Abstract
BackgroundA diagnosis of gestational diabetes (GDM) is associated with an over sevenfold increase in the risk of developing type 2 diabetes (T2D), while among parous women with T2D, up to 30% have a history of GDM. Lifestyle interventions have been shown to reduce the risk of incident T2D in adults with impaired glucose tolerance, including in women with a history of GDM. The aim of this study is to establish whether a group self-management education programme, supported by a mobile web application, can improve levels of physical activity at 12 months in women who have had GDM.MethodsThe study is a randomised controlled trial with follow-up at 6 and 12 months. Primary outcome is change in objectively measured average daily physical activity at 12 months. Secondary outcomes include lipid profile, blood pressure, glycated haemoglobin, obesity, smoking and alcohol status, self-reported physical activity, anxiety, depression and quality of life. Participants are recruited from maternity and diabetes departments in hospital trusts in two sites in the UK. Women aged > 18 years, with a diagnosis of GDM during any pregnancy in the previous 60 months are eligible. Participants need to have a good understanding of written and verbal English, be able to give informed consent and have access to a smart-phone. Women who are pregnant or have type 1 or type 2 diabetes are not eligible. In total, 290 participants will be recruited and randomly assigned, with stratification for age and ethnicity, to either the control group, receiving usual care, or the intervention group who are invited to participate in the Baby Steps programme. This comprises a group education programme and access to a mobile web application which provides an education component and interacts with a wrist-worn activity monitor providing automated messages, setting challenges and encouraging motivation.DiscussionIf effective, the Baby Steps programme could be translated into a primary care-based intervention that women with GDM are referred to in the postnatal period. This could help them make lifestyle changes that could reduce their future risk of T2D.Trial registrationISRCTN, ISRCTN17299860. Registered on 5 April 2017.
Highlights
A diagnosis of gestational diabetes (GDM) is associated with an over sevenfold increase in the risk of developing type 2 diabetes (T2D), while among parous women with T2D, up to 30% have a history of gestational diabetes mellitus (GDM)
The National Institute for Health and Care Excellence (NICE) guidelines on diabetes in pregnancy recommend that women who have been diagnosed with GDM are offered a fasting plasma glucose or HbA1c test at 6–13 weeks postnatally, given lifestyle advice and offered an annual HbA1c test [1]
It recommends that women with an HbA1c of 39–47 mmol/mol (5.7% and 6.4%) are advised that they are at a high risk of developing T2D and should be offered advice, guidance and interventions in line with available guidelines to prevent T2D
Summary
A diagnosis of gestational diabetes (GDM) is associated with an over sevenfold increase in the risk of developing type 2 diabetes (T2D), while among parous women with T2D, up to 30% have a history of GDM. Lifestyle interventions have been shown to reduce the risk of incident T2D in adults with impaired glucose tolerance, including in women with a history of GDM. Maternal outcomes following gestational diabetes Around 700,000 women give birth in England and Wales each year; up to 5% of them have a diagnosis of diabetes in pregnancy [1]. Among women with diabetes in pregnancy, gestational diabetes mellitus (GDM; described as abnormal glucose tolerance which first develops or is recognised during pregnancy) constitutes around 85% of cases, with the remainder due to pre-existing type 1 diabetes (T1D) or type 2 diabetes (T2D). Estimates suggest that lifestyle factors such as obesity, smoking, unhealthy diet and physical inactivity may explain around 50% of the incidence of GDM [5].
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