Lifestyle Interventions to Prevent Type 2 Diabetes in Women with a History of Gestational Diabetes: A Systematic Review and Meta-Analysis through the Lens of Health Equity

Abstract

Background: Type 2 diabetes mellites is one of the health problems disproportionally affecting people with low socioeconomic statuses. Gestational diabetes mellites increases the risk of type 2 diabetes by up to ten-fold for women. Lifestyle interventions prevent type 2 diabetes in women with prior gestational diabetes. However, it is unknown if similar effectiveness can be expected for all population subgroups. Objective: This study aims to assess the prevention of type 2 diabetes in women with prior gestational diabetes using population characteristics according to the PROGRESS (place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, and social capital) criteria. Methods: MEDLINE, CINAHL, EMBASE, PubMed, PsycINFO, Web of Science, and EBM Reviews databases were searched for interventional studies of diet, physical activity, or behavioural interventions published up to 21 February 2023. Random effects subgroup meta-analysis was conducted to evaluate the association of population characteristics and intervention effects. Results: All studies were conducted in high-income countries or middle-income countries. Two-thirds of the studies reported on race/ethnicity and education level. Less than one-third reported on place (urban/rural), occupation, and socioeconomic status. None reported on religion or social capital. Studies from high-income countries (MD = −1.46; 95% CI: −2.27, −0.66, I2 = 70.46, p < 0.001) showed a greater reduction in bodyweight compared with the studies conducted in middle-income countries (MD = −0.11; 95% CI: −1.12, 0.89, I2 = 69.31, p < 0.001) (p for subgroup difference = 0.04). Conclusion: There are significant equity gaps in the evidence for the prevention of type 2 diabetes in women with prior gestational diabetes due to reports on population characteristics being poor. Interventions may be less effective in reducing bodyweight in women from middle-income countries compared to high-income countries. Collecting and analysing data related to equity is needed to understand the effect of lifestyle interventions on type 2 diabetes for different population subgroups.

A holistic lifestyle mobile health intervention for the prevention of type 2 diabetes and common mental disorders in Asian women with a history of gestational diabetes: a randomised control trial with 3-year follow-up protocol

“…Risk factors for T2D among those with a history of GDM included greater pre-pregnancy Body Mass Index (BMI), excessive weight gain, unhealthy dietary patterns, physical inactivity, and a short period of lactation [ 13 ]. Post-natal risk, such as missing medical assistance in the continuum of GDM care after delivery, could be another risk for progression to T2D among Asian mothers with a history of GDM [ 7 ].…”

“…However, most preventative studies are undertaken in Western countries [ 21 ], and it is challenging to directly apply these strategies in Asian countries due to differences in demographics, socioeconomics, ethnicity, and cultural factors [ 7 ]. A recent systematic review study concluded that in most of the studies, the evidence-based intervention might not be culturally appropriate for the prevention of T2D in women with a history of GDM [ 13 ].…”