Lifestyle Intervention for the Prevention of Diabetes in Women With Previous Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis

Abstract

Background: Type 2 diabetes is increasing among the young, and gestational diabetes (GDM) offers a unique opportunity for diabetes prevention. We aimed to systematically review postpartum randomized trials to summarize the benefits of lifestyle interventions for women with previous GDM.Methods:We searched for RCTs involving women with previous GDM that compared lifestyle interventions—diet, physical activity or breastfeeding—at postpartum with usual care up to May 2018.Results:Of 1,895 abstracts identified, we selected 15 studies investigating incidence of diabetes or changes in glycemia. Most interventions focused on changes in diet and physical activity, only one also on incentive to breastfeeding. Meta-analysis of 8 studies investigating incidence of diabetes revealed a homogeneous (I2 = 10%), reduction of 25% (RR = 0.75; 95%CI: 0.55–1.03) borderline statistically significant. Only trials offering intervention soon after delivery (< 6 months post-partum) were effective (RR = 0.61; 95%CI: 0.40–0.94; p for subgroup comparison = 0.11). Overall, no benefit was found regarding measures of glycemia. Although moderate reductions in weight (MD = −1.07 kg; −1.43−0.72 kg); BMI (MD = −0.94 kg/m2; −1.79 −0.09 kg/m2); and waist circumference (MD = −0.98 cm; −1.75 −0.21 cm) were observed, effects were larger with longer follow-up.Conclusions:Summary results of the available evidence support benefits of lifestyle interventions at postpartum for women with previous GDM. Benefits, although smaller than those of major trials based in older subjects receiving intensive interventions, appear clinically relevant for this young subset of woman. Further studies are needed to improve the quality of the evidence and to further tailor interventions to this specific setting.

Intuitive eating is associated with improved health indicators at 1-year postpartum in women with gestational diabetes mellitus

“…In a recent Cochrane review of lifestyle intervention trials among women with GDM, three trials included the incidence of type-2 diabetes and prediabetes in the postpartum period, but only one found a difference between the intervention and the control group (Brown et al, 2017). In another recent systematic review and meta-analysis of 15 trials in women with previous GDM, half of the lifestyle interventions led to a reduction of weight and the incidence of diabetes, but effect sizes were small and their sustained effects were inconsistent (Goveia et al, 2018).…”

Protocol for a randomised controlled trial of a co-produced, complex, health promotion intervention for women with prior gestational diabetes and their families: the Face-it study

“…While BMI is a well-established strong predictor of T2D development, it could be argued that a measure of glucose would be a more obvious choice of primary outcome. However, in their meta-analysis of existing lifestyle interventions aimed at T2D prevention in women with prior GDM, Goveia et al found no effect on glucose measures but did find a moderate reduction in BMI [9]. As argued by the authors, while the observed effects are small, a modest change in anthropometric measures within a short time in relatively young women may still have a substantial impact on the long-term risk of T2D [9].…”

“…However, in their meta-analysis of existing lifestyle interventions aimed at T2D prevention in women with prior GDM, Goveia et al found no effect on glucose measures but did find a moderate reduction in BMI [9]. As argued by the authors, while the observed effects are small, a modest change in anthropometric measures within a short time in relatively young women may still have a substantial impact on the long-term risk of T2D [9]. Thus, based on prior intervention studies targeting women in the first years(s) after their GDM affected pregnancy, we concluded that the existing evidence base for changing BMI in this group was relevant and stronger in terms of providing us with necessary information upon which we could base our sample size calculation.…”

“…Since the cumulative incidence of T2D in women with prior GDM increases substantially within the first 5 years after delivery [8], the need exists to identify effective interventions in this time period. Importantly, a recent meta-analysis of lifestyle interventions for the prevention of T2D in women with previous GDM showed that the effects appear to be larger when the intervention is initiated within 6 months after delivery [9]. However, the authors concluded that there is a need to further tailor interventions to this specific period of life and that additional studies are required to improve the quality of the evidence [9].…”

“…Importantly, a recent meta-analysis of lifestyle interventions for the prevention of T2D in women with previous GDM showed that the effects appear to be larger when the intervention is initiated within 6 months after delivery [9]. However, the authors concluded that there is a need to further tailor interventions to this specific period of life and that additional studies are required to improve the quality of the evidence [9]. A 2017 systematic review also reported that while any intervention was superior to no intervention, based on the current evidence, concluding which behavioural intervention components would be the most effective in reducing T2D risk in women with prior GDM [10] was not possible.…”