Recent Gestational Diabetes Mellitus Research Articles

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)

The Feasibility and Preliminary Efficacy of an eHealth Lifestyle Program in Women with Recent Gestational Diabetes Mellitus: A Pilot Study.

Self-administered eHealth interventions provide a potential low-cost solution for reducing diabetes risk. The aim of this pilot randomised controlled trial (RCT) was to evaluate the feasibility, including recruitment, retention, preliminary efficacy (primary outcome) and acceptability (secondary outcome) of the “Body Balance Beyond” eHealth intervention in women with previous gestational diabetes mellitus (GDM). Women with overweight/obesity who had recent GDM (previous 24 months) were randomised into one of three groups: 1) high personalisation (access to “Body Balance Beyond” website, individual telehealth coaching via video call by a dietitian and exercise physiologist, and text message support); 2) low personalisation (website only); or 3) waitlist control. To evaluate preliminary efficacy, weight (kg), glycosylated hemoglobin, type A1C (HbA1c), cholesterol (total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL)), diet quality and moderate–vigorous physical activity were analysed at baseline and at 3 and 6 months using generalised linear mixed models. To investigate acceptability, process evaluation was conducted at 3 and 6 months. Of the 327 potential participants screened, 42 women (mean age 33.5 ± 4.0 years and BMI 32.4 ± 4.3 kg/m2) were randomised, with 30 (71%) completing the study. Retention at 6 months was 80%, 54% and 79% for high personalisation, low personalisation and waitlist control, respectively (reasons: personal/work commitments, n = 4; started weight-loss diet, n = 1; pregnant, n = 1; resources not useful, n = 1; and not contactable, n = 5). No significant group-by-time interactions were observed for preliminary efficacy outcomes, with the exception of HDL cholesterol, where a difference favoured the low personalisation group relative to the control (p = 0.028). The majority (91%) of women accessed the website in the first 3 months and 57% from 4–6 months. The website provided useful information for 95% and 92% of women at 3 and 6 months, respectively, although only a third of women found it motivating (30% and 25% at 3 and 6 months, respectively). Most women agreed that the telehealth coaching increased their confidence for improving diet (85%) and physical activity (92%) behaviours, although fewer women regarded the text messages as positive (22% and 31% for improving diet and physical activity, respectively). The majority of women (82% at 3 months and 87% at 6 months) in the high personalisation group would recommend the program to other women with GDM. Recruiting and retaining women with a recent diagnosis of GDM is challenging. The “Body Balance Beyond” website combined with telehealth coaching via video call is largely acceptable and useful for women with recent GDM. Further analysis of the effect on diabetes risk reduction in a larger study is needed.

Avoiding Diabetes After Pregnancy Trial In Moms (ADAPT- M): Evaluating Fitness In Postpartum Women Who Have Had Recent Gestational Diabetes Mellitus (GDM)

Gestational diabetes mellitus (GDM) affects approximately 6% of women, and 20% develop type 2 diabetes (T2DM) by 10 years post delivery with higher rates in non-Caucasian ethnic groups. Early postpartum lifestyle interventions such as physical activity (PA) are recommended to improve health outcomes and reduce future T2DM. Despite benefits of PA, postpartum women report difficulty to engage and adhere to PA due to barriers such as childcare and poor support. Little is known about whether this high-risk group are achieving age-predicted fitness (APF) and meeting PA guidelines. PURPOSE: To describe cardiorespiratory fitness and PA levels in Caucasian and non-Caucasian women with recent GDM, and the association between fitness and PA measures. METHODS: This cross-sectional study recorded baseline data from a multi-ethnic cohort of women with recent GDM at 12 to 20 weeks postpartum, who were part of a health-coaching intervention called Avoiding Diabetes after Pregnancy Trial in Moms (ADAPT-M) between 2014 and 2017. Women underwent a graded exercise treadmill test, anthropometric measures, diastasis rectus screening and completed the International Physical Activity Questionnaire (IPAQ). Baseline characteristics were compared between Caucasian and non-Caucasian ethnicity using T-test, Chi square and Mann-Whitney U tests. The relationship between APF and PA guidelines was assessed with a Chi-Square test. RESULTS: We evaluated 149 participants at mean 16.5 + 4.3 weeks postpartum (mean age 36.7 + 4.6 years, 70.5% non-Caucasian), had a mean fitness of 9.7+1.9 metabolic equivalents (98 + 19.2 % APF), body fat 36.2 + 5.6%, BMI 29.7 + 6.8 kg/m2, and diastasis rectus was present in 20%. Of those, 52% were below APF while 84.5% were meeting PA guidelines (IPAQ). Non-Caucasian women were significantly less likely to meet PA guidelines (p=0.0002) and had lower PA levels (p<0.001). Overall, level of PA on the IPAQ did not correlate with APF (p <0.10). CONCLUSION: Postpartum women with recent GDM had average APF and 84.5% were meeting PA guidelines, although significantly lower levels were seen in non-Caucasian women. Level of PA on the IPAQ did not correlate with APF in this population. Postpartum diabetes prevention programs for women with recent GDM should optimize PA, particularly for higher-risk non-Caucasian ethnic groups.

Physical activity behaviour among women with gestational diabetes mellitus and early post-partum

Women with previous history of gestational diabetes mellitus (GDM) has been found to have higher risk of developing type 2 diabetes mellitus (T2DM). Participation in adequate physical activity during and post-pregnancy through has been found to mitigate the risk. The main purpose of this study is to determine the status of physical activity among women with recent GDM during their pregnancy and 8-weeks post-partum. A secondary aim of the study is to explore factors associated with physical activity during and 8-weeks post-partum. Physical activity status was measured using International Physical Activity Questionnaire (IPAQ). The data were collected during pregnancy through a self-reported questionnaire (n=336) and via telephone interview 8-weeks post-partum (n=117). The results showed that there were significant association between physical activity and status of GDM during pregnancy. Women who reported higher physical activity participation during pregnancy were less likely to have GDM. However, there were no significant association between physical activity participation and GDM status post-partum. Age was associated with participation in physical activity during pregnancy. Self-efficacy and their risk perception of developing T2DM were associated with physical activity participation at 8-weeks post-partum. In conclusion, this study highlights the different factors that should be targeted (for during pregnancy and post-partum) to promote physical activity among this high risk population.

The Avoiding Diabetes After Pregnancy Trial in Moms Program: Feasibility of a Diabetes Prevention Program for Women With Recent Gestational Diabetes Mellitus.

Our aim in this study was to evaluate the feasibility of a home-based diabetes prevention program, delivered by interdisciplinary certified diabetes educators (CDEs), and customized for postpartum women with recent gestational diabetes mellitus (GDM). This pilot randomized trial recruited women with GDM from 24 to 40 weeks gestation from 4centres, and trained 10 CDEs in behaviour coaching, physical activity (PA) and low glycemic index education. Women were randomized after 3 months postpartum to standard care (1 visit) or 1 of 3 24-week coaching interventions (1 visit and 12 telephone calls): i) PA and diet, ii) PA only or iii) diet only. Feasibility outcomes included recruitment, retention, adherence and satisfaction. Of 1,342 eligible patients, 392 were actively invited (29.3%) and 227 (16.9%) consented. Of these, 149 (65.6%) were randomized postpartum, of whom 131 (87.9%) started the program and 105 (70.5%) attended the final assessment. Intervention arm participants completed a median 75% (interquartile range, 50% to 92%) of telephone calls. Visit and call duration were a mean 71.4 (standard deviation, 13.8) and 18.1 (standard deviation, 6.5) minutes, respectively. Participants reported excellent/very good satisfaction 73% of the time, and 87% would recommend the program to others. A home-based diabetes prevention program customized for postpartum women with GDM can be feasibly delivered by CDEs, and it is associated with >70% retention, adherence and satisfaction.

Lifestyle Intervention for Women With Recent Pre-eclampsia or Gestational Diabetes Mellitus ('Mom's Healthy Heart')

Lifestyle Intervention for Women With Recent Pre-eclampsia or Gestational Diabetes Mellitus ('Mom's Healthy Heart')

SAT-122 A Mobile App to Decrease Risk Factors for Diabetes in Women with Recent GDM

BACKGROUND: Latinas have one of the highest rates of gestational diabetes mellitus (GDM) in the US. GDM is a major risk factor for type 2 diabetes (T2DM), with up to 60% of women developing T2DM after GDM. Latinos are one of the largest US minority groups, providing impetus for developing lifestyle interventions for this population. The potential to prevent T2DM, including in women with remote GDM, was demonstrated by the Diabetes Prevention Program. However, helping women with recent GDM make behavioral changes needed to decrease risk is a challenge given barriers women with young families face participating in in-person programs. The increasing ubiquity of mobile phone use among Latinos, and rising interest in mobile technologies to deliver healthcare interventions offer the means to overcome these barriers. METHODS: We developed and tested preliminary efficacy of a bilingual (Spanish/English), culturally sensitive, android-based app (¡Hola Bebe, Adios Diabetes!) for promoting healthy lifestyle in obese/overweight Latinas with recent GDM (within 5 years) to reduce risk factors for T2DM in an 8-week trial. Self-efficacy for healthy eating and physical activity (primary outcomes) and weight (secondary outcome) were determined at baseline and study end. The app provided education about health eating and physical activity, action planning, weight tracking, exercise videos, a community forum and motivational text messaging. Achievement in behaviors (e.g., tracking weight) was recognized by badges. RESULTS: We approached 30 women with self-reported Latina ethnicity and recent GDM documented in the medical record within 5 years; 21 provided informed consent and enrolled. Participants were 33 ± 7 (mean±SD) years old and 3 ± 0.7 years from their GDM pregnancy and 14 (64%) reported family history of T2DM. 18 of 21 women (82%) completed the 8-week study providing pre-post data. Self-efficacy for physical activity increased significantly from pre to post (P=.003), self-efficacy for healthy eating increased with borderline significance (P=.059), and weight decreased significantly by 1.5 lbs (P=.003). Backend data revealed a high engagement rate: 91% (19/21) of participants viewed modules/created action plans; 95% (20/21) earned badges by completing a learning module/action plan or weighing. Many posted on the community forum tips for other participants such as a family recipe. Structured interviews with participants revealed that they especially liked the personalized action plans, motivational messages, at-home exercise videos, and recipes. A suggestion for enhancement included adding an “ask the expert” feature to the community forum. CONCLUSION: The ¡Hola Bebe, Adios Diabetes! app was usable and well accepted by Latinas with recent GDM and showed preliminary effectiveness. This program will be tested in a larger, longer randomized trial.*Supported by NIH SBIR grant.

Barriers to Postpartum Glucose Intolerance Screening in an Italian Population.

Background: Gestational diabetes mellitus (GDM) is a strong risk factor for type 2 diabetes mellitus (T2D) and the postpartum period is crucial for early treatment in at-risk women. However, despite recommendations, only a fraction of women undergo a postpartum screening for glucose intolerance (ppOGTT). The present study aims to verify the reason(s) for poor adherence in our population. Research design and methods: This retrospective study includes 451 women in which GDM was diagnosed between 2015–2016. During 2017, we verified by phone interview how many women underwent ppOGTT at 6–12 weeks postpartum, as recommended by the Italian guidelines. The non-compliant women were asked about the reason(s) for failing to screen. The non-parametric Mann-Whitney test and the 2-tailed Fisher exact test were used to compare continuous and categorical features, respectively, among women performing or non-performing ppOGTT. Results: Out of 451 women with GDM diagnosis, we recorded information from 327. Only 97 (29.7%) performed ppOGTT. The remaining 230 women (70.3%) provided the following explanation for non-compliance: (1) newborn care (30.4%); (2) misunderstood importance (28.3%); (3) oversight (13.0%); (4) unavailability of test reservation in the nearest centers (10.4%); (5) normal glycemic values at delivery (8.3%); (6) discouragement by primary care physician (5.6%). Conclusions: In our population, most women with recent GDM failed to perform ppOGTT. Our results indicated that the prominent barriers could potentially be overcome.

Clinical and genetic characteristics of abnormal glucose tolerance in Japanese women in the first year after gestational diabetes mellitus.

Aims/IntroductionRisk factors of type 2 diabetes mellitus in Japanese women with recent gestational diabetes mellitus are unknown. The objective of the present study was to investigate the clinical and genetic characteristics associated with postpartum abnormal glucose tolerance in Japanese women with gestational diabetes mellitus.Materials and MethodsA total of 213 Japanese women with recent gestational diabetes mellitus who underwent a postpartum 2‐h oral glucose tolerance test were investigated. The association between antepartum clinical characteristics and postpartum abnormal glucose tolerance (diabetes or prediabetes based on the Japan Diabetes Society criteria) was examined. Frequencies of 45 known type 2 diabetes mellitus‐associated genetic variants were also compared between women with and without postpartum abnormal glucose tolerance.ResultsA total of 59 women showed postpartum abnormal glucose tolerance (prediabetes, n = 51; diabetes, n = 8). Plasma glucose levels at 1 or 2 h, the insulinogenic index and the insulin secretion‐sensitivity index‐2 of the antepartum oral glucose tolerance test were independent of postpartum abnormal glucose tolerance risk factors (P = 0.006, P = 0.00002, P = 0.01 and P = 0.006, respectively). Four genetic variants (rs266729 [ADIPOQ], rs6017317 [HNF 4A], rs5215 [KCNJ 11] and rs7177055 [HMG 20A]) showed a nominally significant association with postpartum abnormal glucose tolerance (P < 0.05, respectively). Among these, three were related to insulin secretion. Postpartum abnormal glucose tolerance risk significantly increased with increasing risk‐allele number (P = 0.0005; odds ratio 1.91).ConclusionsClinical features and genetic variants related to impaired insulin secretion are risk factors of postpartum abnormal glucose tolerance in Japanese women with recent gestational diabetes mellitus.

Avoiding Diabetes after Pregnancy Trial in Moms (Adapt-M): Feasibility of a Health-Coaching Program for Women with Recent Gestational Diabetes Mellitus

Avoiding Diabetes after Pregnancy Trial in Moms (Adapt-M): Feasibility of a Health-Coaching Program for Women with Recent Gestational Diabetes Mellitus

Prediction and Prevention of Type 2 Diabetes in Women with a History of GDM.

Women with a history of gestational diabetes mellitus (GDM) have an alarmingly high risk of developing type 2 diabetes (T2D); yet, mechanisms underlying this progression are largely unknown. Clinical characteristics of a GDM pregnancy and postpartum metabolomics may contribute to risk prediction of T2D to identify those women at highest risk of progression and need for intervention. Evidence for effective postpartum lifestyle interventions from observational studies include adherence to a healthy dietary pattern, increasing physical activity, and maintaining a healthy body weight. Larger clinical trials with greater participant engagement are warranted to confirm the effectiveness of lifestyle interventions in women with recent GDM. Research is needed to refine prediction models of T2D after GDM, and to determine the most effective strategies to delay or prevent T2D onset. Incorporating novel biomarkers in the postpartum period, such as metabolomics, could offer a powerful approach.

Predictors of very early postpartum weight loss in women with recent gestational diabetes mellitus

Objective: Women with gestational diabetes (GDM) have a 7–12-fold increased risk for developing type 2 diabetes later in life. Postpartum weight retention is highly predictive for future obesity, and further increases risk for type 2 diabetes. We sought to identify predictors of losing at least 75% of gestational weight gain by very early postpartum in women with recent GDM.Methods: We recruited women with GDM during pregnancy or just after delivery. Prepregnancy weight was self-reported at recruitment; gestational weight gain, mode of delivery, and insulin use were extracted from medical records. At a mean of 7.2 (±2.1) weeks postpartum we measured weight and height and administered questionnaires, including demographics, breastfeeding, Edinburgh Postnatal Depression Scale, sleep, Harvard Food Frequency, and the International Physical Activity Questionnaire. We modeled the odds of 75% loss of gestational weight gain at the study visit using multivariable logistic regression models and selected the model with the lowest Akaike information criterion (AIC) as our final model. Analyses were conducted using JMP 10–13 Pro (SAS Institute Inc.)Results: Seventy-five women with recent GDM were included in the study. The mean age of study participants was 33 (SD ±5) years old, of whom 57% were white, 30% were African American, and 20% of the women identified as Hispanic. The mean prepregnancy BMI was 31.4 kg/m2 (SD ±5.6) and the mean pregnancy weight gain was 12.5 kg (SD ±7.8). Fifty-two percent of participants lost at least 75% of their pregnancy weight gain by the early postpartum study visit. Thirty-seven women (49%) exceeded Institute of Medicine (IOM) guidelines for gestational weight gain. In a multivariate model adjusting for weeks postpartum at the time of the study visit, less gestational weight gain (OR 0.56; 95% CI 0.39–0.73), increased age (OR 1.48; 95% CI 1.13–2.20), and lack of insulin use during pregnancy (OR 0.08 for use of insulin; 95% CI 0.00–0.73) were associated with at least 75% postpartum weight loss. Prepregnancy BMI and sleep were not retained in the model. Race/ethnicity, education, breastfeeding, nulliparity, cesarean section, depressive symptoms, dietary composition, glycemic index, and physical activity did not meet criteria for inclusion in the model.Conclusions: A substantial proportion of women with recent GDM lost at least 75% of their gestational weight gain by early postpartum. Older women, those who did not use insulin during pregnancy and those who gained less weight during pregnancy were significantly more likely to have lost 75% of gestational weight by very early postpartum.

Short-Term Sitagliptin-Metformin Therapy Is More Effective Than Metformin Or Placebo In Prior Gestational Diabetic Women With Impaired Glucose Regulation

Our pilot study examined the effectiveness of sitagliptin-metformin (SITA-MET), metformin (MET), and placebo (P) therapy on fasting and post-glucose challenge glucose levels in postpartum women with prior gestational diabetes mellitus (GDM) and impaired glucose regulation. Prediabetic women (N = 36, age 18 to 42 years) with recent GDM were randomized to P (one pill twice a day), MET (1,000 mg twice a day), or SITA-MET (50 mg SITA, 1,000 mg MET twice a day) for 16 weeks in a single-blind fashion. An individualized diet and exercise plan were provided to all participants. At baseline and 16 weeks, oral glucose tolerance tests were performed to assess glycemia, mean blood glucose (MBG), and calculate insulin sensitivity (IS) and secretion (SI) indexes. Lipid profile, thyroid-stimulating hormone level, and pregnancy test were performed in the baseline sample. Thirty-three (92%) participants completed the study. At study end, 15 participants had normal glycemia (SITA-MET vs. MET, P; P = .035). MBG, IS, IS-SI index, and waist to height ratio were significantly improved with SITA-MET compared with MET and P treatment. SITAMET therapy was more effective in lowering body mass index and waist circumference compared to P treatment. Our pilot study is the first to evaluate the use of a dipeptidyl peptidase 4 inhibitor combined with MET in glucose-impaired women with a history of GDM. In this investigation, combination SITA-MET was found to be superior to MET and P in improving glycemia and metabolic measures in this prediabetic population. BID = twice a day; BMI = body mass index; BP = blood pressure; BW = body weight; CHOL = cholesterol; DI = disposition index; DM = diabetes mellitus; DPP-4i = dipeptidyl peptidase 4 inhibitor; FBG = fasting blood glucose; GDM = gestational diabetes mellitus; GLP-1 = glucagon-like peptide 1; HDL-C = high-density-lipoprotein cholesterol; HOMA-IR = homeostasis model assessment of insulin resistance; IGI = insulinogenic index; IGR = impaired glucose regulation; IGT = impaired glucose tolerance; IR = insulin resistance; IS = insulin sensitivity; LDL-C = low-density-lipoprotein cholesterol; MBG = mean blood glucose; MET = metformin; OGTT = oral glucose tolerance test; P = placebo; SI = insulin secretion; SIOGTT = Matsuda's insulin sensitivity index; TRG = triglycerides; WC = waist circumference; WHR = waist to hip ratio; WHtR = waist to height ratio.

Recent gestational diabetes was associated with mothers stopping predominant breastfeeding earlier in a multi-ethnic population.

It has previously been shown that breastfeeding may reduce the risk of type 2 diabetes in mothers with recent gestational diabetes mellitus (GDM). This study compared the cessation of predominant breastfeeding in mothers with and without recent GDM in a multi-ethnic population. From May 2008 to May 2010, healthy pregnant women attending antenatal care provided by community health services in Eastern Oslo, Norway were recruited. We included 616 women-58% non-Western-and interviewed and examined them at a mean of 15 and 28 weeks of gestation and 14 weeks' postpartum. Cox regression models examined the association between GDM, as assessed by the 2013 World Health Organization criteria, and breastfeeding cessation. Overall, 190 of the 616 (31%) mothers had GDM and they ended predominant breastfeeding earlier than mothers without GDM, with an adjusted hazard ratio (aHR) of 1.33 and 95% confidence interval (95% CI) of 1.01-1.77. Mothers of South Asian origin ended predominant breastfeeding earlier than Western European mothers in the adjusted analysis (aHR 1.53, 95% CI: 1.04-2.25), but Middle Eastern mothers did not. Recent gestational diabetes was associated with earlier cessation of predominant breastfeeding in Western European and non-Western women.

Elevated Medium-Chain Acylcarnitines Are Associated With Gestational Diabetes Mellitus and Early Progression to Type 2 Diabetes and Induce Pancreatic β-Cell Dysfunction.

Specific circulating metabolites have emerged as important risk factors for the development of diabetes. The acylcarnitines (acylCs) are a family of metabolites known to be elevated in type 2 diabetes (T2D) and linked to peripheral insulin resistance. However, the effect of acylCs on pancreatic β-cell function is not well understood. Here, we profiled circulating acylCs in two diabetes cohorts: 1) women with gestational diabetes mellitus (GDM) and 2) women with recent GDM who later developed impaired glucose tolerance (IGT), new-onset T2D, or returned to normoglycemia within a 2-year follow-up period. We observed a specific elevation in serum medium-chain (M)-acylCs, particularly hexanoyl- and octanoylcarnitine, among women with GDM and individuals with T2D without alteration in long-chain acylCs. Mice treated with M-acylCs exhibited glucose intolerance, attributed to impaired insulin secretion. Murine and human islets exposed to elevated levels of M-acylCs developed defects in glucose-stimulated insulin secretion and this was directly linked to reduced mitochondrial respiratory capacity and subsequent ability to couple glucose metabolism to insulin secretion. In conclusion, our study reveals that an elevation in circulating M-acylCs is associated with GDM and early stages of T2D onset and that this elevation directly impairs β-cell function.

Efficacy of vildagliptin for prevention of postpartum diabetes in women with a recent history of insulin-requiring gestational diabetes: A phase II, randomized, double-blind, placebo-controlled study

ObjectiveWomen with insulin-requiring gestational diabetes mellitus (GDM) are at high risk of developing diabetes within a few years postpartum. We implemented this phase II study to test the hypothesis that vildagliptin, a dipeptidyl peptidase-4 inhibitor, is superior to placebo in terms of reducing the risk of postpartum diabetes. MethodsWomen with insulin-requiring GDM were randomized to either placebo or 50 mg vildagliptin twice daily for 24 months followed by a 12-month observation period (EudraCT: 2007-000634-39). Both groups received lifestyle counseling. The primary efficacy outcomes were the diagnosis of diabetes (American Diabetes Association (ADA) criteria) or impaired fasting glucose (IFG)/impaired glucose tolerance (IGT). ResultsBetween 2008 and 2015, 113 patients (58 vildagliptin, 55 placebo) were randomized within 2.2–10.4 (median 8.6) months after delivery. At the interim analysis, nine diabetic events and 28 IFG/IGT events had occurred. Fifty-two women withdrew before completing the treatment phase. Because of the low diabetes rate, the study was terminated. Lifestyle adherence was similar in both groups. At 24 months, the cumulative probability of postpartum diabetes was 3% and 5% (hazard ratio: 1.03; 95% confidence interval: 0.15–7.36) and IFG/IGT was 43% and 22% (hazard ratio: 0.55; 95% confidence interval: 0.26–1.19) in the placebo and vildagliptin groups, respectively. Vildagliptin was well tolerated with no unexpected adverse events. ConclusionsThe study did not show significant superiority of vildagliptin over placebo in terms of reducing the risk of postpartum diabetes. However, treatment was safe and suggested some improvements in glycemic control, insulin resistance, and β-cell function. The study identified critical issues in performing clinical trials in the early postpartum period in women with GDM hampering efficacy assessments. With this knowledge, we have set a basis for which properly powered trials could be performed in women with recent GDM. Trial registration number at ClinicalTrials.govNCT01018602.

Facilitators of postpartum diabetes screening in women with recent gestational diabetes: A qualitative study

Background: Risk of diabetes mellitus is higher in women with a history of gestational diabetes mellitus (GDM). Postpartum diabetes screening is recommended in women with GDM. However, the rate of this screening is low. Objectives: The purpose of this study was to perform an in-depth exploration of perceived facilitators of attendance to postpartum diabetes screening in women with recent GDM. Methods: This qualitative study was conducted in 2016 in Tehran. Semi-structured interviews carried out with 22 women with a recent GDM who gave birth at least 6 months before the interview. Results: Four main categories were emerged from the data. Each category included two to three subcategories. The first category was appropriate education and included two subcategories of prenatal education and postpartum education. The second category was feeling the ease of screening and included two subcategories of spousal support, and appropriate laboratory facilities. The third category was self-regulation and included three subcategories of importance of health, a desire toward learning about health, and proper planning. The fourth category was attitudes toward the screening and included three subcategories of initial fear better than consequences, feeling comfortable, and uncertainty regarding glucometers' accuracy. The last category was perceived threat and included three subcategories of fear of developing diabetes, being healthy to serve the child/children, and being healthy for other roles. Conclusion: Iranian women with recent GDM reported several facilitators for diabetes postpartum screening. Further studies are suggested.

Translating Healthy Living Messages to Postpartum Women and Their Partners After Gestational Diabetes (GDM): Body Habitus, A1C, Lifestyle Habits, and Program Engagement Results From the Families Defeating Diabetes (FDD) Randomized Trial.

The Families Defeating Diabetes intervention evaluated a postpartum healthy living program for women with recent gestational diabetes mellitus (GDM). Randomized controlled trial. Tertiary centers in London, Calgary, and Victoria, Canada. Women with GDM and partners; 46% of eligible maternal participants agreed to participate. Interventional (INT) participants received a healthy living seminar at 3 months; access to a walking group/Website; biweekly e-mails. Control (CON) participants received a contemporary postpartum diabetes prevention handout. Maternal, partner, and offspring demographics at baseline, 3, and 12 months. Percentages of women losing ≥7% of postpartum weight were compared by χ2 testing; body habitus comparisons by analysis of covariance (ANCOVA); maternal A1C comparisons by unpaired t tests; participant outcome associations by Pearson correlation coefficients. Maternal participants were 170 (89 INT and 81 CON) with 63 partners (30 INT and 33 CON); 103 (73 maternal; 30 partners) were lost to follow-up; 57% of maternal participants completed 12 months; 33% INT women (n = 50) lost ≥7% weight versus 25% CON women (n = 47), P = .43. Interventional participant results did not correlate with accession of study elements. Maternal completion was significantly associated with partner involvement, breastfeeding, higher income, and education. Paternal weights correlated significantly with maternal and offspring weights. Families Defeating Diabetes outcomes were not significantly different for INT maternal or paternal participants versus CON participants. Secondary outcomes of future value included statistically significant positive associations between paternal participation, socioeconomic indicators, and maternal study completion, significant correlations between maternal, paternal, and offspring weights as well as insights into study component engagement.

Reliability and Validity of Measures for Investigating the Determinants of Health Behaviors Among Women With a History of Gestational Diabetes.

Assisting women with a history of gestational diabetes mellitus (GDM) to adopt healthy lifestyles is a priority for diabetes prevention. The aim of this study was to develop and evaluate measures that can be used to assess the efficacy of behavior change interventions in this group. Measures of psychosocial influences on physical activity and diet were derived from formative research and examination of established instruments. Item reduction by principal components analysis was undertaken following telephone survey administration to 160 women with recent GDM, and the internal reliability and construct validity of the derived scales were assessed. Test-retest reliability was assessed in another sample of 97 women. Scales with acceptable internal reliability were developed for physical activity outcome expectancies (α = .82), perceived barriers (α = .75), encouragement (α = .76) and self-efficacy (α = .82), weight control attitudes (α = .90), and diabetes-related fear (α = .70). Construct validity in relation to physical activity participation was found for the encouragement and self-efficacy scales. The weight control attitudes scale showed construct validity in relation to fruit and vegetable intake. The test-retest reliability of most scales was moderate to good (weighted κ = 0.55-0.69). Reliable and valid measures relevant to the psychosocial needs of women with GDM have been developed with a multiethnic population. These will assist future evidence generation, particularly in relation to the adoption of physical activity, which has been a challenging area of lifestyle intervention to date.