OAKLAND, Calif., -- In women with gestational
diabetes, a lifestyle intervention, including modified diet and physical
activity that starts during pregnancy and continues postpartum is feasible and
may prevent diabetes by reducing pregnancy weight retention and help overweight
women lose weight, according to Kaiser Permanente researchers.
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.
