Appreciating Recent Motherhood and Culture: A Systematic Review of Multimodal Postpartum Lifestyle Interventions to Reduce Diabetes Risk in Women with Prior Gestational Diabetes.

Abstract

Objectives Gestational diabetes mellitus (GDM) substantially increases a woman's lifetime risk of developing type 2 diabetes mellitus (DM). Lifestyle modification interventions have been effective in preventing DM in high-risk populations but present challenges in diverse, postpartum women. We systematically reviewed the literature to synthesize current knowledge and practices around tailoring multimodal, primarily home-based interventions for situational and cultural relevance to reduce DM risk in women with prior GDM. Methods We identified original research articles published from January 2000 through July 2015 describing randomized controlled trials testing multimodal interventions to reduce DM risk in women with prior GDM. We compared articles by study objective, delivery modes, intervention components, degree of individualization, theoretical basis, design, population, outcome variables, and findings. Results Ten studies met the inclusion criteria. Telephone and mailings (n=7) and websites (n=3) were the primary modes of participant contact in these primarily home-based interventions. These studies demonstrate that individualizing interventions may contribute to increased postpartum weight loss and improved dietary behaviors; however, researchers remain challenged to improve physical activity in this population. Additionally, even when testing primarily home-based interventions, recruitment rates were very low, underscoring challenges of engaging this population in lifestyle changes. Conclusions Postpartum interventions addressing the broader social-ecological dimensions of health behaviors should be tested in women with prior GDM. Researchers and clinicians must continue to explore ways to engage women, including women's families and communities, in interventions to adequately address the sociocultural determinants that affect women's lifestyle behaviors impacting their DM risk.