A randomized controlled trial of prenatal physical activity to prevent gestational diabetes: design and methods. An evaluation of Croí MyAction community lifestyle modification programme compared to standard care to reduce progression to diabetes/pre-diabetes in women with prior gestational diabetes mellitus (GDM): study protocol for a randomised controlled trial Nonpharmacological interventions to prevent type 2 diabetes in women diagnosed with gestational diabetes mellitus: a systematic overview Rationale, design, and methodology for the optimizing outcomes in women with gestational diabetes mellitus and their infants study lmplementing lifestyle change through phone-based motivational interviewing in rural-based women with previous gestational diabetes mellitus. Can the Onset of Type 2 Diabetes Be Delayed by a Group-Based Lifestyle Intervention in Women with Prediabetes following Gestational Diabetes Mellitus (GDM)? Findings from a Randomized Control Mixed Methods Trial A pragmatic cluster randomized clinical trial of diabetes prevention strategies for women with gestational diabetes: design and rationale of the Gestational Diabetes’ Effects on Moms (GEM) study Gestational Diabetes Mellitus Can Be Prevented by Lifestyle Intervention: The Finnish Gestational Diabetes Prevention Study (RADIEL) Lifestyle INtervention for Diabetes prevention After pregnancy (LINDA-Brasil): study protocol for a multicenter randomized controlled trial Reasons for participation and non-participation in a diabetes prevention trial among women with prior gestational diabetes mellitus (GDM) Mothers After Gestational Diabetes in Australia Diabetes Prevention Program (MAGDA-DPP) post-natal intervention: study protocol for a randomized controlled trial Effect of intensive counselling on physical activity in pregnant women at high risk for gestational diabetes mellitus. A clinical study in primary care. The Impact of Health Education Intervention for Prevention and Early Detection of Type 2 Diabetes in Women with Gestational Diabetes Effect of an Exercise Intervention on Gestational Diabetes Mellitus: A Randomized Controlled Trial A Pregnancy and Postpartum Lifestyle Intervention in Women With Gestational Diabetes Mellitus Reduces Diabetes Risk Factors Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. A prospective study of pregravid determinants of gestational diabetes mellitus.
BACKGROUND Women diagnosed with gestational diabetes mellitus ( GDM ) are at substantially increased risk of developing type 2 diabetes and obesity , currently at epidemic rates in the United States . GDM , therefore , identifies a population of women at high risk of developing type 2 diabetes and provides an opportunity to intervene before the development of this disorder . It is well recognized that acute as well as chronic physical activity improves glucose tolerance in type 2 diabetes . To date , however , primary prevention trials have not been conducted to test whether an increase in physical activity reduces risk of developing GDM among women at high risk of this disorder . METHODS The aims of this study are to investigate the effects of a motivationally targeted , individually tailored 12-week physical activity intervention on ( 1 ) development of GDM , ( 2 ) serum biomarkers associated with insulin resistance , and ( 3 ) the adoption and maintenance of exercise during pregnancy .  Women at high risk of GDM are recruited in early pregnancy and r and omized to either an individually tailored exercise intervention or a comparison health and wellness intervention . RESULTS The overall goal of the exercise intervention is to encourage pregnant women to achieve the American College of Obstetricians and Gynecologists guidelines for physical activity during pregnancy through increasing walking and developing a more active lifestyle . CONCLUSIONS The intervention takes into account the specific social , cultural , economic , and physical environmental challenges faced by pregnant women of diverse socioeconomic and ethnic background Background Universal screening using the International Association of Diabetes and Pregnancy Study Groups ( IADPSG ) criteria has identified a prevalence of gestational diabetes mellitus ( GDM ) of 12.4 % in women living in Irel and . Women with prior GDM are at increased risk of developing type 2 diabetes later in life . A number of risk factors linked to the development of type 2 diabetes are potentially modifiable through lifestyle and behaviour changes , and medical management . No previous Irish studies have adequately investigated the efficacy of lifestyle intervention programmes in reducing these risk factors in women with prior GDM . Through a two-group , parallel r and omised controlled trial ( RCT ) , this study aims to assess the clinical impact , cost-effectiveness and psychological experience of the Croí MyAction intensive lifestyle modification programme for women with prior GDM . Methods / Design A total of 54 women with a history of GDM and persistent post-partum glucose dysfunction ( impaired glucose tolerance ( IGT ) or impaired fasting glucose ( IFG ) ) , are r and omly assigned to a  control arm ( n = 27 ) or to the Croí MyAction intervention group ( n = 27 ) . The control arm receives usual health care advice - written information on diet and lifestyle changes for reducing diabetes risks and visits with general practitioners as required . The intervention group receives usual health care as per the control group in addition to attending a 12-week intensive lifestyle modification programme known as Croí MyAction . Croí MyAction involves 2.5 hour sessions once per week ( for 12 weeks ) comprising a group exercise programme , group health promotion or education seminars , and one-to-one meetings with a multidisciplinary health care team to personalise risk factor reductions . R and omisation and allocation to the intervention arms is carried out by an independent research er , ensuring that the allocation sequence is concealed from study research ers until the interventions are assigned . The primary analysis is based on glucose dysfunction , comparing a mean reduction in fasting plasma glucose ( FPG ) levels on a 75 gram oral glucose tolerance test ( OGTT ) in the two groups at a one-year , post-intervention follow-up . The trial is funded by the Irish Health Research Board ( HRB ) . Ethics approval was obtained on 27 March 2012 from the Clinical Research Ethics Committee , Galway University Hospitals , Health Service Executive of Irel and ( Ref : C.A.691).Trial registration Current Controlled Trials IS RCT N41202110 This systematic overview summarizes the relevant evidence from multiple systematic review s of the benefits of nonpharmacological interventions for preventing  type 2 diabetes mellitus ( T2MD ) in women diagnosed with gestational diabetes mellitus ( GDM ) . A comprehensive search using the Cochrane Library , CINAHL , EMBASE and MEDLINE via Ovid SP , and PubMed data bases was completed on 18 November 2015 . Any systematic review s that evaluated r and omized controlled trials ( RCTs ) with defined nonpharmacological interventions for preventing T2DM in women diagnosed with GDM were eligible for inclusion . The authors independently performed critical appraisal s and quality assessment s of the included review s using the AMSTAR tool , and extracted data were converted to coherent values for tabular summarization . Six eligible review s of diet and /or exercise , breastfeeding , and reminder interventions were identified ; however , the method ologies of the review s varied greatly , and the majority of the evidence suggested unclear bias . We found inconsistent reporting on the rates at which diet and exercise interventions reduced the risk of T2DM progression , but these interventions were found to be effective at reducing glycemic load . Combined diet , exercise , and breastfeeding interventions proved to be effective at returning women to their postpartum weight . Neither diet alone nor exercise alone proved to be effective at lowering the risk of T2DM . Overall , there was no robust evidence to support the hypothesis that nonpharmacological interventions are effective at lowering the risk of T2DM in women diagnosed with GDM , and there was no consistent evidence showing that these interventions improved the predictor outcomes of T2DM , such as glycemic load or anthropometric changes Background Women who are diagnosed with gestational diabetes mellitus ( GDM ) are at increased risk for developing prediabetes and type 2 diabetes mellitus ( T2DM ) . To date , there have been few interdisciplinary interventions that target predominantly ethnic minority low-income women diagnosed with GDM . This paper describes the rationale , design and methodology of a 2-year , r and omized , controlled study being conducted in North Carolina . Methods / Design Using a two-group , repeated measures , experimental design , we will test a 14- week intensive intervention on the benefits of breastfeeding , underst and ing gestational diabetes and risk of progression to prediabetes and T2DM , nutrition and exercise education , coping skills training , physical activity ( Phase I ) , educational and motivational text messaging and 3 months of continued monthly contact ( Phase II ) . A total of 100 African American , non-Hispanic white , and bilingual Hispanic women between 22–36 weeks of pregnancy who are diagnosed with GDM and their infants will be r and omized to either the experimental group or the wait-listed control group . The first aim of the study is to determine the feasibility of the intervention . The second aim of study is to test the effects of the intervention on maternal outcomes from baseline ( 22–36 weeks pregnant ) to 10 months postpartum . Primary maternal outcomes will include fasting blood glucose and weight ( BMI ) from baseline to 10 months postpartum . Secondary maternal outcomes will include clinical , adiposity , health behaviors and self-efficacy outcomes from baseline to 10 months postpartum . The third aim of the study is to quantify the effects of the intervention on infant feeding and growth . Infant outcomes will include weight status and breastfeeding from birth through 10 months of age . Data analysis will include general linear mixed-effects models . Safety endpoints include adverse event reporting . Discussion Findings from this trial may lead to an effective intervention to assist women diagnosed with GDM to improve maternal glucose homeostasis and weight as well as stabilize infant growth trajectory , reducing the burden of metabolic disease across two generations . Trial registration ISSUE ADDRESSED Substantial numbers of women with past gestational diabetes mellitus ( GDM ) develop type 2 diabetes mellitus ( T2DM ) . In northern New South Wales 23 % of women attending diabetes services between 2007 and 2010 with T2DM previously had GDM . This study investigated whether phone-based lifestyle education using motivational interviewing result ed in positive lifestyle change post GDM for women in a large rural area . METHOD Thirty-eight women were recruited to this pilot study following GDM diagnosis and r and omly allocated to either the control or intervention group . Following baseline assessment , the intervention group received a 6-month phone-based motivational interviewing program , and access to usual care . The control group received usual care only . Measures were collected at baseline ( 6 weeks postnatal ) , and at 6 months follow-up . Outcome measures included body mass index , diet , and physical activity . RESULTS At follow-up , the intervention group compared to the control group significantly reduced total fat intake by -19 g/d ( 95%CI : -37 to -1 ) , total carbohydrate intake by -42 g/d ( 95%CI : -82 to -1 ) , and glycaemic load by -26 units ( 95%CI : -48 to -4 ) . These women also increased leisure physical activity compared to the control group by 11 min/d ( 95%CI : 1 to 22 ) ; no significant change in total physical activity levels occurred . At follow-up , body mass index in the intervention group improved by -1.5 kg/m2 ( 95%CI : -2.8 to -0.1 ) compared to the control group . CONCLUSION The intervention group showed positive trends across lifestyle variables compared to the control group . Further large-scale research on the effectiveness of phone-based lifestyle counselling following GDM is warranted Objective . To evaluate a 12-week group-based lifestyle intervention programme for women with prediabetes following gestational diabetes ( GDM ) . Design . A two-group , mixed methods r and omized controlled trial in which 50 women with a history of GDM and abnormal glucose tolerance postpartum were r and omly assigned to intervention ( n = 24 ) or wait control ( n = 26 ) and postintervention qualitative interviews with participants . Main Outcome Measures . Modifiable biochemical , anthropometric , behavioural , and psychosocial risk factors associated with the development of type 2 diabetes . The primary outcome variable was the change in fasting plasma glucose ( FPG ) from study entry to one-year follow-up . Results . At one-year follow-up , the intervention group showed significant improvements over the wait control group on stress , diet self-efficacy , and quality of life . There was no evidence of an effect of the intervention on measures of biochemistry or anthropometry ; the effect on one health behaviour , diet adherence , was close to significance . Conclusions . Prevention programmes must tackle the barriers to participation faced by this population ; home-based interventions should be investigated . Strategies for promoting long-term health self-management need to be developed and tested Background Women with gestational diabetes ( GDM ) are at high risk of developing diabetes later in life . After a GDM diagnosis , women receive prenatal care to control their blood glucose levels via diet , physical activity and medications . Continuing such lifestyle skills into early motherhood may reduce the risk of diabetes in this high risk population . In the Gestational Diabetes ’ Effects on Moms ( GEM ) study , we are evaluating the comparative effectiveness of diabetes prevention strategies for weight management design ed for pregnant/postpartum women with GDM and delivered at the health system level . Methods / Design The GEM study is a pragmatic cluster r and omized clinical trial of 44 medical facilities at Kaiser Permanente Northern California r and omly assigned to either the intervention or usual care conditions , that includes 2,320 women with a GDM diagnosis between March 27 , 2011 and March 30 , 2012 . A Diabetes Prevention Program-derived print/telephone lifestyle intervention of 13 telephonic sessions tailored to pregnant/postpartum women was developed . The effectiveness of this intervention added to usual care is to be compared to usual care practice s alone , which includes two pages of printed lifestyle recommendations sent to postpartum women via mail . Primary outcomes include the proportion of women who reach a postpartum weight goal and total weight change . Secondary outcomes include postpartum glycemia , blood pressure , depression , percent of calories from fat , total caloric intake and physical activity levels . Data were collected through electronic medical records and surveys at baseline ( soon after GDM diagnosis ) , 6 weeks ( range 2 to 11 weeks ) , 6 months ( range 12 to 34 weeks ) and 12 months postpartum ( range 35 to 64 weeks ) . Discussion There is a need for evidence regarding the effectiveness of lifestyle modification for the prevention of diabetes in women with GDM , as well as confirmation that a diabetes prevention program delivered at the health system level is able to successfully reach this population . Given the use of a telephonic case management model , our Diabetes Prevention Program-derived print/telephone intervention has the potential to be adopted in other setting s and to inform policies to promote the prevention of diabetes among women with GDM.Trial registration Clinical Trials.gov number , NCT01344278 OBJECTIVE To assess whether gestational diabetes mellitus ( GDM ) can be prevented by a moderate lifestyle intervention in pregnant women who are at high risk for the disease . RESEARCH DESIGN AND METHODS Two hundred ninety-three women with a history of GDM and /or a prepregnancy BMI of ≥30 kg/m2 were enrolled in the study at < 20 weeks of gestation and were r and omly allocated to the intervention group ( n = 155 ) or the control group ( n = 138 ) . Each subject in the intervention group received individualized counseling on diet , physical activity , and weight control from trained study nurses , and had one group meeting with a dietitian . The control group received st and ard antenatal care . The diagnosis of GDM was based on a 75-g , 2-h oral glucose tolerance test at 24–28 weeks of gestation . RESULTS A total of 269 women were included in the analyses .  The incidence of GDM was 13.9 % in the intervention group and 21.6 % in the control group ( [ 95 % CI 0.40–0.98 % ] ; P = 0.044 , after adjustment for age , prepregnancy BMI , previous GDM status , and the number of weeks of gestation ) . Gestational weight gain was lower in the intervention group ( −0.58 kg [ 95 % CI −1.12 to −0.04 kg ] ; adjusted P = 0.037 ) . Women in the intervention group increased their leisure time physical activity more and improved their dietary quality compared with women in the control group . CONCLUSIONS A moderate individualized lifestyle intervention reduced the incidence of GDM by 39 % in high-risk pregnant women . These findings may have major health consequences for both the mother and the child Background Gestational diabetes mellitus ( GDM ) , a hyperglycemic state detected during pregnancy , is an established risk factor for diabetes . However , treatment during pregnancy in and of itself is not able to eliminate this risk , and a considerable fraction of women with GDM will develop frank diabetes in the decade following pregnancy . Our aim is to conduct a multicenter r and omized controlled trial to investigate the effectiveness of a lifestyle intervention program implemented after a pregnancy complicated by GDM in delaying or preventing the development of type 2 diabetes . Methods Women aged 18 or older identified as having recent GDM are recruited and followed by telephone to assess eligibility for the trial . To be eligible , women must have used insulin during pregnancy or present intermediate hyperglycemia postpartum . Women are encouraged to enter the trial as early as 10 weeks , and are permitted to do so up to 2 years after a pregnancy with GDM . An estimated 740 women will be r and omized to either conventional care or to coach-based interventions focused on breastfeeding , weight loss , healthy eating , and increased physical activity , and predominantly delivered by telephone . Women are followed annually to detect new onset diabetes , the primary outcome , and additional secondary outcomes which include reversion to normoglycemia , weight loss , physical activity and fitness , and insulin resistance . Discussion Though previous studies have demonstrated that type 2 diabetes can be delayed or prevented , no study has yet demonstrated the feasibility and effectiveness of similar interventions implemented in the postpartum period for women with recent GDM . If shown to be successful , this approach could become an important means of preventing diabetes in primary care setting s . Trial registration Clinical Trials.gov Identifier : NCT02327286 ; Registered 23 December 2014 Background Gestational diabetes mellitus ( GDM ) is a risk factor for the development of type 2 diabetes . Lifestyle intervention can prevent progression to type 2 diabetes in high risk population s. We design ed a r and omised controlled trial ( RCT ) to evaluate the effectiveness of an established lifestyle intervention compared to st and ard care for delaying diabetes onset in European women with recent GDM . Recruitment into the RCT was more challenging than anticipated with only 89 of 410 ( 22 % ) women agreeing to participate . This paper identifies factors that could enhance participation of the target population in future interventions . Methods We hypothesised that women who agreed to participate would have higher diabetes risk profiles than those who declined , and secondly that it would be possible to predict participation on the bases of those risk factors . To test our hypothesis , we identified the subset of women for whom we had comprehensive data on diabetes risks factors 3 - 5 years following GDM , reducing the sample to 43 participants and 73 decliners . We considered established diabetes risk factors : smoking , daily fruit and vegetable intake , participation in exercise , family history of diabetes , glucose values and BMI scores on post-partum re-screens , use of insulin during pregnancy , and age at delivery . We also analysed narrative data from 156 decliners to further underst and barriers to and facilitators of participation . Results Two factors differentiated participants and decliners : age at delivery ( with women older than 34 years being more likely to participate ) and insulin use during pregnancy ( with women requiring the use of insulin in pregnancy less likely to participate ) . Binary logistic regression confirmed that insulin use negatively affected the odds of participation . The most significant barriers to participation included the accessibility , affordability and practicality of the intervention . Conclusions Women with recent GDM face multiple barriers to lifestyle change . Intervention design ers should consider : ( i ) the practicalities of participation for this population , ( ii ) research design s that capitalise on motivational differences between participants , ( iii ) alleviating concerns about long-term diabetes management . We hope this work will support future research ers in developing interventions that are more relevant , effective and successful in recruiting the desired population .Trial registration Current Controlled Trials IS RCT Background Gestational diabetes mellitus ( GDM ) is defined as glucose intolerance with its onset or first recognition during pregnancy . Post-GDM women have a life-time risk exceeding 70 % of developing type 2 diabetes mellitus ( T2DM ) . Lifestyle modifications reduce the incidence of T2DM by up to 58 % for high-risk individuals . Methods / Design The Mothers After Gestational Diabetes in Australia Diabetes Prevention Program ( MAGDA-DPP ) is a r and omized controlled trial aim ing to assess the effectiveness of a structured diabetes prevention intervention for post-GDM women . This trial has an intervention group participating in a diabetes prevention program ( DPP ) , and a control group receiving usual care from their general practitioners during the same time period . The 12-month intervention comprises an individual session followed by five group sessions at two-week intervals , and two follow-up telephone calls .  A total of 574 women will be recruited , with 287 in each arm . The women will undergo blood tests , anthropometric measurements , and self-reported health status , diet , physical activity , quality of life , depression , risk perception and healthcare service usage , at baseline and 12 months . At completion , primary outcome ( changes in diabetes risk ) and secondary outcome ( changes in psychosocial and quality of life measurements and in cardiovascular disease risk factors ) will be assessed in both groups . Discussion This study aims to show whether MAGDA-DPP leads to a reduction in diabetes risk for post-GDM women . The characteristics that predict intervention completion and improvement in clinical and behavioral measures will be useful for further development of DPPs for this population .Trial registration Australian New Zeal and Clinical Trials Registry ANZCTRN OBJECTIVE The level of  physical activity ( PA ) of pregnant women in Finl and is unknown . Even more limited is our knowledge of PA of women at high risk for gestational diabetes mellitus ( GDM ) . METHODS The women ( n=54 ) were r and omly assigned to a lifestyle intervention group ( n=27 ) including exercise advice by a physiotherapist six times during pregnancy or to a control group ( n=27 ) without additional exercise advice . Outcomes of the present study were required sample size , timing of counselling and change of PA . PA was retrospectively reported during 12 months before pregnancy and recorded one week monthly during pregnancy . RESULTS Individualized counselling by a physiotherapist result ed in small changes of  recreational PA  ( 2.7 MET hours/week , p=0.056 ) up to gestational week 25 compared with the similar decreasing tendency of PA in the control group . The women decreased recreational PA  after week 30 . Sample size of 550 women at high risk for GDM per group would be needed for a PA study . CONCLUSIONS The optimal time window for increasing PA  must be earlier than in the last trimester of pregnancy . Sample size for a study to increase PA  by 2.7 MET hours/week on pregnant women at high risk of GDM should be about 550 per group This study aims to investigate the impact of a health belief model (HBM)-based educational intervention on knowledge , beliefs , self-reported practice s , gestational and postpartum weight in women with gestational diabetes mellitus ( GDM ) . Subjects and Methods : A cluster r and omized controlled trial was performed , with r and omization at the level of Primary Health Care centers in three Egyptian cities . Eligible women with GDM were enrolled at 24 weeks pregnancy . The intervention group ( n = 103 ) received health education intervention based on the HBM construct . Control subjects ( n = 98 ) received the  usual care . The outcomes measured were : women ’s knowledge , beliefs , self-reported practice s , gestational weight gain ( GWG ) , and postpartum weight retention . Patients were investigated at baseline , at end of pregnancy , and at 6 weeks postpartum . Results : After the intervention , percentages of women who had high knowledge and beliefs scores had significantly increased from less than 50 % to more than 70 % in the intervention group ( p < 0.001 ) . More women in the intervention group reported practicing exclusive breast feeding ( 85.4 % ) and screening for T2DM ( 43.7 % ) at 6 weeks postpartum compared to the control group ( 63.3 and 19.4 % respectively ) ( p < 0.001 ) . More women with excessive body mass index in the intervention group ( 65 % ) compared to the control group ( 11.6 % ) were meeting recommended GWG ( p < 0.001 ) , and postpartum weight ( 37.7 , and 20.3 % respectively ) ( p < 0.01 ) . Conclusion : This intervention significantly improved knowledge , beliefs , self-reported practice s , and gestational and postpartum weight in patients with GDM . Further research is needed for investigating the effectiveness of applying early , multi-phase , and longer intervention OBJECTIVE : To examine the effect of an individually tailored , motivationally matched prenatal exercise intervention on gestational diabetes mellitus ( GDM ) and other measures of glucose intolerance among ethnically diverse prenatal care patients at increased risk for GDM . METHODS : The Behaviors Affecting Baby and You study r and omized eligible women at a mean ( st and ard deviation ) of 18.2 ( 4.1 ) weeks of gestation to a 12-week individually tailored , motivationally matched exercise intervention or a comparison health and wellness intervention . The goal of the exercise intervention was to achieve the American College of Obstetricians and Gynecologists ' guidelines for physical activity during pregnancy . Diagnosis of GDM , impaired glucose tolerance , abnormal glucose screen , and screening glucose values ( mg/dL ) were abstract ed from medical records . A sample size of 352 women ( 176 per group ) was planned to have 80 % power to detect reductions in risk of 35 % or larger . RESULTS : From July 2007 to December 2012 , a total of 251 ( 86.5 % ) women completed the intervention ; n=124 and 127 in the exercise and comparison interventions , respectively . Based on an intention-to-treat analysis , no statistically significant differences between the intervention groups were observed ; the relative odds of GDM in the exercise group was 0.61 ( 95 % confidence interval [ CI ] 0.28–1.32 ) as compared with the health and wellness comparison group . Odds ratios for impaired glucose tolerance and abnormal glucose screen were 0.68 ( 95 % CI 0.35–1.34 ) and 0.86 ( 95 % CI 0.51–1.47 ) , respectively . The intervention had no effect on birth outcomes . CONCLUSION : In this r and omized trial among ethnically diverse pregnant women at increased risk for GDM , we found that a prenatal exercise intervention implemented in the second trimester did not result in a statistically significant reduction in relative odds for GDM , impaired glucose tolerance , or abnormal glucose screen . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00728377 . LEVEL OF EVIDENCE : OBJECTIVE To pilot , among women with gestational diabetes mellitus ( GDM ) , the feasibility of a prenatal/postpartum intervention to modify diet and physical activity similar to the Diabetes Prevention Program . The intervention was delivered by telephone , and support for breastfeeding was addressed . RESEARCH DESIGN AND METHODS The goal was to help women return to their prepregnancy weight , if it was normal , or achieve a 5 % reduction from prepregnancy weight if overweight . Eligible participants were identified shortly after a GDM diagnosis ; 83.8 % consented to be r and omly assigned to intervention or usual medical care ( 96 and 101 women , respectively ) . The retention was 85.2 % at 12 months postpartum . RESULTS The proportion of women who reached the postpartum weight goal was higher , although not statistically significant , in the intervention condition than among usual care ( 37.5 vs. 21.4 % , absolute difference 16.1 % , P = 0.07 ) . The intervention was more effective among women who did not exceed the recommended gestational weight gain ( difference in the proportion of women meeting the weight goals : 22.5 % , P = 0.04 ) . The intervention condition decreased dietary fat intake more than the usual care ( condition difference in the mean change in percent of calories from fat : −3.6 % , P = 0.002 ) and increased breastfeeding , although not significantly ( condition difference in proportion : 15.0 % , P = 0.09 ) . No differences in postpartum physical activity were observed between conditions . CONCLUSIONS This study suggests that a lifestyle intervention that starts during pregnancy and continues postpartum is feasible and may prevent pregnancy weight retention and help overweight women lose weight . Strategies to help postpartum women overcome barriers to increasing physical activity are needed CONTEXT A past history of gestational diabetes mellitus ( GDM ) confers a very high risk of postpartum development of diabetes , particularly type 2 diabetes . OBJECTIVE The Diabetes Prevention Program ( DPP ) sought to identify individuals with impaired glucose tolerance ( IGT ) and intervene in an effort to prevent or delay their progression to diabetes . This analysis examined the differences between women enrolled in DPP with and without a reported history of GDM . DESIGN The DPP was a r and omized , controlled clinical trial . SETTING The study was a multicenter , National Institutes of Health-sponsored trial carried out at 27 centers including academic and Indian Health Services sites . PATIENTS A total of 2190 women were r and omized into the DPP and provided information for past history of GDM . This analysis addressed the differences between those 350 women providing a past history of GDM and those 1416 women with a previous live birth but no history of GDM . INTERVENTIONS Subjects were r and omized to either st and ard lifestyle and placebo or metformin therapy or to an intensive lifestyle intervention . MAIN OUTCOMES The primary outcome was the time to development of diabetes ascertained by semiannual fasting plasma glucose and annual oral glucose tolerance testing . Assessment s of insulin secretion and insulin sensitivity were also performed . RESULTS Whereas entering the study with similar glucose levels , women with a history of GDM r and omized to placebo had a crude incidence rate of diabetes 71 % higher than that of women without such a history . Among women reporting a history of GDM , both intensive lifestyle and metformin therapy reduced the incidence of diabetes by approximately 50 % compared with the placebo group , whereas this reduction was 49 and 14 % , respectively in parous women without GDM . These data suggest that metformin may be more effective in women with a GDM history as compared with those without . CONCLUSIONS Progression to diabetes is more common in women with a history of GDM compared with those without GDM history despite equivalent degrees of IGT at baseline . Both intensive lifestyle and metformin are highly effective in delaying or preventing diabetes in women with IGT and a history of GDM CONTEXT Gestational diabetes mellitus ( GDM ) affects 3 % to 5 % of pregnancies . Knowledge of risk factors for GDM is needed to identify possible preventive strategies . OBJECTIVE To assess whether recognized determinants of noninsulin-dependent diabetes mellitus also may be markers for increased risk of GDM . DESIGN Prospect i ve cohort study . SETTING The Nurses ' Health Study II , which involves female US nurses aged 25 to 42 years at entry . PARTICIPANTS The analyses included 14613 women without previous GDM or other known diabetes who reported a singleton pregnancy between 1990 and 1994 . Of these women , 722 ( 4.9 % ) reported a new diagnosis of GDM . MAIN OUTCOME MEASURE Self-report of GDM , vali date d by medical record review in a subset . RESULTS In multivariate analyses including age , pregravid body mass index ( BMI ) , and other GDM risk factors , the risk for GDM increased significantly with increasing maternal age ( P for trend , < .01 ) and family history of diabetes mellitus ( relative risk , 1.68 ; 95 % confidence interval [ CI ] , 1.39 - 2.04 ) . Relative risks for GDM were 2.13 ( 95 % CI , 1.65 - 2.74 ) for pregravid BMI of 25 to 29.9 kg/m2 and 2.90 ( 95 % CI , 2.15 - 3.91 ) for BMI of 30 kg/m2 or more ( vs BMI of < 20 kg/m2 ) . Risk for GDM increased with greater weight gain in early adulthood , and it also increased among nonwhite women . Pregravid current smokers had a relative risk for GDM of 1.43 ( 95 % CI , 1.14 - 1.80 ) , and pregravid vigorous exercise was associated with a nonsignificant reduction in GDM risk . CONCLUSIONS Advanced maternal age , family history of diabetes mellitus , nonwhite ethnicity , higher BMI , weight gain in early adulthood , and cigarette smoking predict increased GDM risk . These observations may facilitate the identification of women at particular risk for GDM and suggest potential strategies for reducing this risk even before a woman becomes pregnant , such as avoiding substantial weight gain and smoking
CONCLUSIONS Lack of method ologically robust trials gives limited evidence for the success of lifestyle interventions in women with prior GDM .
PURPOSE To systematic ally review lifestyle interventions for women with prior Gestational Diabetes Mellitus ( GDM ) to report study characteristics , intervention design and study quality and explore changes in 1 ) diet , physical activity and sedentary behaviour ; 2 ) anthropometric outcomes and ; 3 ) glycaemic control and diabetes risk .