Lifestyle and glycemic health 5\xa0years postpartum in obese and non-obese high diabetes risk women

Emilia Huvinen,Jelena Meinilä,Paula Bergman,Kati Heinonen,Elina Engberg,Janne Kulmala,Beata Stach-Lempinen,Tuija Tammelin,Saila Koivusalo

doi:10.1007/s00592-020-01553-1

Abstract

AimWomen with prior gestational diabetes (GDM) are at increased diabetes risk. This study aimed to assess whether lifestyle is associated with glycemic health of high-risk women 5 years postpartum, taking into account the pre-pregnancy BMI.MethodsThe RADIEL study enrolled before or in early pregnancy 720 women with pre-pregnancy BMI ≥ 30 kg/m2 and/or prior GDM. The follow-up visit 5 years postpartum included questionnaires and measurements of anthropometrics, blood pressure, and physical activity (PA) as well as analyses of glucose metabolism, lipids, and inflammatory markers. We measured body composition (Inbody) and calculated a Healthy Food Intake Index (HFII) from Food Frequency Questionnaires (FFQ). ArmBand measured PA, sedentary time, and sleep. To take into account the diverse risk groups of GDM, we divided the women based on pre-pregnancy BMI over/under 30 kg/m2.ResultsAltogether 348 women attended the follow-up. The obese and non-obese women showed similar prevalence of glycemic abnormalities, 13% and 19% (p = 0.139). PA levels were higher among the non-obese women (p < 0.05), except for step count, and their HFII was higher compared to the obese women (p = 0.033). After adjusting for age, education, and GDM history, PA and HFII were associated with glycemic health only among obese women. When both lifestyle factors were in the same model, only PA remained significant. PA associated with other markers of metabolic health also among the non-obese women, excluding HbA1c.ConclusionLifestyle 5 years postpartum was associated with better glycemic health only among the obese high-risk women. PA, however, is essential for the metabolic health of all high-risk women.Clinical trial registrationClinicalTrials.gov, http://www.clinicaltrials.com, NCT01698385.

Highlights

The escalating epidemic of obesity and diabetes [1] requires efficient methods for prevention
The RADIEL (The Finnish Gestational Diabetes Prevention) lifestyle intervention starting during pregnancy and continuing during the 1st postpartum year successfully reduced the incidence of glycemic abnormalities 1 year after delivery [7]
Data on glucose metabolism were available for 348 women, Healthy Food Intake Index (HFII) for 298 women, and device-measured physical activity (PA) for 206 women

Summary

Introduction

The escalating epidemic of obesity and diabetes [1] requires efficient methods for prevention. Acta Diabetologica preventable among high-risk groups with lifestyle intervention [2, 3]. Women with a history of gestational diabetes (GDM) are at a sevenfold risk of developing future diabetes [4, 5] and many intervention studies have recently focused on women with prior GDM [6]. The RADIEL (The Finnish Gestational Diabetes Prevention) lifestyle intervention starting during pregnancy and continuing during the 1st postpartum year successfully reduced the incidence of glycemic abnormalities 1 year after delivery [7]. In the RADIEL study, the incidence of glycemic abnormalities was high 5 years postpartum among the non-obese women with prior GDM, and they presented often with normal-weight obesity (NWO), i.e., normal body mass index (BMI) but high body fat percentage [13]

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