Recent Gestational Diabetes Mellitus Research Articles

Lactation duration and development of type 2 diabetes and metabolic syndrome in postpartum women with recent gestational diabetes mellitus

BackgroundThe World Health Organization and United Nations Children’s Fund recommend exclusive breastfeeding (EBF) for the first six months of an infant’s life. Although evidence suggests that maintaining breastfeeding has positive impacts on glucose and lipid metabolism in postpartum women with a history of gestational diabetes mellitus (GDM), no study has investigated whether such effects differ between breastfeeding intensities. This study aimed to evaluate the impact of maintaining breastfeeding on prediabetes, type 2 diabetes mellitus (T2DM), and metabolic syndrome (MetS) six months postpartum in women with GDM. This study also examined the potential variations in glucometabolic outcomes between EBF at six months and partial breastfeeding at six months.MethodsThis prospective cohort study included 130 women with recent GDM who experienced live births between 7 September 2020 and 31 January 2023 at a university hospital in Bangkok, Thailand. All the women were free of T2DM and MetS at baseline (six weeks postpartum). We followed up these women six months postpartum to assess their breastfeeding practices (EBF at six months, partial breastfeeding at six months, or not maintaining breastfeeding) and evaluate their progression to prediabetes, T2DM, and MetS. Maintaining breastfeeding was defined as breastfeeding for six months. EBF was determined using the “recall since birth” method.ResultsOf the 130 participants included, the rates of prediabetes, T2DM, and MetS six months postpartum were 33% (n = 43), 2% (n = 3), and 17% (n = 22), respectively. In the unadjusted model, maintaining breastfeeding was associated with a reduction in the risks of prediabetes and MetS but not T2DM. After adjusting for potential confounders, maintaining breastfeeding was a significant protective factor only for prediabetes. The adjusted risk ratios and 95% confidence intervals were 0.54 (0.29, 0.99) for prediabetes and 0.47 (0.19, 1.06) for MetS. When EBF at six months and partial breastfeeding at six months were separately analyzed, the risks of prediabetes and MetS differed between the two groups. In the EBF at six months-to-partial breastfeeding at six months comparison, the adjusted risk ratios (95% confidence intervals) of prediabetes and MetS were 0.46 (0.22, 0.97) vs. 0.79 (0.25, 2.49) and 0.34 (0.11, 0.99) vs. 0.69 (0.22, 2.07), respectively.ConclusionsMaintaining breastfeeding reduced the risk of prediabetes and MetS, but not of T2DM, six months postpartum; these effects were significant only with EBF. These findings indicate that supporting maternal efforts to practice EBF for six months may improve women’s health after GDM.Trial registrationThai Clinical Trials Registry Registration No. TCTR20200902003. Date of registration: September 2, 2020. Date of initial participant enrollment: September 7, 2020.

Impact of postpartum weight change on metabolic syndrome and its components among women with recent gestational diabetes mellitus

BackgroundWhile postpartum weight changes may affect the levels of metabolic parameters, the direct effects of weight changes in the postpartum period on changes in the prevalence rates of metabolic syndrome and its components remain unstudied. This study aimed to investigate the effects of postpartum weight changes between 6 weeks and 6 months on changes in the prevalence rates of metabolic syndrome and its components in women who have recently experienced gestational diabetes mellitus.MethodsThis prospective cohort study included 171 postpartum women with recent gestational diabetes mellitus, who underwent serial weight and metabolic risk factor assessments at 6 weeks and 6 months postpartum. Weight changes between these time points were classified as weight loss (> 2 kg), weight stability (± 2 kg), or weight gain (> 2 kg). Metabolic syndrome comprised the following metabolic risk factors: large waist circumference, elevated blood pressure, elevated fasting plasma glucose levels, high triglyceride levels, and low high-density lipoprotein cholesterol levels.ResultsOf the 171 women in our cohort, 30 women (17.5%) lost > 2 kg of body weight, while 85 (49.7%) maintained a stable weight and 56 (32.8%) gained > 2 kg. The weight loss group experienced significant changes in the prevalence rates of the following metabolic risk factors compared to the weight stability and weight gain groups: large waist circumference (% change: − 26.7 vs − 5.9 vs 5.4, respectively; p = 0.004), elevated fasting plasma glucose levels (% change: − 3.4 vs 18.9 vs 26.8, respectively; p = 0.022), and high triglyceride levels (% change: − 30.0 vs 0 vs − 7.2, respectively; p = 0.024). A significantly greater decrease in the prevalence of metabolic syndrome was also found in the weight loss group than in the other two groups (% change: − 20.0 vs 11.8 vs 14.2, respectively; p = 0.002).ConclusionsWeight changes from 6 weeks to 6 months postpartum significantly altered the prevalence rates of metabolic syndrome and its components in women with recent gestational diabetes mellitus. Early postpartum weight loss can reverse metabolic risk factors and reduce the prevalence of metabolic syndrome.Trial registrationThai Clinical Trials Registry: Registration no. TCTR20200903001. Date of registration: September 3, 2020. Date of initial participant enrolment: September 7, 2020.

Machine Learning for Early Diabetes Detection and Diagnosis

In this work, a machine learning (ML)-based e-diagnostic system is suggested specifically for the detection of gestational diabetes mellitus (GDM). Reviewing recent GDM data and outlining the intimate connection between GDM and prediabetic conditions, as well as the potential for future declines in insulin resistance and the emergence of overt Type 2 diabetes, were our goals. The present study explores the application of the K-nearest neighbors (KNN) algorithm to project diabetes diagnosis on the widely-used Pima Indians Diabetes database. The KNN algorithm, a non-parametric, instance-based learning method, was employed to classify individuals as either diabetic or non-diabetic, our objectives were to evaluate the algorithm’s ability to make accurate predictions and explore factors influencing its performance. The study commenced with data preprocessing, including handling missing values, feature scaling, and data splitting into training and testing sets. The KNN classifier was trained and tested using these best-fit parameters. The results of this study revealed a model with an accuracy of approximately 0.76 in predicting diabetes diagnosis. This study looked at the various machine-learning approaches for diabetes patient classification, including recall, accuracy, precision, and F1-score. The study discusses the significance of hyperparameter tuning, data preprocessing, and imbalanced data handling in achieving optimal KNN model performance. Lastly, this study shows how the KNN algorithm may be used to project diabetes using the Pima Indians Diabetes Database. The findings suggest that KNN can serve as a viable tool in the early detection of diabetes, paving the way for more extensive applications in healthcare and predictive modelling.

Effect of dietary and physical activity behavioral interventions on reducing postpartum weight retention among women with recent gestational diabetes: A systematic review and meta-analysis of randomized controlled trials.

Postpartum weight retention (PPWR) increases the risk of long-term obesity and metabolic disease in women with recent gestational diabetes mellitus (GDM). This systematic review aimed to assess the effectiveness of dietary and physical activity behavior interventions in reducing PPWR. We systematically searched 13 electronic databases to retrieve articles published in English or Chinese before October 22, 2022. Randomized controlled trials (RCTs) that assessed dietary and/or physical activity behaviors interventions on the outcomes of PPWR among women with recent GDM were included. Twelve studies researched a total of 5672 participants. The meta-analysis indicated that dietary and physical activity behaviors interventions showed significant effects on the pooled effect size of body weight changes (WMD = -2.19, 95% CIs: -3.39, -0.98 kg), body mass index (WMD = -0.98, 95% CIs: -1.56, -0.39 kg/m2 ), and waist circumference (WMD = -1.20, 95% CIs: -2.49, 0.08 cm). Furthermore, the intervention group was more likely to achieve weight reduction (OR = 0.76, 95% CIs: 0.67, 0.87) than the control group. Postpartum dietary and physical activity behavior interventions for women with a recent GDM can reduce PPWR, and 1 year postpartum may be a window of opportunity.

Health promotion intervention among women with recent gestational diabetes mellitus: penetration, participation, and baseline findings from the Face-it randomized controlled trial

IntroductionFace-it is a randomized controlled trial for women with recent gestational diabetes mellitus (GDM) and their families designed to evaluate the effect of a health promotion intervention on type 2...

Motivation for Behavior Change among Women with Recent Gestational Diabetes and Their Partners-A Qualitative Investigation among Participants in the Face-It Intervention.

Promoting diet and physical activity is important for women with recent gestational diabetes mellitus (GDM) and their partners to reduce the risk of future type 2 diabetes (T2D). The study aimed to understand how motivation for changing diet and physical activity behaviors among women with recent GDM and their partners was experienced after participation in the Danish Face-it intervention. Fourteen couples' interviews were conducted. Data analysis followed a reflexive thematic analysis. Guided by self-determination theory and interdependence theory, we identified four themes affecting couples' motivation for health behavior change: (1) The need to feel understood after delivery; (2) adjusting health expectations; (3) individual and mutual preferences for health behaviors; and (4) the health threat of future T2D as a cue to action. We found that couples in general perceived the Face-it intervention as useful and motivating. Using couple interviews increased our understanding of how the women and partners influenced each other's perspectives after a GDM-affected pregnancy and thus how targeting couples as opposed to women alone may motivate health behavior change.

Effect of prenatal counseling on postpartum follow-up and contraceptive use in women with gestational diabetes mellitus: a randomized controlled trial

Postpartum visit attendance for glucose screening and uptake of effective contraception is crucial after a pregnancy with gestational diabetes mellitus (GDM). Although postpartum women with recent GDM are generally advised in the early postnatal period to attend postpartum visits, data have shown suboptimal rates of postpartum glucose testing and highly effective contraceptive use in these women. Compared to the early postnatal period, the antenatal period is when women and healthcare providers have more contact. This may facilitate a better relationship between the pregnant woman and her healthcare providers, thereby improving the women's trust in the providers' counseling. This study aimed to investigate whether adding prenatal counseling to routine early postnatal counseling increases the rates of glucose screening and contraceptive use by 6 weeks postpartum in pregnant women with GDM. A randomized controlled trial including 280 women diagnosed with GDM was conducted. Participants were randomly allocated (1:1, stratified with a permuted block method) to the intervention group (receiving prenatal counseling at 35-36 weeks of gestation plus routine early postnatal counseling) or the control group (receiving only routine early postnatal counseling). The two primary outcomes were glucose screening and highly effective contraceptive uptake by 6 weeks postpartum. The secondary outcome was the use of any contraceptive by 6 weeks postpartum. Data were analyzed according to the intention-to-treat principle. The rate of postpartum glucose screening was 86.4% (121/140) in the intervention group, which was significantly higher than the 50.7% rate (71/140) in the control group (adjusted relative risk [RR], 1.70; 95% confidence interval [CI], 1.27-2.28). The uptake of highly effective contraceptive methods was increased in the intervention group compared to that in the control group (59.3% vs 30.7%; adjusted RR, 1.90; 95% CI, 1.31-2.74). The uptake of any contraceptive method by 6 weeks postpartum was reported by 122 of 140 participants (87.1%) in the intervention group and 77 of 140 participants (55.0%) in the control group (adjusted RR, 1.58; 95% CI, 1.19-2.10). Adding prenatal counseling to routine early postnatal counseling significantly increased the rates of glucose screening and contraceptive use by 6 weeks postpartum in pregnant women with GDM. Given that incorporating counseling regarding postpartum glucose testing and effective contraceptive use into standard prenatal care requires minimal increases in expenditure and manpower, implementation of this counseling strategy in clinical practice seems advisable.

Facilitators and barriers to attending postpartum screening in women with a recent pregnancy complicated by gestational diabetes mellitus: a qualitative study

ObjectivePregnant women with gestational diabetes mellitus (GDM) are 50% more likely to develop type II diabetes (T2D) within 6 months to 2 years after giving birth. Therefore, international guidelines recommend it is best practice for women diagnosed with GDM to attend screening for T2D 6–12 weeks postpartum and every 1–3 years thereafter for life. However, uptake of postpartum screening is suboptimal. This study will explore the facilitators of and barriers to attending postpartum screening for T2D that women experience. Study designThis was a prospective qualitative cohort study using thematic analysis. MethodsA total of 27 in-depth, semistructured interviews were conducted over the telephone with women who had recent GDM. Interviews were recorded and transcribed, and data were analysed using thematic analysis. ResultsFacilitators of and barriers to attending postpartum screening were identified at three different levels: personal, intervention, and healthcare systems level. The most common facilitators identified were concern for their own health and having the importance of screening explained to them by a health professional. The most common barriers identified were confusion over the test and COVID-19. ConclusionThis study identified several facilitators of and barriers to attending postpartum screening. These findings will help to inform research and interventions for improving rates of attendance at postpartum screening to reduce the subsequent risk of developing T2D.

Feasibility of a Postpartum Web- and Phone-Based Lifestyle Program for Women with a History of Preeclampsia or Gestational Diabetes: A Pilot Intervention Study.

Women with a history of preeclampsia (PE) or gestational diabetes mellitus (GDM) are at increased risk of diabetes and cardiovascular disease (CVD) later in life. Increased awareness of pregnancy complications as early warning signs for CVD has called for postpartum primordial prevention strategies. The aim of this study was to evaluate the feasibility of a postpartum web- and phone-based lifestyle program promoting healthy lifestyle behaviors to women after a pregnancy complicated by PE or GDM. Women with a validated history of PE or GDM were invited to participate in a nonrandomized pilot intervention study 3-12 months after delivery. The intervention was delivered over 6 months. All participants received tailored lifestyle counseling by a registered dietitian and access to information material on healthy lifestyle behaviors on the study's website. After inclusion, participants were invited to three study visits at baseline, 3 months, and 6 months. Feasibility outcomes included assessment of recruitment, retention, and acceptability. Secondary outcomes were changes in lifestyle behaviors and cardiovascular risk factors. Of the 207 women invited, 44 were enrolled in the feasibility study and 40 women completed the intervention, corresponding to a recruitment rate of 21% and a retention rate of 91%. At the 3-month study visit, 94.6% of participants reported they had used the website. A total of 41.7% of the participants reported that they had achieved their personal goals during the intervention period. This study suggested the feasibility and potential acceptability of a web- and phone-based lifestyle intervention for mothers with recent PE or GDM. clinicaltrials.gov, www.clinicaltrials.gov, no. NCT03993145.

Postpartum women’s experiences in a randomized controlled trial of a web-based lifestyle intervention following Gestational Diabetes: a qualitative study

Introduction Gestational diabetes mellitus (GDM) is associated with an increased maternal risk for the development of type 2 diabetes (T2DM). We previously demonstrated in a randomized trial that a web-based postpartum lifestyle intervention program, Balance After Baby, increased weight loss among postpartum women with recent pregnancies complicated by GDM. The aim of this analysis is to identify the impact of the intervention on study participants as assessed by exit interviews after completion of the 12 month study. Methods We conducted structured exit interviews created with a concurrent-contextual design with subjects randomized to the intervention group at the conclusion of their participation (∼12 months) in the Balance After Baby study, with the objectives of 1) understanding the impact of the intervention on participants and their family members, 2) identifying which program components were most and least helpful, and 3) identifying the perceived best timing for diabetes prevention interventions in postpartum women with recent GDM. Results Seventy-nine percent (26/33) of eligible intervention participants participated in interviews. Participants noted changes in diet and physical activity as a result of the intervention. Several components of the intervention, particularly the online modules and support from the lifestyle coach, were perceived by intervention participants to have had a positive effect on personal and familial lifestyle change, while other components were less utilized, including the community forum, YMCA memberships, and pedometers. Nearly all participants felt that the timing in the intervention study, beginning about 6 weeks postpartum, was ideal. Discussion Results of this study identify the importance of individualized coaching, impact on family members, and demonstrate that postpartum women feel ready to make changes by 6 weeks postpartum. Findings from this study will help inform the development of future technologically-based lifestyle interventions for postpartum women with recent GDM.

Effects of low-GI biscuits as pre-loads or mid-meal snacks on post-prandial glycemic excursions in women with recent gestational diabetes: A protocol for a randomized crossover trial and an extended tailored intervention.

Increased post-prandial glycemic excursions contribute to the development of diabetes and have been observed in women with recent gestational diabetes mellitus (GDM) and with normal glucose tolerance at post-partum. As a convenient meal replacement, low-GI biscuits are helpful for improving glycemic excursions in patients with type 2 diabetes. However, it is unknown whether low-GI biscuits as pre-loads or mid-meal snacks have a better effect in diminishing post-prandial glycemic excursions from the individual level in women with recent GDM. Therefore, the aim of this trial is to tailor a better dietary strategy utilizing low-GI biscuits (Fitmeal) to improve post-prandial glycemic excursions through within-subject comparison in such a population and observe the long-term effect of a tailored dietary approach in glycemic control. We have designed a two-phase trial including a randomized, crossover, non-blinded trial in the first phase, followed by a 4-week tailored intervention in the second phase. A total of 52 post-partum women with recent GDM will be allocated into four meal plans: (1) Fitmeal pre-load 30 min before standard lunch meal (P+L), (2) Fitmeal as a mid-meal snack 2 h before standard lunch meal (S+L), (3) isocaloric standard control with co-ingestion of Fitmeal and standard lunch meal (CL) at the same time, and (4) placebo control with 200 ml of water taken 30 min before standard lunch meal (W + L), on four consecutive days. Acute post-prandial glycemic response (PGR) measured by continuous glucose monitoring (CGM) will be compared among the four meals. In the second phase, all participants will receive a 4-week tailored intervention using Fitmeal as pre-loads or mid-meal snacks based on within-subject PGR results from the first phase. Glycemic metrics, dietary behaviors, and psychosocial factors (e.g., quality of life, self-efficacy, perceived stress, and depression) will be examined at baseline and end-point. This trial is expected to optimize the use of low-GI biscuits as pre-loads or mid-meal snacks in improving individual post-prandial glycemic excursions among women with recent GDM. Furthermore, the findings of this study will provide novel information on how to deliver an effective dietary intervention at the individual level and guide future clinical practice of medical nutrition therapy for diabetes prevention. Chinese clinical trial registry, ChiCTR2200060923.

RF16 | PSUN177 Predictors of Postpartum Depressive Symptoms in Women with Recent GDM

Abstract Background Patients with gestational diabetes mellitus (GDM) have an increased risk of developing type 2 diabetes mellitus (T2DM) after delivery and are encouraged to practice behaviors, such as healthy nutrition, physical activity and weight loss to attenuate future risk of T2DM. GDM has been shown to significantly increase the risk for post-partum depressive symptoms, which can impair a woman's ability to engage in and adhere to diabetes prevention efforts. To further inform the development and adapation of lifestyle interventions to prevent T2DM, we sought to identify factors associated with depressive symptoms in the early postpartum period among women with recent GDM. Methods Participants are from the baseline cohort of the Balance after Baby Intervention study, a two-year randomized clinical trial of a lifestyle intervention for women with recent history GDM conducted in Boston, MA and Denver, CO between 2016-2019. Prior to randomization, a study visit was scheduled at approximately 6 weeks post-partum. At this visit, weight and height were measured for determination of BMI. We administered the Edinburgh Postpartum Depression Scale (EPDS) and Perceived Stress Scale (PSS-10). We used an EPDS score of ≥9 as depressive symptoms and a PSS score of ≥14 as moderate to high perceived stress. We collected self-reported pre-pregnancy weight, and reviewed medical records to obtain medical history, including GDM diagnosis, mode of delivery, gestational weight gain and insulin use during pregnancy. We conducted bivariate analyses to identify predictors of postpartum depressive symptoms, then modeled the odds of post-partum depressive symptoms using multivariate logistic regression. Results Our study included 181 women (mean age, SD 32.6 ± 5.3 years, 51.4% White/14.4% Black/33.7% Latinx, mean pre-pregnancy BMI 29.8 ± 6.0 kg/m2). 19% of women scored ≥9 on EPDS and 53% of women scored ≥14 on PSS at the post-partum visit. Variables included in the bivariate analysis were age, Black/Latinx-identifying, college completion, perceived stress, primiparity, having a partner, pre-pregnancy BMI, gestational weight gain, C-section, insulin use during pregnancy, breastfeeding, 1st GDM pregnancy, exceeding IOM weight gain guidelines and income level. Of those variables, the best fit multivariate model with the lowest Akaike information criterion (AIC) included perceived stress, C-section and 1st GDM pregnancy. Using this model, the regression analysis showed that only perceived stress (4.5 OR, 95% CI [2.6-7.7], p was predictive of post-partum depressive symptoms. Conclusion Perceived stress was predictive of post-partum depressive symptoms in women with recent GDM. Addressing perceived stress in the early post-partum period may be an important target for development or adaptations of future lifestyle interventions to prevent T2DM in women with recent GDM. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Sunday, June 12, 2022 1:18 p.m. - 1:23 p.m.

Predicting Progression from Gestational Diabetes to Impaired Glucose Tolerance Using Peridelivery Data: An Observational Study.

This article aimed to develop a predictive model to identify persons with recent gestational diabetes mellitus (GDM) most likely to progress to impaired glucose tolerance postpartum. We conducted an observational study among persons with GDM in their most recent pregnancy, defined by Carpenter-Coustan criteria. Participants were followed up from delivery through 1-year postpartum. We used lasso regression with k-fold cross validation to develop a multivariable model to predict progression to impaired glucose tolerance, defined as HbA1c≥5.7%, at 1-year postpartum. Predictive ability was assessed by the area under the curve (AUC), sensitivity, specificity, and positive and negative predictive values (PPV and NPV). Of 203 participants, 71 (35%) had impaired glucose tolerance at 1-year postpartum. The final model had an AUC of 0.79 (95% confidence interval [CI]: 0.72, 0.85) and included eight indicators of weight, body mass index, family history of type 2 diabetes, GDM in a prior pregnancy, GDM diagnosis<24 weeks' gestation, and fasting and 2-hour plasma glucose at 2 days postpartum. A cutoff point of ≥ 0.25 predicted probability had sensitivity of 80% (95% CI: 69, 89), specificity of 58% (95% CI: 49, 67), PPV of 51% (95% CI: 41, 61), and NPV of 85% (95% CI: 76, 91) to identify women with impaired glucose tolerance at 1-year postpartum. Our predictive model had reasonable ability to predict impaired glucose tolerance around delivery for persons with recent GDM. · We developed a predictive model to identify persons with GDM most likely to develop IGT postpartum.. · The final model had an AUC of 0.79 (95% CI: 0.72, 0.85) and included eight clinical indicators.. · If validated, our model could help prioritize diabetes prevention efforts among persons with GDM..

Prolactin and Maternal Metabolism in Women With a Recent GDM Pregnancy and Links to Future T2D: The SWIFT Study.

Prolactin is a multifaceted hormone known to regulate lactation. In women with gestational diabetes mellitus (GDM) history, intensive lactation has been associated with lower relative risk of future type 2 diabetes (T2D). However, the role of prolactin in T2D development and maternal metabolism in women with a recent GDM pregnancy has not been ascertained. We examined the relationships among prolactin, future T2D risk, and key clinical and metabolic parameters. We utilized a prospective GDM research cohort (the SWIFT study) and followed T2D onset by performing 2-hour 75-g research oral glucose tolerance test (OGTT) at study baseline (6-9 weeks postpartum) and again annually for 2 years, and also by retrieving clinical diagnoses of T2D from 2 years through 10 years of follow up from electronic medical records. Targeted metabolomics and lipidomics were applied on fasting plasma samples collected at study baseline from 2-hour 75-g research OGTTs in a nested case-control study (100 future incident T2D cases vs 100 no T2D controls). Decreasing prolactin quartiles were associated with increased future T2D risk (adjusted odds ratio 2.48; 95% CI, 0.81-7.58; P = 0.05). In women who maintained normoglycemia during the 10-year follow-up period, higher prolactin at baseline was associated with higher insulin sensitivity (P = 0.038) and HDL-cholesterol (P = 0.01), but lower BMI (P = 0.001) and leptin (P = 0.002). Remarkably, among women who developed future T2D, prolactin was not correlated with a favorable metabolic status (all P > 0.05). Metabolomics and lipidomics showed that lower circulating prolactin strongly correlated with a T2D-high risk lipid profile, with elevated circulating neutral lipids and lower concentrations of specific phospholipids/sphingolipids. In women with recent GDM pregnancy, low circulating prolactin is associated with specific clinical and metabolic parameters and lipid metabolites linked to a high risk of developing T2D.

Breastfeeding Rates and Related Factors at 1 Year Postpartum in Women With Gestational Diabetes Initially Recruited for a Diabetes Prevention Program

ObjectivesOur aim in this study was to evaluate breastfeeding up to 1 year postpartum and factors related to weaning in women with recent gestational diabetes mellitus (GDM). MethodsWe assembled a cohort study of women with GDM enrolled in prenatal clinics of the Brazilian National Health System as possible candidates for the Lifestyle Intervention for Diabetes Prevention After Pregnancy (LINDA-Brasil) postpartum trial (N=2,220). Sociodemographics and clinical and nutritional information, including breastfeeding, were obtained by interview or chart review. Follow-up by telephone was done at specific intervals during the first year postpartum. ResultsThe probability of breastfeeding at 1 year postpartum, estimated from Kaplan–Meier survival analysis, was 53.5%. Cox regression models showed increased risk of weaning for those introducing milk or formula before 6 months (hazard ratio [HR], 2.55; 95% confidence interval [CI], 2.10 to 3.09); reporting problems in breastfeeding (HR, 1.49; 95% CI, 1.22 to 1.82); being Caucasian (HR, 1.46; 95% CI, 1.21 to 1.76); smoking during pregnancy (HR, 1.68; 95% CI, 1.28 to 2.20); and living in 2 southern cities of Brazil (HR, 1.58; 95% CI, 1.16 to 2.16; and HR, 1.76; 95% CI, 1.20 to 2.58). ConclusionsAbout half of the women with GDM ceased breastfeeding before 1 year postpartum, a rate matching that of the general population in Brazil. The main risk factor was not exclusively breastfeeding up to 6 months. Given the possibility of curbing diabetes risk by maintaining longer breastfeeding, further promotion of exclusive breastfeeding up to 6 months for these high-risk women is much needed.

The experience of women with recent gestational diabetes during the COVID-19 lockdown: a qualitative study from Denmark

BackgroundFollowing COVID-19 and the lockdowns, maternity care and support for women after delivery have been temporary restructured. Studies show that COVID-19 adversely impacts pregnant and peripartum women in the general population, but experiences among women in the first year after delivery/in the wider postpartum period remain unexplored. Moreover, experiences among women with recent gestational diabetes mellitus (GDM) are lacking; though it is a group with a potential high need for support after delivery. The aim of our study was to investigate (i) how women with recent GDM experienced COVID-19 and the first lockdown in Denmark, and (ii) the women’s risk perception and health literacy in terms of interaction with the healthcare system in relation to COVID-19.MethodsWe performed a qualitative study among 11 women with recent GDM (infants aged 2-11 months old). Semi-structured interviews were conducted in April-May 2020 by telephone or Skype for Business, when Denmark was under lockdown. We analysed data using a thematic qualitative content analysis.ResultsThree themes emerged: i) Everyday life and family well-being, ii) Worries about COVID-19 and iii) Health literacy: Health information and access to healthcare. The women were generally not worried about their own or their infant’s risk of COVID-19. The lockdown had a negative impact on everyday life e.g. routines, loneliness, breastfeeding uncertainties and worries for the infant’s social well-being; but better family dynamics were also described. It was challenging to maintain healthy behaviours and thus the women described worries for the risk of type 2 diabetes and GDM in subsequent pregnancies. The women missed peer support and face-to-face visits from health visitors and found it difficult to navigate the restructured care with online/telephone set-ups.ConclusionsCOVID-19 and the lockdown affected everyday life among women with recent GDM both positively and negatively. Our findings suggest a need for care that are responsive to psychological and social aspects of health throughout the COVID-19 pandemic and support to limit worries about adaptation to motherhood and the infant’s social well-being. Communication focusing on the importance and relevance of contacting healthcare providers should also be strengthened.

Breastfeeding Associated with Lower Prevalence of Metabolic Syndrome in Women with Gestational Diabetes in the Very Early Postpartum Period.

The aim of this study is to examine the association of breastfeeding with metabolic syndrome (MetS) in women with recent gestational diabetes mellitus (GDM) in the very early postpartum (PP) period. We performed a secondary analysis of the Balance After Baby Intervention (BABI) study which enrolled women with recent GDM. Data collected during an early (~8 weeks) PP visit were used in this analysis. At this visit, weight, height, waist circumference (WC), blood pressure (BP), fasting plasma glucose (FPG), and lipids were obtained. MetS was classified per National Cholesterol Education Program Adult Treatment Program III (NCEP-ATP III) criteria. We defined breastfeeding as currently breastfeeding or not currently breastfeeding for the main analysis. Of 181 women enrolled in BABI, 178 were included in this analysis (3 excluded for missing lipids). Thirty-four percent were Hispanic. Of non-Hispanics, 31.5% were White, 18.5% Asian, and 12.9% Black/African American. The prevalence of MetS was 42.9% in women not breastfeeding versus 17.1% in women breastfeeding (p < 0.001; adjusted odds ratio [aOR] = 0.16 [95% confidence interval (CI): 0.06-0.41]). Breastfeeding women had significantly lower odds of FPG ≥100 mg/dL (aOR = 0.36 [95% CI: 0.14-0.95], p = 0.039), HDL < 50 mg/dL (aOR = 0.19 [95% CI: 0.08-0.46], p < 0.001), and triglycerides (TG) ≥ 150 mg/dL (aOR = 0.26 [95% CI: 0.10-0.66], p = 0.005). When evaluated as continuous variables, WC, FPG, and TG were significantly lower and HDL significantly higher in women breastfeeding in the very early PP period (vs. not breastfeeding). In a diverse population of women with recent GDM, there was lower prevalence of MetS in women breastfeeding compared with those not breastfeeding in the very early PP period. This study extends the findings of an association of breastfeeding with MetS previously reported at time points more remote from pregnancy to the very early PP period and to an ethnically and racially diverse population. · MetS prevalence in women with recent GDM was lower in breastfeeding than not breastfeeding women.. · FPG, HDL, WC, and TG were improved in the breastfeeding group.. · This study extends prior findings to the very early PP period and to a diverse population..

Postpartum dietary and physical activity-related beliefs and behaviors among women with recent gestational diabetes mellitus: a qualitative study from Singapore

BackgroundA woman with a history of GDM has at least seven-fold increased lifetime risk of developing type 2 diabetes mellitus (T2DM), compared to women who have normoglycemic pregnancies. Postpartum lifestyle modification has been shown to reduce postpartum weight retention and prevent the progression to T2DM. The aim of this study was to explore the postpartum dietary and physical activity-related beliefs and behaviors among women in Singapore who had GDM in their most recent pregnancies.MethodsSemi-structured in-depth interviews were conducted with 14 women, who were up to four months postpartum and had GDM in their most recent pregnancies. Interview data were analyzed using thematic analysis.ResultsThree themes were identified in the analysis: (1) risk perception and knowledge regarding future diabetes, (2) suboptimal diet and physical activity after delivery and (3) factors influencing the postpartum lifestyle.ConclusionsThe study findings provided useful information on the postpartum lifestyle beliefs and behaviors among women with a history of GDM. Most participants had low risk perception of future diabetes and their diet and physical activity after delivery were suboptimal due to various influences. These insights can be used to design tailored materials and programs to support women who have had GDM reduce their risk of developing future T2DM.

A Smartphone App to Restore Optimal Weight (SPAROW) in Women With Recent Gestational Diabetes Mellitus: Randomized Controlled Trial.

BackgroundWomen with a history of gestational diabetes mellitus (GDM) are at an increased risk of developing type 2 diabetes mellitus (T2DM). Lifestyle interventions aimed at postpartum weight loss to reduce T2DM risk have been reported, but poor compliance remains a barrier. Smartphone-based interventions may improve compliance, but data on its use in women with recent GDM are limited.ObjectiveThis trial aimed to investigate the efficacy of a smartphone app in restoring optimal weight following delivery in women with GDM, in the setting of a population with high rates of GDM and type 2 diabetes.MethodsIn this unblinded randomized controlled trial, 200 women with GDM were randomized to receive the intervention or standard care following delivery. The intervention enabled logging of weight, meals, and activity, with web-based interaction with a team comprising dieticians, a physiotherapist, and an occupational therapist. The primary outcome was an achievement of optimal weight (defined as the restoration of first trimester weight if first trimester BMI≤23 kg/m2 or weight loss of at least 5% from first trimester weight if first trimester BMI>23 kg/m2) at 4 months post partum. Secondary outcome measures included absolute weight loss, serum metabolic markers, self-reported nutritional intake, health education, and quality of life via questionnaires and user engagement in the intervention group.ResultsIn total, 40% (38/96) of women in the intervention group achieved optimal weight at 4 months post delivery compared with 32% (28/93) in the control group (P=.27). Compared with the control group, women in the intervention group reported significantly reduced caloric intake at 4 months after delivery (P<.001) and higher health-directed behavior scores (P=.045). The intervention group also reported increased emotional distress scores (P=.01). At 4 months, participant engagement with the intervention was maintained at 60.8% (SD 33.9%).ConclusionsAlthough a statistically significant increase in women achieving healthy weight was not observed, this app remains promising, as women in the intervention group reported improved health behaviors and lower caloric intake. Importantly, the high retention rates suggest that a larger study with a longer follow-up period might confirm the effectiveness of this app for weight management.Trial RegistrationClinicalTrials.gov NCT03324737; https://clinicaltrials.gov/ct2/show/NCT03324737International Registered Report Identifier (IRRID)RR2-10.1186/s12889-019-7691-3

The Effects of a Lifestyle Intervention to Prevent Deterioration in Glycaemic Status Among South Asian Women with Recent Gestational Diabetes Mellitus: A Randomised Control Trial

Background: Women with recent gestational diabetes mellitus (GDM) have increased risk of developing type 2 diabetes mellitus (T2DM). We aimed to determine whether a resource- and culturally-appropriate lifestyle intervention could prevent glycaemic deterioration in South Asia.Methods: This was an open-label parallel-group randomised trial. Women with GDM from 19 urban hospitals in India, Sri Lanka and Bangladesh underwent an oral glucose tolerance test (OGTT) 3-18 months post-partum. Those without T2DM were randomised to a 12-month lifestyle intervention focused on diet and physical activity or usual care. The primary outcome was the proportion with worsening category of glycaemia based on OGTT using American Diabetes Association criteria: 1) normal glucose tolerance to pre-diabetes (impaired fasting glucose and/or impaired glucose tolerance) or T2DM; or 2) pre-diabetes to T2DM. Secondary outcomes included new-onset T2DM, and change in body weight.Findings: 1823 women underwent OGTT at a median of 6·9 months post-partum. After excluding 162 (8·9%) with T2DM, 1612 (37·5% with pre-diabetes and 62·5% with normoglycaemia) were randomised between November 2017 and January 2020. Baseline mean age was 30·9 years (SD 4·9), mean BMI was 26·6 kg/m 2 (SD 4·7). Among participants randomised to the intervention, 79·7% were exposed to all programme content although pandemic lockdowns impacted the delivery model. After 14·5 months median follow-up, 1308 (81·2%) participants had primary outcome data. The intervention, compared to usual care, did not reduce worsening glycaemic status (25·5% vs. 27·1%; hazard ratio, 0·92 [95% CI: 0·76‒1·12]) or any secondary outcome. There was no evidence of heterogeneity of intervention effect by baseline characteristics. Interpretation: A large proportion of South Asian women in urban centres develop dysglycaemia soon after a GDM-affected pregnancy. A low-intensity lifestyle intervention, substantially modified due to the COVID-19 pandemic, did not prevent subsequent deterioration in glycaemic status. Alternate or additional approaches are needed, especially among high-risk individuals.Trial Registration: Clinical Trials Registry of India (CTRI/2017/06/008744), Sri Lanka Clinical Trials Registry (SLCTR/2017/001) and ClinicalTrials.gov (NCT03305939).Funding: Global Alliance for Chronic Disease grants from the Indian Council of Medical Research (NO.58/1/1/GACD/NCD-II) and Australian National Health and Medical Research Council (1093171). Additional funding was received from USV Pharmaceuticals Ltd. and Lupin Pharmaceuticals Ltd. for sub-studies (data not reported here).Declaration of Interest: None to declare. Ethical Approval: The study protocol was approved by Human Research Ethics Committees of the All India Institute of Medical Sciences (India), icddr,b (Bangladesh), Faculty of Medicine, University of Kelaniya (Sri Lanka) and the University of Sydney (Australia)