Effects of lifestyle intervention on long‐term risk of diabetes in women with prior gestational diabetes: A systematic review and meta‐analysis of randomized controlled trials

We performed two meta‐analyses to estimate the effects of lifestyle intervention during pregnancy and after delivery on the risk of postpartum diabetes among women with gestational diabetes mellitus (GDM). We searched the major databases to retrieve articles published in English or Chinese before 15 December 2019. The inclusion criteria were randomized controlled trials (RCTs) of diet, physical activity or both, conducted during or after pregnancy among women with GDM. The exclusion criteria were (1) having type 1 or type 2 diabetes before the intervention and (2) without postpartum diabetes documented. Fixed‐effects model analysis was used to obtain the pooled relative risks (RRs) and 95% confidence intervals (CIs) of lifestyle intervention for diabetes in women with GDM. Four RCTs were identified to have implemented the intervention during pregnancy (n = 2883) and 10 to have conducted it within 3 years after delivery (n = 1733). Lifestyle intervention during pregnancy was not effective at reducing the risk of postpartum diabetes (RR: 0.91, 95%CI: 0.66–1.25). However, lifestyle intervention initiated within 3 years after delivery was highly effective in reducing the risk of postpartum diabetes (pooled RR: 0.57, 95% CI: 0.42–0.78). In conclusion, our findings support the early initiation of lifestyle intervention in women with GDM for the prevention of diabetes.     

Changing psychosocial determinants of physical activity and diet in women with a history of gestational diabetes mellitus

Background

To investigate how a behavioural lifestyle intervention influences psychosocial determinants of physical activity and dietary behaviours in a population at risk of type 2 diabetes (T2DM).

Methods

Fifty‐nine women with a body mass index of ≥25 kg/m² and a history of gestational diabetes mellitus (GDM) participated in a randomized controlled study. The intervention group (n = 29) received 2 face‐to‐face and 5 telephone lifestyle‐counselling sessions with a health professional. The control group (n = 30) received care as usual. At baseline and 6 months, psychosocial determinants related to physical activity and diet were measured with a self‐administrated questionnaire. Linear regression analyses were applied to test for intervention effects.

Results

The intervention was effective in improving social support (β = 3.5, P < 0.001; β = 2.1, P = 0.02), modifying self‐efficacy (β = ‐2.2, P = 0.02; β = ‐4.3, P < 0.001), and reducing barriers (β = ‐3.5, P = 0.01; β = ‐3.8, P = 0.01) for, respectively, physical activity and diet from baseline to 6‐month follow‐up in the intervention group compared with the control group. The intervention reduced the following barriers to a physically active lifestyle: lack of energy and lack of motivation. Physical activity barriers like lack of time and lack of childcare were unchanged. The intervention reduced the following barriers to a healthy diet: lack of time, costs, having unhealthy snacks at home, and having cravings for sweets.

Conclusion

This lifestyle intervention influenced psychosocial determinants relevant for overweight women with a history of gestational diabetes mellitus (GDM) in prevention of T2DM.     

Avoiding the slippery slope: preventing the development of diabetes in women with a history of gestational diabetes

Women with a history of gestational diabetes are at increased risk of developing type 2 diabetes. By identifying this high-risk group who has not yet developed the disease, we have the opportunity to try to prevent this progression to diabetes. In this article, we review the evidence for different strategies used to prevent the onset of diabetes in women with a history of gestational diabetes. These strategies include lifestyle changes, medications and breastfeeding.     

Screening practices for gestational diabetes mellitus in UK obstetric units.

AIM: To identify current screening practices for gestational diabetes mellitus (GDM) in all maternity units. METHODS: A questionnaire was sent to the senior obstetrician of all obstetric units known to the UK Royal College of Obstetricians and Gynaecologists. RESULTS: A response rate of 84% was achieved. 89% of units reported that they screened for GDM with a wide variation in the screening methods used, both between and within units. The most commonly employed procedure (81% of units) was screening based on the presence of maternal risk factors. The 75 g oral glucose tolerance test (OGTT) was the commonest diagnostic test (79% of units). Sixty-six per cent of units operate a combined diabetic antenatal clinic and 58% of units have written guidelines for screening. Seventy-six per cent of units would welcome national guidelines. CONCLUSION: The majority of obstetric units in the UK screen for GDM but with little consensus on the appropriate screening methods. National guidelines would probably be welcomed.     

Effect of breastfeeding on metabolic-related outcomes in women with previous gestational diabetes mellitus: A protocol for systematic review and meta-analysis

Background:This meta-analysis was to systematically investigate the effect of breastfeeding on metabolic-related outcomes in women with previous gestational diabetes mellitus (GDM).Methods:We will search the online databases of Relevant studies were searched in Pubmed, Embase, Cochrane Library, Web of Science. Relative risk and weighted mean difference with 95% confidence interval will pooled using Stata14.0 software.Conclusion:Our meta-analysis will explore the effect of breastfeeding on metabolic-related outcomes in women with previous GDM and may provide effective treatment options of GDM.OSF registration number:10.17605/OSF.IO/HA5U8     

Women with a history of gestational diabetes of European and South Asian origin are shorter than women with normal glucose tolerance in pregnancy.

AIMS: It has been reported that short individuals are more likely to have abnormalities of glucose homeostasis. The aim of this study was to examine the relationship between adult height and gestational diabetes mellitus (GDM), taking into account possible artefactual or confounding explanations. METHODS: Three hundred and forty-six women with previous GDM (169 European, 102 South Asian, 75 Afro-Caribbean) and 470 control women with no previous history of GDM (282 European, 94 South Asian and 94 Afro-Caribbean) were studied. Post-partum glucose status and height were measured. RESULTS: European and South Asian women with previous GDM were shorter than control women from the same ethnic groups (European: (mean +/- SD) 162.9 +/- 6.1 vs. 165.3 +/- 6.8 cm, P < 0.0001; South Asian: 155.2 +/- 5.4 vs. 158.2 +/- 6.3 cm, P = 0.003, adjusted for age). A similar, but non-significant trend was observed among Afro-Caribbean women (162.2 +/- 6.2 vs. 163.7 +/- 6.1 cm, P = 0.1). Similar, significant height differences were observed in Europeans and South Asians when analysis was restricted to those GDM women who had received insulin during pregnancy. There was no association between height and glucose tolerance postpartum within the GDM group. CONCLUSIONS: European and South Asian women with previous GDM are shorter than control women from the same ethnic groups. The data demonstrate that this is unlikely to be an artefact resulting from the use of an fixed 75 g load in women of differing sizes, and suggest that there are likely to be common pathophysiological mechanisms underlying GDM and the determination of final adult height.     

Lifestyle intervention can reduce the risk of gestational diabetes: a meta‐analysis of randomized controlled trials

This study aimed to examine the effect of lifestyle intervention on the risk of gestational diabetes mellitus (GDM). We searched PubMed, Springer and other databases to retrieve articles published in English and Chinese up to 30 September 2015. The inclusion criteria were randomized controlled trials evaluating the effects of lifestyle intervention on risk of GDM. Exclusion criteria were studies with prepregnancy diabetes mellitus or interventions with nutrient supplements. Random‐effect and fixed‐effect model analyses were used to obtain pooled relative risks and 95% confidence intervals (CIs) of diet and physical activity on the risk of GDM. Subgroup analyses were performed to check the consistency of effect sizes across groups where appropriate. We identified 29 randomized controlled trials with 11,487 pregnant women, addressing the effect of lifestyle intervention on the risk of GDM. In the pooled analysis, either diet or physical activity resulted in an 18% (95%CI 5–30%) reduction in the risk of GDM (P = 0.0091). Subgroup analysis showed that such intervention was effective among women with intervention before the 15th gestational week (relative risk: 0.80, 95%CI 0.66–0.97), but not among women receiving the intervention afterwards. We conclude that lifestyle modification during pregnancy, especially before the 15th gestational week, can reduce the risk of GDM. © 2016 World Obesity     

Simple lifestyle recommendations and the outcomes of gestational diabetes. A 2×2 factorial randomized trial

The benefits of exercise and behavioural recommendations in gestational diabetes mellitus (GDM) are controversial. In a randomized trial with a 2×2 factorial design, we examined the effect of exercise and behavioural recommendations on metabolic variables, and maternal/neonatal outcomes in 200 GDM patients. All women were given the same diet: group D received dietary recommendations only; group E was advised to briskly walk 20‐min/day; group B received behavioural dietary recommendations; group BE was prescribed the same as B + E. Dietary habits improved in all groups. In a multivariable regression model, fasting glucose did not change. Exercise, but not behavioural recommendations, was associated with the reduction of postprandial glucose (p < 0001), glycated haemoglobin (HbA1c; p < 0.001), triglycerides (p = 0.02) and C‐reactive protein (CRP; p < 0.001) and reduced any maternal/neonatal complications (OR = 0.50; 95%CI=0.28–0.89;p = 0.02). In GDM patients a simple exercise programme reduced maternal postprandial glucose, HbA1c, CRP, triglycerides and any maternal/neonatal complications, but not fasting glucose values.     

Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with a similar risk profile.

AIMS: To assess maternal and fetal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM) compared to non-diabetic pregnancies with an otherwise similar risk profile and to study the association between different anti-diabetic treatments and fetal outcomes. METHODS: The records of 143 consecutive GDM pregnancies and 143 non-diabetic controls matched on the basis of age, parity and pre-pregnancy body mass index (BMI) were studied. The GDM patients were treated with diet, tolbutamide and insulin. Data were collected from medical records and birth records. RESULTS: Despite treatment, the GDM group had a statistically significant higher frequency of maternal hypertension (20% vs. 11%), induction of labour (61% vs. 24%), Caesarean section (33% vs. 21%), macrosomia (14% vs. 6%), neonatal hypoglycaemia (24% vs. 0) and admission to a neonatal unit (46% vs. 12%). The risk of complications was similar in the different treatment groups. However, in the tolbutamide-treated group, one case of long-standing severe hypoglycaemia in a premature neonate occurred. CONCLUSIONS: Pregnancies complicated by GDM are associated with a higher frequency of adverse maternal and fetal outcomes. The outcomes seem to be unaffected by treatment modality. However, because of the potential risk of hypoglycaemia in some neonates, tolbutamide treatment cannot be recommended in pregnancy.     

Managing women with gestational diabetes mellitus in the postnatal period

Guidelines for management of women with a history of gestational diabetes mellitus (GDM) in the postpregnancy period have lagged behind the recognition that this is an important time for medical intervention. However, in the past decade, the evidence-base for screening algorithms, contraceptive management, diabetes prevention strategies and implications for offspring has expanded. In this review, we discuss current recommendations for managing women with GDM in the postnatal period, with particular attention to postpartum diabetes screening, prevention of future glucose intolerance and family planning.     

Maternal vitamin D deficiency,ethnicity and gestational diabetes

Aims Vitamin D deficiency has been linked to impaired glucose metabolism. We determined whether serum 25‐hydroxyvitamin D (25OHD) is associated with glucose metabolism in pregnant women and the effect of ethnicity on this relationship. Methods We analysed serum 25OHD concentrations in 307 pregnant women attending a metropolitan obstetric clinic between October 2003 and May 2005. Measurements from 264 of the women were taken at the time of glucose tolerance testing at mid‐gestation, a population therefore at increased risk for gestational diabetes. Pearson correlation analysis was used to test for univariate linear relationships between the natural log of serum 25OHD (ln‐25OHD) and other variables. Multiple regression analysis was used to adjust for confounding factors. Results Mean serum 25OHD concentration was 53.8 ± 23.9 nmol/l (sd ). Ln‐25OHD was negatively correlated with serum parathyroid hormone as expected (r ?0.24, confidence intervals ?0.35 to ?0.12). Ln‐25OHD was also negatively correlated with fasting plasma glucose (r?0.20, ?0.31 to ?0.08), fasting insulin (r ?0.20, ?0.31 to ?0.08) and insulin resistance as calculated by homeostatis model assessment (r ?0.21, ?0.32 to ?0.09). The association between fasting glucose and log‐transformed 25OHD concentration was of borderline significance after accounting for ethnicity, age and body mass index in multivariate analyses (?0.13, ?0.26 to 0.01). The odds ratio of gestational diabetes in women with 25OHD < 50 nmol/l did not reach statistical significance (1.92, 95% confidence interval 0.89–4.17). Conclusions Maternal 25OHD concentrations are inversely related to fasting glucose, although further studies are required to establish whether this is independent of the effects of ethnic background.     

The effectiveness of glibenclamide in women with gestational diabetes

Background: Several studies have suggested that glibenclamide may be used safely and effectively in women with gestational diabetes mellitus (GDM). The aim of our study was to assess effectiveness and safety of glibenclamide for GDM in UK clinical practice. Methods: Women with GDM requiring pharmacological therapy were offered a choice of insulin or glibenclamide. Maternal and foetal outcomes were assessed in women treated with insulin (45) or glibenclamide (44) and also compared with women treated with diet alone (55). Results: Thirty‐four (77%) achieved adequate glycaemic control with glibenclamide. Women choosing glibenclamide were more likely to be Asian and had higher fasting and 2‐h glucose at diagnosis than those choosing insulin. There was no difference in maternal age or parity. Ten women treated with glibenclamide switched to insulin [inadequate control (7), unpredictable hypoglycaemia (1) and other reason (2)]. There was no difference in mode of birth, birth weight or birth weight centile between groups. One stillbirth occurred with glibenclamide. Glibenclamide treatment was associated with lower Apgar scores and increased neonatal jaundice. Neonatal hypoglycaemia occurred more frequently in babies of women treated with either glibenclamide or insulin. Conclusion: The use of glibenclamide in pregnancy is associated with adequate glycaemic control in 77% of women and achieved similar foetal outcomes to women treated with insulin.