective cohort study using survival analysis. Diabetes Care 2007;30:878–883
    1. Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001;344;1343–1350
    1. Knowler WC, Barrett-Connor E, Fowler SE, et al. ; Diabetes Prevention Program Research Group Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393–403
    1. Buchanan TA, Xiang AH, Peters RK, et al. Preservation of pancreatic beta-cell function and prevention of type 2 diabetes by pharmacological treatment of insulin resistance in high-risk Hispanic women. Diabetes 2002;51:2796–2803
    1. Mamun AA, Kinarivala M, O’Callaghan MJ, Williams GM, Najman JM, Callaway LK. Associations of excess weight gain during pregnancy with long-term maternal overweight and obesity: evidence from 21 y postpartum follow-up. Am J Clin Nutr 2010;91:1336–1341
    1. Linné Y, Dye L, Barkeling B, Rössner S. Long-term weight development in women: a 15-year follow-up of the effects of pregnancy. Obes Res 2004;12:1166–1178
    1. Amorim AR, Rössner S, Neovius M, Lourenço PM, Linné Y. Does excess pregnancy weight gain constitute a major risk for increasing long-term BMI? Obesity (Silver Spring) 2007;15:1278–1286
    1. Diabetes Prevention Program. Lifestyle Manuals of Operation. 1996. Available from . Accessed on 1 October 2010.
    1. American Diabetes Association Gestational diabetes mellitus (Position Statement). Diabetes Care 2000;23(Suppl. 1):S77–S79
    1. Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ, Prentice Hall, 1986
    1. Prochaska JO, DiClemente CC. Common processes of self-change in smoking, weight control and psychological distress. In Coping and Substance Use. Shiffman S, Wills T, Eds. New York, Academic Press, 1985, p. 345–363
    1. Committee on Nutritional Status During Pregnancy and Lactation, Institute of Medicine. Nutrition During Pregnancy. Part I: Weight Gain. Washington, DC, National Academy of Sciences, Food and Nutrition Board, 1990
    1. Sheard NF, Clark NG, Brand-Miller JC, et al. Dietary carbohydrate (amount and type) in the prevention and management of diabetes: a statement by the American Diabetes Association. Diabetes Care 2004;27:2266–2271
    1. Exercise during pregnancy and the postpartum period. ACOG Technical Bulletin Number 189—February 1994. Int J Gynaecol Obstet 1994;45:65–70
    1. Gartner LM, Morton J, Lawrence RA, et al. ; American Academy of Pediatrics Section on Breastfeeding Breastfeeding and the use of human milk. Pediatrics 2005;115:496–506
    1. The Diabetes Prevention Program's Lifestyle Change Program Participant Notebook. The Diabetes Prevention Program Lifestyle Resource Core. Wing R, Gillis, B, Eds . Pittsburgh, PA, University of Pittsburgh, 1996
    1. Patterson RE, Kristal AR, Tinker LF, Carter RA, Bolton MP, Agurs-Collins T. Measurement characteristics of the Women’s Health Initiative food frequency questionnaire. Ann Epidemiol 1999;9:178–187
    1. Sallis JF, Haskell WL, Wood PD, et al. Physical activity assessment methodology in the Five-City Project. Am J Epidemiol 1985;121:91–106
    1. Moses RG, Shand JL, Tapsell LC. The recurrence of gestational diabetes: could dietary differences in fat intake be an explanation? Diabetes Care 1997;20:1647–1650
    1. Ratner RE, Christophi CA, Metzger BE, et al. ; Diabetes Prevention Program Research Group Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. J Clin Endocrinol Metab 2008;93:4774–4779
    1. Greene GW, Smiciklas-Wright H, Scholl TO, Karp RJ. Postpartum weight change: how much of the weight gained in pregnancy will be lost after delivery? Obstet Gynecol 1988;71:701–707

Source: PubMed

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