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Lifestyle intervention increases postpartum weight loss in women with gestational diabetes

A lifestyle intervention derived from the Diabetes Prevention Program resulted in reduced postpartum weight retention and increased physical activity, according to data published in Diabetes Care.

The Gestational Diabetes' Effect on Moms (GEM) study found that the lifestyle intervention was more effective than usual care in women with gestational diabetes.

"Type 2 diabetes is a costly disease affecting [about] 12.6 million women in the [United States]," Assiamira Ferrara, MD, PhD, a senior research scientist at the Kaiser Permanente Northern California Division of Research, and colleagues wrote. "Randomized efficacy trials demonstrated that weight loss programs can prevent diabetes. Diabetes prevention is critical for women with gestational diabetes mellitus, which affects 7 to 14% of pregnancies, as women with [gestational diabetes mellitus] are seven times more likely to develop type 2 diabetes than parous women without [gestational diabetes mellitus]."

Assiamira Ferrara

Ferrara and colleagues conducted a cluster randomized controlled trial in which 2,280 women from 44 medical facilities were randomly assigned to usual care or the lifestyle intervention. Usual care consisted of telephone-based management for glucose control during pregnancy and mailed recommendations from the Kaiser Permanente Northern California Perinatal Center at 6 weeks postpartum. The Diabetes Prevention Program (DPP)-derived lifestyle intervention consisted of usual care plus the addition of telephone coaching and personalized mailings.

Over the 12-month postpartum period, women assigned to the intervention program had higher odds of meeting weight goals than women in the usual care group (OR = 1.28; 95% CI, 1.1-1.47). More women assigned to the intervention program met weight goals than women in the usual care group at 6 weeks postpartum (25.5% vs. 22.4%; OR = 1.17) and at 6 months postpartum (30.6% vs. 23.9%; OR = 1.45). This difference was reduced at 12 months (33% vs. 28%; OR = 1.25).

Ferrara and colleagues also reported that at 6 months postpartum, women assigned to the intervention program retained less weight than women in usual care (mean 0.39 kg vs. 0.95 kg) and demonstrated greater increases in vigorous intensity physical activity (adjusted mean condition difference = 15.4 min/week; 95% CI, 4.9-25.8).

The researchers noted that fewer women in the intervention program developed prediabetes or diabetes than women in usual care (29.7% and 3.5% vs. 32.4% and 4.4%), but the risk estimate for prediabetes and diabetes combined was not statistically significant (33.2% vs. 36.8%; HR = 0.9; 95% CI, 0.78-1.04).

"The GEM study is unique in that it was a trial embedded in real-world practice," Ferrara said in a press release. "Our findings show the benefits of lifestyle intervention diabetes prevention programs in helping women with gestational diabetes manage their weight and increase physical activity, thereby potentially preventing or delaying the onset of diabetes." – by Chelsea Frajerman Pardes

Disclosures: The authors report no relevant financial disclosures.