The Impact of a Cultural Lifestyle Intervention on Metabolic Parameters After Gestational Diabetes Mellitus A Randomized Controlled Trial

Objectives

The prevalence of type 2 diabetes in Israel is increasing in all ethnic groups but most markedly in the Bedouin population. We aimed to assess the effects of a lifestyle change intervention on risk markers for type 2 diabetes after gestational diabetes mellitus (GDM).

Methods

One hundred eighty Jewish and Bedouin post-GDM women were randomly assigned to a lifestyle intervention group (IG) or a control group (CG) starting 3–4 months after delivery. The IG participated in healthy lifestyle sessions led by a dietician and a sports instructor for 24 months after delivery. The IG participants had three individual 45-min counseling sessions and four 90-min group meetings (10 women each). The dietary and exercise recommendations were culturally adapted. The primary outcome of the study was HOMA-IR. We monitored clinical and chemical biomarkers 1 and 2 years after delivery.

Results

After 1 and 2 years of intervention, the metabolic measures improved substantially. The intervention reduced the insulin, glucose and HOMA-IR levels in the IG compared with those in the CG (p?<?0.001).

Conclusions

This novel culturally tailored lifestyle intervention program significantly improved the metabolic and morphometric indices measured 1 and 2 years after delivery. These results highlight and underscore the importance of effective lifestyle change education following GDM.

     

生活方式干预对肥胖妊娠糖尿病患者外周血炎性指标的影响

目的探讨生活方式干预对肥胖妊娠糖尿病(GDM)患者外周血炎性指标的影响。方法选取我院收治的56例肥胖GDM患者(身体质量指数>30 kg/m2),随机平均分为干预组和对照组。对照组接受孕期健康教育和常规产检,干预组在此基础上进行个体化饮食指导和运动干预。采用食物频率调查表记录两组患者的孕期饮食,并检测外周血APN、血脂、HOMA-IR、CRP、IL-6和TNF-α水平。结果干预后,干预组的蛋白质、脂肪和总热量摄入均低于对照组,差异有统计学意义(P<0.05)。干预组的空腹血糖、HOMA-IR均低于对照组,HDL-C和APN均高于对照组,差异均有统计学意义(P<0.05)。干预组的IL-6和CRP水平均低于对照组,差异有统计学意义(P<0.05),但两组的TNF-α水平比较差异无统计学意义(P>0.05)。干预组的胰岛素使用率、新生儿出生体重和孕期体重增加均明显低于对照组,差异有统计学意义(P<0.05)。结论对肥胖GDM患者进行生活方式干预后,糖代谢得到较好的控制,其机制可能是生活方式干预降低了外周血炎性指标水平。     

The 6-Month Efficacy of an Intensive Lifestyle Modification Program on Type 2 Diabetes Risk Among Rural Women with Prior Gestational Diabetes Mellitus: a Cluster Randomized Controlled Trial

Prevention Science - This study aimed to evaluate the efficacy of an intensive lifestyle modification program tailored to rural Chinese women with prior gestational diabetes mellitus compared with...     

Postpartum Diabetes Testing Among Women with Recent Gestational Diabetes Mellitus: PRAMS 2009–2010

The objective of this study was to estimate rates of and factors associated with postpartum diabetes testing in women with recent gestational diabetes mellitus (GDM). Secondary data analysis was conducted using data from the 2009 and 2010 Pregnancy Risk Assessment Monitoring System from three states and one city (Colorado, Minnesota, Utah, and New York City). Frequency of postpartum diabetes testing was estimated overall and among women who attended a postpartum visit. Multivariable logistic regression was used to determine factors associated with postpartum diabetes testing. Approximately 8.2 % [95 % confidence interval (CI) 7.5–8.9] of women self-reported a history of GDM (n = 829), of which 48.5 % (43.9–53.1) reported being tested for diabetes postpartum. Among the 90.0 % (86.5–93.4) of women with recent GDM who attended the postpartum visit, 51.7 % (46.1–57.2) reported being tested for diabetes postpartum. Women who received inadequate/intermediate prenatal care were half as likely to report postpartum testing compared with women who received adequate prenatal care [odds ratio 0.45 (95 % CI 0.25–0.83)]. Women with a prepregnancy body mass index classified as obese were over twice as likely to report postpartum testing compared to normal weight women. Women with GDM are at increased risk of persistent glucose intolerance after delivery, yet postpartum testing rates remain around 50 %, regardless of attendance to the postpartum visit. Improving adequacy of prenatal care might further increase postpartum testing rates. Continued efforts to translate postpartum testing into practice are needed among these women at risk for future type 2 diabetes.     

The Impact of Lifestyle Intervention on Dietary Quality among Rural Women with Previous Gestational Diabetes Mellitus—A Randomized Controlled Study

Healthy diet is essential to type 2 diabetes mellitus (T2DM) prevention for women with previous gestational diabetes mellitus (GDM). To evaluate the effect of a lifestyle intervention program on diet quality for rural women who were previously diagnosed with GDM, we conducted a randomized controlled study in two counties located in south-central China. A total of 404 eligible women were allocated into an intervention group and control group. Participants in the intervention group received 6-month lifestyle intervention including six group seminars and eight telephone consultations. Dietary data were collected at baseline and 18 months via a 24 h dietary recall, and dietary quality was measured by two indicators, Chinese Healthy Eating Score (CHEI) and Minimum Dietary Diversity for Women (MDD-W). Baseline CHEI scores (54.4 vs. 53.5, p = 0.305) and the proportions of participants who met MDD-W (73.8% vs. 74.5%, p = 0.904) were comparable between the two groups. The intervention group achieved a higher CHEI score (62.2 vs. 58.9, p = 0.001) and higher MDD-W proportion (90.6% vs. 81.2%, p = 0.023) at 18 months. Lifestyle intervention was associated with the change of CHEI (p = 0.049) but not with MDD-W (p = 0.212). In conclusion, compared with usual care, lifestyle intervention resulted in greater improvement of dietary quality among rural women with previous GDM.     

Intensive Medical Nutrition Therapy Alone or with Added Metformin to Prevent Gestational Diabetes Mellitus among High-Risk Mexican Women: A Randomized Clinical Trial

The aim of this study was to examine the efficacy of intensive medical nutrition therapy (MNT) plus metformin in preventing gestational diabetes mellitus (GDM) among high-risk Mexican women. An open-label randomized clinical trial was conducted. Inclusion criteria were pregnant women with three or more GDM risk factors: Latino ethnic group, maternal age >35 years, body mass index >25 kg/m², insulin resistance, and a history of previous GDM, prediabetes, a macrosomic neonate, polycystic ovarian syndrome, or a first-degree relative with type 2 diabetes. Women before 15 weeks of gestation were assigned to group 1 (n = 45): intensive MNT-plus metformin (850 mg twice/day) or group 2 (n = 45): intensive MNT without metformin. Intensive MNT included individual dietary counseling, with ≤50% of total energy from high carbohydrates. The primary outcome was the GDM incidence according to the International Association of Diabetes Pregnancy Study Groups criteria. There were no significant differences in baseline characteristics and adverse perinatal outcomes between the groups. The GDM incidence was n = 11 (24.4%) in the MNT plus metformin group versus n = 7 (15.5%) in the MNT without metformin group: p = 0.42 (RR: 1.57 [95% CI: 0.67–3.68]). There is no benefit in adding metformin to intensive MNT to prevent GDM among high-risk Mexican women. Clinical trials registration: {"type":"clinical-trial","attrs":{"text":"NCT01675310","term_id":"NCT01675310"}}NCT01675310.     

Community Trial of a Faith-Based Lifestyle Intervention to Prevent Diabetes Among African-Americans

About 75 % of African-Americans (AAs) ages 20 or older are overweight and nearly 50 % are obese, but community-based programs to reduce diabetes risk in AAs are rare. Our objective was to reduce weight and fasting plasma glucose (FPG) and increase physical activity (PA) from baseline to week-12 and to month-12 among overweight AA parishioners through a faith-based adaptation of the Diabetes Prevention Program called Fit Body and Soul (FBAS). We conducted a single-blinded, cluster randomized, community trial in 20 AA churches enrolling 604 AAs, aged 20–64 years with BMI ≥ 25 kg/m² and without diabetes. The church (and their parishioners) was randomized to FBAS or health education (HE). FBAS participants had a significant difference in adjusted weight loss compared with those in HE (2.62 vs. 0.50 kg, p = 0.001) at 12-weeks and (2.39 vs. ?0.465 kg, p = 0.005) at 12-months and were more likely (13 %) than HE participants (3 %) to achieve a 7 % weight loss (p < 0.001) at 12-weeks and a 7 % weight loss (19 vs. 8 %, p < 0.001) at 12-months. There were no significant differences in FPG and PA between arms. Of the 15.2 % of participants with baseline pre-diabetes, those in FBAS had, however, a significant decline in FPG (10.93 mg/dl) at 12-weeks compared with the 4.22 mg/dl increase in HE (p = 0.017), and these differences became larger at 12-months (FBAS, 12.38 mg/dl decrease; HE, 4.44 mg/dl increase) (p = 0.021). Our faith-based adaptation of the DPP led to a significant reduction in weight overall and in FPG among pre-diabetes participants. ClinicalTrials.gov Identifier NCT01730196.     

Factors Associated with Depressive Symptoms in the Early Postpartum Period Among Women with Recent Gestational Diabetes Mellitus

Women with gestational diabetes mellitus (GDM) have a substantial risk of subsequently developing type 2 diabetes. This risk may be mitigated by engaging in healthy eating, physical activity, and weight loss when indicated. Since postpartum depressive symptoms may impair a woman’s ability to engage in lifestyle changes, we sought to identify factors associated with depressive symptoms in the early postpartum period among women with recent GDM. The participants are part of the baseline cohort of the TEAM GDM (Taking Early Action for Mothers with Gestational Diabetes Mellitus) study, a one-year randomized trial of a lifestyle intervention program for women with a recent history of GDM, conducted in Boston, Massachusetts between June 2010 and September 2012. We administered the Edinburgh Postnatal Depression Scale (EPDS) at 4–15 weeks postpartum to women whose most recent pregnancy was complicated by GDM (confirmed by laboratory data or medical record review). An EPDS score ≥9 indicated depressive symptoms. We measured height and thyroid stimulating hormone, and administered a questionnaire to collect demographic data and information about breastfeeding and sleep. We calculated body mass index (BMI) using self-reported pre-pregnancy weight and measured height. We reviewed medical records to obtain data about medical history, including history of depression, mode of delivery, and insulin use during pregnancy. We conducted bivariable analyses to identify correlates of postpartum depressive symptoms, and then modeled the odds of postpartum depressive symptoms using multivariable logistic regression. Our study included 71 women (mean age 33 years ± 5; 59 % White, 28 % African-American, 13 % Asian, with 21 % identifying as Hispanic; mean pre-pregnancy BMI 30 kg/m² ± 6). Thirty-four percent of the women scored ≥9 on the EPDS at the postpartum visit. In the best fit model, factors associated with depressive symptoms at 6 weeks postpartum included cesarean delivery (aOR 4.32, 95 % CI 1.46, 13.99) and gestational weight gain (aOR 1.21 [1.02, 1.46], for each additional 5 lbs gained). Use of insulin during pregnancy, breastfeeding, personal history of depression, and lack of a partner were not retained in the model. Identifying factors associated with postpartum depression in women with GDM is important since depression may interfere with lifestyle change efforts in the postpartum period. In this study, cesarean delivery and greater gestational weight gain were correlated with postpartum depressive symptoms among women with recent GDM (Clinicaltrials.gov NCT01158131).     

孕期体脂百分比对妊娠期妇女糖尿病影响因素分析

目的 探索孕中期妇女体成分与妊娠期糖尿病(GDM)的关联.方法 采用病例对照研究,以2018年4月至2019年4月在北京市某妇幼保健院进行产检孕妇为研究对象,在妊娠24～28周进行口服糖耐量试验,以明确是否存在GDM,并使用人体成分分析仪测定孕妇体成分.最终获得124例诊断GDM的孕妇作为病例组,130例血糖正常孕妇作...     

Effects of a Lifestyle Intervention in Young Women with GDM and Subsequent Diabetes

The purpose of this study was to examine whether a 9-month intensive lifestyle intervention could lead to weight loss and improve cardiovascular risk factors among young women with both gestational diabetes mellitus (GDM) and newly diagnosed diabetes. A total of 83 young women, who had GDM and were subsequently diagnosed as type 2 diabetes at an average of 2.6 years after delivery, participated in a 9-month intensive lifestyle intervention and a follow-up survey at 6–9 years postintervention. After the 9-month intervention, these women had a weight loss of 2.90 kg (−4.02% of initial weight), decreased waist circumference (−3.12 cm), body fat (−1.75%), diastolic blood pressure (−3.49 mmHg), fasting glucose (−0.98 mmol/L) and HbA1c (−0.72%). During the 6–9 years postintervention period, they still had lower weight (−3.71 kg; −4.62% of initial weight), decreased waist circumference (−4.56 cm) and body fat (−2.10%), but showed a slight increase in HbA1c (0.22%). The prevalence of using glucose-lowering agents increased from 2.4% at baseline to 34.6% after the 9-month lifestyle intervention, and to 48.4% at 6–9 years postintervention. A 9-month intensive lifestyle intervention can produce beneficial effects on body weight, HbA1c and other cardiovascular risk factors among young women with previous GDM who subsequently developed new diabetes.     

综合护理干预对妊娠糖尿病孕妇妊娠结局的影响

目的探讨综合护理干预对妊娠糖尿病（GDM）患者孕期血糖和改善妊娠结局的影响。方法对确诊为GDM的孕妇分为两组,观察组62例实施综合护理干预,包括营养、运动、心理干预;对照组63例实施常规健康教育,分析两组孕妇妊娠末期空腹血糖（FPG）及餐后2h血糖（2hPG）、孕期体重增加值、焦虑和抑郁发生率,妊娠结局的影响。结果与对照组相比,实施综合护理干预的孕妇血糖控制在较好水平,焦虑和抑郁发生率明显减少（P〈0.05）,实验组孕妇产科并发症及围产儿并发症较对照组低（P〈0.05）。结论对GDM患者进行综合护理干预,可降低孕产妇及围产儿并发症的发生率,有利于优生优育。     

Appreciating Recent Motherhood and Culture: A Systematic Review of Multimodal Postpartum Lifestyle Interventions to Reduce Diabetes Risk in Women with Prior Gestational Diabetes

Objectives Gestational diabetes mellitus (GDM) substantially increases a woman’s lifetime risk of developing type 2 diabetes mellitus (DM). Lifestyle modification interventions have been effective in preventing DM in high-risk populations but present challenges in diverse, postpartum women. We systematically reviewed the literature to synthesize current knowledge and practices around tailoring multimodal, primarily home-based interventions for situational and cultural relevance to reduce DM risk in women with prior GDM. Methods We identified original research articles published from January 2000 through July 2015 describing randomized controlled trials testing multimodal interventions to reduce DM risk in women with prior GDM. We compared articles by study objective, delivery modes, intervention components, degree of individualization, theoretical basis, design, population, outcome variables, and findings. Results Ten studies met the inclusion criteria. Telephone and mailings (n = 7) and websites (n = 3) were the primary modes of participant contact in these primarily home-based interventions. These studies demonstrate that individualizing interventions may contribute to increased postpartum weight loss and improved dietary behaviors; however, researchers remain challenged to improve physical activity in this population. Additionally, even when testing primarily home-based interventions, recruitment rates were very low, underscoring challenges of engaging this population in lifestyle changes. Conclusions Postpartum interventions addressing the broader social-ecological dimensions of health behaviors should be tested in women with prior GDM. Researchers and clinicians must continue to explore ways to engage women, including women’s families and communities, in interventions to adequately address the sociocultural determinants that affect women’s lifestyle behaviors impacting their DM risk.     

Ophthalmic Pathology in the Offspring of Pregnant Women with Gestational Diabetes Mellitus

Maternal and Child Health Journal - Gestational diabetes (GD) occurs in 5.8% to 25.1% of pregnant women. This disorder has been linked with intrauterine growth delays, congenital anomalies, and...     

血清胎球蛋白A对妊娠期糖尿病孕妇的影响

目的分析并评价血清胎球蛋白A对妊娠期糖尿病孕妇（GDM）所产生的影响。方法对38例GDM孕妇、30例非妊娠妇女以及41例正常妊娠孕妇的空腹血糖值（FPG）、空腹血清AHSG含量、胰岛素抵抗指数（HOMA-IR）、血清胰岛素含量以及胰岛素分泌指数（HBCI）进行测定。结果随孕妇孕周的增大,正常妊娠孕妇的血AHSG含量明显升高（P〈0.01）,而GDM组孕妇上升幅度更为显著（P〈0.001）;GDM组孕妇血清AHSG含量显著高于非妊娠孕妇与健康妊娠孕妇（均P〈0.001）;GDM组孕妇的空腹血清胰岛素指标、血清AHSG与FPG明显高于正常妊娠组（P〈0.05）,具有统计学意义。结论 GDM孕妇的血清AHSG含量明显上升,不能认为GDM妇女的高水平AHSG含量能够作为评价其胰岛素抵抗状态的单一预测因子。     

优质护理模式在妊娠期糖尿病合并妊娠期高血压产妇中的应用

目的分析优质护理模式在妊娠期糖尿病合并妊娠期高血压产妇中的应用效果。方法选取2018年1月至2019年1月我院收治的妊娠期糖尿病合并妊娠期高血压产妇100例,随机分为两组各50例。对照组采用常规护理模式,研究组采用优质护理模式。比较两组护理前后的血糖、血压水平,以及并发症、护理依从性。结果研究组护理后的空腹血糖、餐后2 h血糖、收缩压及舒张压水平均显著低于对照组(P <0.05)。研究组的并发症发生率为4.00%,显著低于对照组的16.00%(P <0.05)。研究组的护理依从性为98.00%,显著高于对照组的84.00%(P <0.05)。结论优质护理模式应用于妊娠期糖尿病合并妊娠期高血压患者中,能改善患者的血糖、血压水平,减少并发症的发生,有效提高患者的护理依从性。     

Peer Reviewed: Postpartum Screening for Diabetes Among Women With a History of Gestational Diabetes Mellitus

Introduction

To make recommendations for future clinical, public health, and research practices for women with abnormal glucose tolerance during pregnancy, we reviewed the latest evidence regarding rates of postpartum diabetes screening and types of screening tests.

Methods

We searched PubMed for journal articles published from January 2008 through December 2010 that reported on postpartum screening and studies designed to prevent progression to type 2 diabetes among women with gestational diabetes mellitus (GDM). Two authors independently reviewed titles and abstracts from 265 articles.

Results

From 34% to 73% of women with GDM completed postpartum glucose screening. Predictors of higher screening rates included older age, nulliparity, and higher income or education. Screening rates varied by race/ethnicity; Asian women were more likely to be screened than were other racial/ethnic minorities. Women who received prenatal care, who were treated with insulin during pregnancy, or who completed a 6-week postpartum visit were also more likely to receive screening. A moderate proportion of women screened had type 2 diabetes (1.2%-4.5%) or prediabetes (12.2%-36.0%).

Conclusion

Rates of postpartum screening among women with a history of GDM are low; only half of women in most populations are screened. Our findings can inform future screening initiatives designed to overcome barriers to screening for both providers and patients. Well-designed lifestyle interventions specific to women with a history of abnormal glucose tolerance during pregnancy and also studies to determine the efficacy and safety of pharmacological interventions will be important to help prevent progression to diabetes among these high-risk women.     

FTO and ADRB2 Genetic Polymorphisms Are Risk Factors for Earlier Excessive Gestational Weight Gain in Pregnant Women with Pregestational Diabetes Mellitus: Results of a Randomized Nutrigenetic Trial

Excessive gestational weight gain (GWG) is associated with increased risk of maternal and neonatal complications. We investigated obesity-related polymorphisms in the FTO gene (rs9939609, rs17817449) and ADRB2 (rs1042713, rs1042714) as candidate risk factors concerning excessive GWG in pregnant women with pregestational diabetes. This nutrigenetic trial, conducted in Brazil, randomly assigned 70 pregnant women to one of the groups: traditional diet (n = 41) or DASH diet (n = 29). Excessive GWG was the total weight gain above the upper limit of the recommendation, according to the Institute of Medicine guidelines. Genotyping was performed using real-time PCR. Time-to-event analysis was performed to investigate risk factors for progression to excessive GWG. Regardless the type of diet, AT carriers of rs9939609 (FTO) and AA carriers of rs1042713 (ADRB2) had higher risk of earlier exceeding GWG compared to TT (aHR 2.44; CI 95% 1.03–5.78; p = 0.04) and GG (aHR 3.91; CI 95% 1.12–13.70; p = 0.03) genotypes, respectively, as the AG carriers for FTO haplotype rs9939609:rs17817449 compared to TT carriers (aHR 1.79; CI 95% 1.04–3.06; p = 0.02).     

妊娠期糖尿病规范化治疗对妊娠结局的影响

目的探讨妊娠期糖尿病(GDM)进行规范化治疗的效果并分析其对妊娠结局的影响。方法对2011年7月到2013年7月我院收治的226例GDM患者根据住院期间血糖控制情况分为血糖控制良好组(187例)和血糖控制不良组(39例),同时选取同期住院的100例糖代谢正常的孕妇作为健康对照组。分析三组在孕妇及围生儿并发症和分娩方式方面的差异。结果血糖控制良好组孕产妇各种并发症的发病率及剖宫产率与健康对照组相比差异均无统计学意义(P>0.05),血糖控制不良组孕产妇各种并发症的发病率及剖宫产率均高于健康对照组,差异均有统计学意义(P<0.05);血糖控制良好组围生儿各种并发症的发病率与健康对照组相比差异均无统计学意义(P>0.05);血糖控制不良组围生儿并发症的发病率均高于健康对照组,差异均有统计学意义(P<0.05)。结论 GDM患者有效控制病情,可将孕妇及围生儿发生并发症的风险和剖宫产率降低到健康对照组水平。     

妊娠期糖尿病规范化治疗对妊娠结局的影响

目的探讨妊娠期糖尿病（GDM）进行规范化治疗的效果并分析其对妊娠结局的影响。方法对2011年7月到2013年7月我院收治的226例GDM患者根据住院期间血糖控制情况分为血糖控制良好组（187例）和血糖控制不良组（39例）,同时选取同期住院的100例糖代谢正常的孕妇作为健康对照组。分析三组在孕妇及围生儿并发症和分娩方式方面的差异。结果血糖控制良好组孕产妇各种并发症的发病率及剖宫产率与健康对照组相比差异均无统计学意义（P〉O．05）．血糖控制不良组孕产妇各种并发症的发病率及剖宫产率均高于健康对照组,差异均有统计学意义（P〈0．05）;血糖控制良好组围生儿各种并发症的发病率与健康对照组相比差异均无统计学意义（P〉0．05）;血糖控制不良组围生儿并发症的发病率均高于健康对照组,差异均有统计学意义（P〈0．05）。结论GDM患者有效控制病情,可将孕妇及围生儿发生并发症的风险和剖宫产率降低到健康对照组水平。