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Lifestyle Intervention Helps Women With Gestational Diabetes Achieve Appropriate Weight Loss, Exercise Levels After Birth of Baby

A diabetes prevention program administered within the nation’s largest, integrated health care system was effective in helping women with a history of gestational diabetes reach weight loss goals and increase physical activity following the birth of their children, according to a new Kaiser Permanente study published online today in the journal Diabetes Care.

Women with gestational diabetes mellitus, which occurs during pregnancy, are up to seven times more likely to develop type 2 diabetes in the years after they give birth, and more than 75 percent belong to racial or ethnic minority groups.

Being overweight or obese is an important factor contributing to the risk of developing type 2 diabetes. The Gestational Diabetes Effects on Moms study (or GEM) sought to identify health-system-based methods for helping women with gestational diabetes meet weight goals in the year after giving birth. The study offered a lifestyle intervention to 1,087 women at 22 medical clinics in Kaiser Permanente’s Northern California Region. These programs included direct mailings and telephone coaching. A total of 1,193 women in the remaining 22 medical clinics received printed materials describing diabetes risk and how to prevent it.

During the six months postpartum, women with gestational diabetes receiving care in the clinics assigned to the intervention were 45 percent more likely to meet their weight goals than the women in the clinics assigned to usual care (31 percent versus 24 percent, respectively); they also increased their vigorous-intensity physical activity by an average of 15.4 minutes per week.

“The GEM study is unique in that it was a trial embedded in real-world practice. 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,” said Assiamira Ferrara, MD, PhD, the study’s lead author and section chief of Women’s and Children’s Health at the Kaiser Permanente Northern California Division of Research.

“This study’s findings will inform how we help Kaiser Permanente members who had gestational diabetes reduce their chances of developing type 2 diabetes,” said Yvonne Crites, MD, perinatologist at Kaiser Permanente’s Santa Clara Medical Center and medical director of the Perinatal Center.

In this cluster-randomized controlled trial, both approaches to the diabetes prevention programs were provided by the Kaiser Permanente Perinatal Center between March 2011 and March 2012. The postpartum weight loss goals included returning to pre-pregnancy weight for normal weight women or losing 5 percent of their pre-pregnancy weight for overweight or obese women.

Women in the intervention clinics were mailed information about weight gain during their pregnancies, and were offered a lifestyle workbook and the opportunity to participate in 13 telephone sessions (conducted between six weeks and six months after giving birth) with a lifestyle coach trained in motivational interviewing.

“Motivational interviewing is a patient-centered approach for encouraging behavior change, which is increasingly applied in health care settings,” said study co-author Susan D. Brown, PhD, research scientist with the Kaiser Permanente Division of Research. “Lifestyle coaches help women identify their own reasons for making changes in their eating and exercise habits.”

Half of the 1,087 women in the clinics who were offered the lifestyle intervention chose to participate, which indicates these women learned about the future risks associated with gestational diabetes and may have been highly motivated to reduce those risks. Analyses also showed that the intervention’s effectiveness would have doubled if all women offered it had participated, and that the number of women who met weight goals increased with the number of coaching sessions that they completed.

“This suggests a potential for great impact if we can improve patient engagement and participation in such lifestyle interventions,” said co-author Monique M. Hedderson, PhD, research scientist with the Kaiser Permanente Division of Research.

In addition to Dr. Ferrara, Hedderson, Brown and Dr. Crites, co-authors of the study were Samantha F. Ehrlich, PhD, Ai-Lin Tsai, MS, Bette J. Caan, DrPH, Barbara Sternfeld, PhD, MPH, Nancy P. Gordon, ScD, Julie A. Schmittdiel, PhD, Erica P. Gunderson, PhD, Ashley A. Mevi, MPH, and Charles P. Quesenberry Jr., PhD, Kaiser Permanente Division of Research; Cheryl L. Albright, PhD, MPH, School of Nursing and Dental Hygiene, University of Hawaii at Manoa; William H. Herman, MD, MPH, Department of Internal Medicine and Epidemiology, University of Michigan; and Jenny Ching, RN, Department of Obstetrics and Gynecology, Kaiser Permanente Medical Center, Santa Clara, Calif.

The study was funded by the Agency for Healthcare Research and Quality and the National Institute of Diabetes and Digestive and Kidney Diseases.

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