Designing a lifestyle intervention to reduce risk of type 2 diabetes in postpartum mothers following gestational diabetes: An online survey with mothers and health professionals

Moore, Amelia; D’Amico, Maria; Cooper, Natalie Am; Thangaratinam, Shakila

doi:10.1016/j.ejogrb.2017.11.012

Cited by 11 publications

(16 citation statements)

References 36 publications

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“…Lacking knowledge on when to safely resume exercise after childbirth and the health consequences of pregnancy complications were barriers for postpartum women especially in those who had a pregnancy complicated by GDM or pre‐eclampsia 44,49,54 . Similarly, HPs believed that women were unaware of the benefits of physical activity, the importance of postpartum dietary modifications and weight control in reducing future risk of type 2 diabetes 50,58,59 . In one study, HPs themselves reported lacking knowledge of the relationship between GDM and diabetes mellitus (DM) and the role of dietary habits in the progression of GDM to DM 59 …”

Section: Resultsmentioning

confidence: 99%

“…HPs similarly reported that women did not prioritise their health after childbirth, believing that they did not need to care for their own health anymore now that the baby was no longer part of their body. HPs also face time constraints, in that they felt they did not have enough time during consultation to support women with postpartum weight management 50 …”

Section: Resultsmentioning

confidence: 99%

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Barriers and facilitators to a healthy lifestyle in postpartum women: A systematic review of qualitative and quantitative studies in postpartum women and healthcare providers

et al. 2021

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Summary A healthy postpartum lifestyle is vital for the promotion of optimal maternal health, return to pre‐pregnancy weight and prevention of postpartum weight retention, but barriers exist. We performed a systematic review that aimed to describe the barriers and facilitators to a healthy lifestyle in the first 2 years postpartum from the perspectives of women and healthcare providers. Databases were searched for eligible studies published up to 26 August 2019. Following thematic analysis, identified themes were mapped to the Theoretical Domains Framework and the Capability, Opportunity, Motivation and Behaviour model. We included 28 qualitative and quantitative studies after screening 15,643 citations and 246 full texts. We identified barriers and facilitators relating to capability (e.g., lack of knowledge regarding benefits of lifestyle behaviours; limitations in healthcare providers' skills in providing lifestyle support), opportunity (e.g., social support from partners, family, friends and healthcare providers; childcare needs) and motivation (e.g., identifying benefits of exercise and perception of personal health; enjoyment of the activity or food). We suggest intervention components to include in lifestyle interventions for postpartum women based on the identified themes. Our findings provide evidence to inform the development of interventions to support postpartum women in adopting and maintaining a healthy lifestyle.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Barriers and facilitators to a healthy lifestyle in postpartum women: A systematic review of qualitative and quantitative studies in postpartum women and healthcare providers

et al. 2021

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“…Our survey of 106 healthcare professionals showed that 80% (17/21) of midwives and about 50% (11/21) of the obstetricians were unsure of the future risk of type 2 diabetes after gestational diabetes. 17 This further hinders provision of interventions to prevent type 2 diabetes in the postnatal period. Three-quarters of mothers (50/67) were interested in continuing metformin after delivery to prevent type 2 diabetes.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and acceptability of metformin in preventing the onset of type 2 diabetes after gestational diabetes in postnatal women: a protocol for a randomised, placebo-controlled, double-blind feasibility trialOptimising health outcomes with Metformin to prevent diAbetes After pregnancy (OMAhA)

et al. 2020

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IntroductionUp to half of all women diagnosed with gestational diabetes mellitus develop type 2 diabetes within 5 years after delivery. Metformin is effective in preventing type 2 diabetes in high-risk non-pregnant individuals, but its effect when commenced in the postnatal period is not known. We plan to assess the feasibility of evaluating metformin versus placebo in minimising the risk of dysglycaemia including type 2 diabetes after delivery in postnatal women with a history of gestational diabetes through a randomised trial.Methods and analysisOptimising health outcomes with Metformin to prevent diAbetes After pregnancy (OMAhA) is a multicentre placebo-controlled double-blind randomised feasibility trial, where we will randomly allocate 160 postnatal women with gestational diabetes treated with medication to either metformin (intervention) or placebo (control) tablets to be taken until 1 year after delivery. The primary outcomes are rates of recruitment, randomisation, adherence and attrition. The secondary outcomes are maternal dysglycaemia, cost and quality of life outcomes in both arms, and acceptability of the study and intervention, which will be evaluated through a nested qualitative study. Feasibility outcomes will be summarised using descriptive statistics, point estimates and 95% CIs.Ethics and disseminationThe OMAhA study received ethics approval from the London-Brent Research Ethics Committee (18/LO/0505). Trial findings will be published in a peer-reviewed journal, disseminated at conferences, through our Patient and Public Involvement advisory group (Katie’s Team) and through social media platforms.Trial registration numberISRCTN20930880

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“…Interventions to improve physical activity among women with past GDM continue to be challenging for long-term behavior change. 33 Social support, 34 including partner 35 and peer support, 36 and walking programs 37 have been recommended for women with past GDM. Diabetes educators should refer women with past GDM to community resources that offer social support for physical activity.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Health-Protective Behavior and Glycemia After Gestational Diabetes, NHANES 2007-2014

et al. 2019

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Purpose This study examined weight loss behavior and the prevalence of hyperglycemia unawareness (unknown high blood glucose) after gestational diabetes mellitus (GDM), within a nationally, representative sample. This study also examined social-demographic, psychosocial, provider communication, and health care access/utilization factors as predictors of A1C and health-protective behavior after GDM. Methods A secondary analysis of 2007-2014 National Health and Nutrition Examination Surveys (NHANES) data was conducted, including 205 women, aged 20 to 44 years, with a history of GDM, whose last live birth was in the past 10 years, excluding pregnant women and those with diabetes. Weighted bivariate, stepwise linear, and binary logistic regression analyses were conducted to examine correlates of A1C, weight change, weight loss attempt and behavior, diabetes screening, and physical activity. Results Hyperglycemia unawareness was associated with increased A1C and weight gain in the past year. Personal weight loss goal and perception of overweight increased the odds of weight loss attempt. Depressive symptoms were associated with weight gain over the past year. A third of the sample failed to have their glucose tested in the past 3 years. Two-thirds were never told about their personal risk for diabetes, but provider communication increased the odds of meeting weekly activity recommendations and glucose screening. Hispanic women and non-Hispanic black women were less likely to have had glucose screening than non-Hispanic white women. Conclusion Diabetes educators should address gaps in provider communication, while supporting psychosocial needs and reducing disparities to encourage health-protective behavior after GDM. The American Association of Diabetes Educators, 7 Self-Care Behaviors (AADE-7TM) provides an excellent framework for interventions to support health-protective behavior after GDM.

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Designing a lifestyle intervention to reduce risk of type 2 diabetes in postpartum mothers following gestational diabetes: An online survey with mothers and health professionals

Abstract: A walking programme, recipe ideas and weight monitoring may be useful components when designing a postpartum lifestyle intervention. Barriers to engagement are evident and the intervention should allow women to engage at a time that is appropriate for them.

Cited by 11 publications

References 36 publications

Barriers and facilitators to a healthy lifestyle in postpartum women: A systematic review of qualitative and quantitative studies in postpartum women and healthcare providers

Barriers and facilitators to a healthy lifestyle in postpartum women: A systematic review of qualitative and quantitative studies in postpartum women and healthcare providers

Effectiveness and acceptability of metformin in preventing the onset of type 2 diabetes after gestational diabetes in postnatal women: a protocol for a randomised, placebo-controlled, double-blind feasibility trialOptimising health outcomes with Metformin to prevent diAbetes After pregnancy (OMAhA)

Predictors of Health-Protective Behavior and Glycemia After Gestational Diabetes, NHANES 2007-2014

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