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Tailored letter promotes weight management in women with gestational diabetes
Women with gestational diabetes who received a personalized letter were more likely to meet recommendations for weight gain during pregnancy than women receiving usual care, according to study results published in Diabetes Care.
“A tailored letter with personalized recommendations effectively helped women with gestational diabetes to meet national guidelines for healthy weight gain during pregnancy,” Monique M. Hedderson, PhD, a research scientist in the division of research at Kaiser Permanente Northern California in Oakland, California, told Endocrine Today. “The tailored letter efficiently leveraged information from electronic health records and was sent on behalf of a health care system. This study provides evidence that a simple, scalable, low-intensity intervention may have beneficial effects at the population level.”
In a cluster-randomized controlled trial of 44 medical facilities, Hedderson and colleagues randomly assigned pregnant women to usual care (n = 1,047; 40.4% Asian; 25.7% white; 22.5% Hispanic; 4.8% black; 6.5% other; 37.5% with obesity) or a multicomponent lifestyle intervention (n = 967; 43.4% Asian; 23.9% white; 22.2% Hispanic; 3.9% black; 6.3% other; 35.2% with obesity). Usual care consisted of a packet of health education materials and one to two telephone calls from nurses per week, whereas intervention added a separate tailored letter. Utilizing EHR data, letters provided personalized recommendations for gestational weight management based on prepregnancy BMI, end-of-pregnancy weight goals, postpartum weight-management recommendations, lifestyle tips and additional information on the effects of weight gain on pregnancy and maternal health. Intervention also included 13 telephone sessions with a lifestyle coach after delivery.
Researchers found that women in the intervention group who had received the tailored letter were more likely to meet the Institute of Medicine guidelines for gestational weight gain than those receiving usual care (72.6% vs. 67.1%). Women assigned to the intervention were no more likely to meet end-of-pregnancy weight goals than those randomly assigned to usual care (36% vs. 33%). However, in stratified analyses, women with a prepregnancy BMI of less than 25 kg/m2 were 28% more likely to meet end-of-pregnancy weight goals than those whose prepregnancy BMI was at least 25 kg/m2. In addition, women who received the tailored letter were less likely to have a baby who was large for gestational age (9.7% vs. 12.8%).
“We know that for women with gestational diabetes, gaining too much weight during pregnancy increases their risk of pregnancy complications and of developing type 2 diabetes later in life,” study author Susan D. Brown, PhD, a research scientist in the division of research at Kaiser Permanente Northern California, told Endocrine Today. “It is exciting to find that a simple personalized letter is a tool that clinicians could use to help women with gestational diabetes meet national guidelines for healthy weight gain during pregnancy.” – by Melissa J. Webb
For more information:
Monique M. Hedderson, PhD, can be reached at monique.m.hedderson@kp.org.
Disclosures: The authors report no relevant financial disclosures.
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Hedderson MM, et al. Diabetes Care. 2018;doi:10.2337/dc17-1133.