Avoiding Diabetes After Pregnancy Trial In Moms (ADAPT- M): Evaluating Fitness In Postpartum Women Who Have Had Recent Gestational Diabetes Mellitus (GDM)

Abstract

Gestational diabetes mellitus (GDM) affects approximately 6% of women, and 20% develop type 2 diabetes (T2DM) by 10 years post delivery with higher rates in non-Caucasian ethnic groups. Early postpartum lifestyle interventions such as physical activity (PA) are recommended to improve health outcomes and reduce future T2DM. Despite benefits of PA, postpartum women report difficulty to engage and adhere to PA due to barriers such as childcare and poor support. Little is known about whether this high-risk group are achieving age-predicted fitness (APF) and meeting PA guidelines. PURPOSE: To describe cardiorespiratory fitness and PA levels in Caucasian and non-Caucasian women with recent GDM, and the association between fitness and PA measures. METHODS: This cross-sectional study recorded baseline data from a multi-ethnic cohort of women with recent GDM at 12 to 20 weeks postpartum, who were part of a health-coaching intervention called Avoiding Diabetes after Pregnancy Trial in Moms (ADAPT-M) between 2014 and 2017. Women underwent a graded exercise treadmill test, anthropometric measures, diastasis rectus screening and completed the International Physical Activity Questionnaire (IPAQ). Baseline characteristics were compared between Caucasian and non-Caucasian ethnicity using T-test, Chi square and Mann-Whitney U tests. The relationship between APF and PA guidelines was assessed with a Chi-Square test. RESULTS: We evaluated 149 participants at mean 16.5 + 4.3 weeks postpartum (mean age 36.7 + 4.6 years, 70.5% non-Caucasian), had a mean fitness of 9.7+1.9 metabolic equivalents (98 + 19.2 % APF), body fat 36.2 + 5.6%, BMI 29.7 + 6.8 kg/m2, and diastasis rectus was present in 20%. Of those, 52% were below APF while 84.5% were meeting PA guidelines (IPAQ). Non-Caucasian women were significantly less likely to meet PA guidelines (p=0.0002) and had lower PA levels (p<0.001). Overall, level of PA on the IPAQ did not correlate with APF (p <0.10). CONCLUSION: Postpartum women with recent GDM had average APF and 84.5% were meeting PA guidelines, although significantly lower levels were seen in non-Caucasian women. Level of PA on the IPAQ did not correlate with APF in this population. Postpartum diabetes prevention programs for women with recent GDM should optimize PA, particularly for higher-risk non-Caucasian ethnic groups.