Abstract
PurposeTo systematically review lifestyle interventions for women with prior Gestational Diabetes Mellitus (GDM) to report study characteristics, intervention design and study quality and explore changes in 1) diet, physical activity and sedentary behaviour; 2) anthropometric outcomes and; 3) glycaemic control and diabetes risk. MethodsDatabases (Web of Science, CCRCT, EMBASE and Science DIRECT) were searched (1980 to April 2014) using keywords for controlled or pre–post design trials of lifestyle intervention targeting women with previous GDM reporting at least one behavioural, anthropometric or diabetes outcome. Selected studies were narratively synthesized with anthropometric and glycaemic outcomes synthesized using meta-analysis. ResultsThree of 13 included studies were rated as low bias risk. Recruitment rates were poor but study retention good. Six of 11 studies reporting on physical activity reported favourable intervention effects. All six studies reporting on diet reported favourable intervention effects. In meta-analysis, significant weight-loss was attributable to one Chinese population study (WMD=−1.06kg (95% CI=−1.68, −0.44)). Lifestyle interventions did not change fasting blood glucose (WMD=−0.05mmol/L, 95% CI=−0.21, 0.11) or type 2 diabetes risk. ConclusionsLack of methodologically robust trials gives limited evidence for the success of lifestyle interventions in women with prior GDM. Recruitment into trials is challenging.
Highlights
Gestational Diabetes Mellitus (GDM) is a form of diabetes that is diagnosed during pregnancy and affects up to 16% of pregnant women (Coustan et al, 2010)
In meta-analysis, significant weight-loss was attributable to one Chinese population study (WMD = −1.06 kg)
Lifestyle interventions did not change fasting blood glucose (WMD = −0.05 mmol/L, 95% CI = −0.21, 0.11) or type 2 diabetes risk
Summary
Gestational Diabetes Mellitus (GDM) is a form of diabetes that is diagnosed during pregnancy and affects up to 16% of pregnant women (Coustan et al, 2010). The Diabetes Prevention Program (DPP) showed that lifestyle interventions and Metformin reduced type 2 diabetes incidence by 58% and 31% respectively in people with impaired glucose tolerance (IGT), including those with a history of GDM (Ratner et al, 2008). These reductions in incidence rate were maintained up to 10 years (Knowler et al, 2009)
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