Lifestyle Interventions After Gestational Diabetes

Abstract

Gestational Diabetes Mellitus (GDM) is a form of diabetes diagnosed during pregnancy affecting up to 16% of pregnant women. Recent guideline changes for GDM diagnosis and increases in obesity and unhealthy lifestyles, have increased the number of women being diagnosed with GDM. Women with GDM are at risk of developing type 2 diabetes, but lifestyle intervention can reduce this risk. PURPOSE: To systematically review published studies on lifestyle interventions for women with prior diagnosis of GDM. This abstract reports on study characteristics, intervention design and study quality and changes in anthropometric and glycaemic control outcomes. METHODS: Databases (Web of Science, The Cochrane Library, EMBASE and Science DIRECT) were searched for randomised controlled trial (RCTs), controlled trials or pre-post design trials of lifestyle interventions targeting women with previous GDM reporting at least one behavioural, anthropometric or diabetes outcome. Relevant data were extracted and methodological quality was assessed using Cochrane criteria for judging bias in intervention studies. Anthropometric and glycemic outcomes were synthesized using meta-analysis with random effects models using weighted mean difference (WMD). Only RCTs were included in the meta-analysis. RESULTS: In total 13 studies were included in the systematic review, three study interventions targeted physical activity only, two targeted diet only and eight targeted a combination of diet and physical activity. Few studies provided information on intervention adherence. Three of the 13 studies were rated as low bias risk. Recruitment rates were poor (7 - 28% of women approached then participated) but study retention was good (retention rate at follow up 80 – 100%). Five studies were included in the meta-analysis of anthropometric outcomes; significant improvement was found in weight (WMD = −1.06kg (95% CI = −1.68, −0.44). Four studies were included in meta-analysis of glucose outcomes; no change was observed in fasting blood glucose (WMD = −0.05mmol/L, 95% CI = −0.21, 0.11). CONCLUSIONS: A lack of methodologically robust trials gives limited evidence on the effect of lifestyle interventions on anthropometric and glycaemic health outcomes in women with prior GDM. Recruitment into trials appears particularly challenging.