Abstract
BackgroundWomen with gestational diabetes have low diet quality. We evaluated the effectiveness of a group-based lifestyle modification program for improvement of dietary quality in women with previous gestational diabetes predominantly within their first postnatal year.MethodsWomen were randomised to intervention (n = 284) or usual care (n = 289). Dietary data was collected at baseline and twelve months using a food frequency questionnaire and recoded into the Australian Recommended Food Score (ARFS). Mixed model analyses investigated the intervention effect on ARFS (per-protocol-set (PPS) excluded women without the minimum intervention exposure).ResultsBaseline mean total ARFS was low (31.8 ± 8.9, maximum score = 74) and no significant changes were seen in total ARFS (Cohen’s D = − 0.06). 2% reduction in alcohol for intervention (0.05, 0.26) compared with − 1% for usual care (Odds ratio: 0.68; 95%CI 0.46, 0.99). Dairy ARFS sub-category significantly improved (low fat/saturated fat foods) in the intervention group over time compared with usual care for the PPS analysis (dairy + 0.28 in intervention (95%CI 0.08, 0.48) compared with + 0.02 in usual care (95%CI -0.14, 0.18) (group-by-treatment interaction p = 0.05, Cohen’s D = 0.14)).ConclusionsEngaging with the intervention improved aspects of diet quality that aligned with minimum intervention exposure, but the total diet quality remains low. Further research is needed to improve diabetes prevention program engagement.Trial registrationAustralian New Zealand Clinical Trials Registry ANZCTRN12610000338066, April 2010.
Highlights
Women with gestational diabetes have low diet quality
According to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria, about one in five pregnancies are complicated with Gestational diabetes mellitus (GDM) [1] and this will lead to increased risk of caesarean section, macrosomia and preeclampsia [2]
The intervention group’s mean increase in fasting blood glucose was 0.18 mmol/L compared with an increase of 0.22 mmol/L in the usual care group over 12 months
Summary
Women with gestational diabetes have low diet quality. We evaluated the effectiveness of a group-based lifestyle modification program for improvement of dietary quality in women with previous gestational diabetes predominantly within their first postnatal year. O’Reilly et al BMC Women's Health (2019) 19:88 prevention programs in women with previous GDM have shown small but significant reduction in T2DM incidence and insulin resistance [11] Participants in such programs are generally younger and healthier than typical older at-risk populations but a small, earlier intervention effect can potentially yield greater benefits in terms of health over the longer term - if improvements are sustained. Achieving a greater number of quantitative dietary goals (e.g. less than 30% energy from fat, less than 10% energy from saturated fat, and increased fibre) are associated with an incremental reduction in diabetes risk [14] To achieve these defined macronutrient goals, specific individualised meal plans are required yet these are rarely done in routine disease prevention practice because long term adherence is challenging [15]. Achieving qualitative dietary changes are potentially more likely for diabetes prevention in postpartum women over achieving set macronutrient intakes and describing the resulting changes in terms of food groups and food types may be a better reflection of dietary advice uptake
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