The study appears in the current online issue of Diabetes Care.
Researchers conducted a pilot among women with gestational diabetes (GDM) to determine if reduction of gestational weight gain and a postpartum lifestyle intervention (modeled after the Diabetes Prevention Program) delivered by phone to modify diet and physical activity and addressing support for breast feeding could help women return to their pre-pregnancy weight, if it was normal, or achieve a 5 percent reduction from pre-pregnancy weight if overweight. Eligible participants were identified shortly after a GDM diagnosis and randomly assigned to intervention or usual care.
The proportion of women who reached the postpartum weight goals was higher in the intervention group than among those in usual care (absolute difference 16.1%, though not statistically significant), explain the researchers. They add that the intervention was more effective among women who did not exceed the recommended gestational weight gain. In addition, the interventional arm experienced decreased fat intake more than the usual care arm. Women in the intervention arm also breastfed their infants for longer time(not statistically significant).
Researchers explain that GDM complicates between 7-14 percent of pregnancies in the Unites States and its incidence has increased between 35 and 100 percent. They add that a history of GDM is one of the strongest risk factors for type 2 diabetes. In addition, there is strong evidence from previous efficacy trials in at-risk individuals that type 2 diabetes is preventable by lifestyle interventions focusing on weight management.
Despite the evidence, this study represents the first lifestyle intervention for diabetes prevention starting during pregnancy and continuing postpartum that has been translated for use in women with GDM, said Assiamira Ferrara, MD, PhD, a research scientist with the Kaiser Permanente Division of Research in Oakland, CA and the lead author of the study.
“Starting an intervention soon after diagnosis of GDM is important because evidence shows that women who exceed Institute of Medicine guidelines during pregnancy retain twice as much weight compared to women who gain weight within recommendations. This weight retention is associated with and increased likelihood of long term obesity,” said Ferrara. “ Also, a lifestyle intervention that starts soon after the diagnosis of GDM takes advantage of the teachable moment of pregnancy because women with GDM are concerned about their children’s increased risk of adverse health outcomes as well as their own increased risk of diabetes, which can motivate the adoption of preventive behaviors.”
She also explained that GDM patients’ frequent interactions with the healthcare system during pregnancy presents an opportunity for such an intervention to be adopted by the health care system.
Researchers enrolled women diagnosed with GDM in Kaiser Permanente’s Northern California integrated care delivery system. The study was conducted in collaboration with the Kaiser Permanente Perinatal Service center, which provides supplemental prenatal care over the telephone to women with GDM. Recruitment occurred between October 2005 and June 2009.
The intervention used in this study was — called Diet, Exercise and Breastfeeding Intervention (DEBI) – was delivered telephone by trained dieticians and comprised 3 phases: prenatal, post-partum and maintenance. Women were encouraged to follow the ADA diet and engage in moderate intensity physical activity for 150 minutes per week. Written intervention materials about portion size, foods with low glycemic index or low fat, and how to read food labels were discussed during telephone counseling. Toward the end of pregnancy, women were referred to a lactation consultant. The early postpartum phase began 6 weeks after delivery and ended 7 months postpartum. Women were given self-monitoring diaries for recording fat grams consumed and minutes of physical activity and were asked to reach their weight goal during the first 12 months postpartum. The maintenance phase began soon after the early postpartum phase and ended 12 months postpartum. Women in usual care received printed education materials about GDM and received in the postpartum period two newsletters focused on issues related to infant safety and general health.
The research was funded by the National Institute of Diabetes and Digestive and Kidney Disease and a grant from the Kaiser Permanente Garfield Foundation. Co-authors on the study include, Monique Hedderson, PhD; Samantha F. Ehrlich, MPH; Charles Quessenberry, PhD; Tiffany Peng, MA; Juanran Feng, MS, all with the Kaiser Permanente Division of Research; Cheryl L Albright, PhD, MPH, from the University of Hawaii Cancer Center; Jenny Chin RN, and Yvonne Crites, MD, both with the Kaiser Permanente Santa Clara division of perinatology, department of obstetrics and gynecology.