Advertisement

Systematic Review of Lifestyle Interventions for Gestational Diabetes Mellitus in Pregnancy and the Postpartum Period

Published:November 26, 2021DOI:https://doi.org/10.1016/j.jogn.2021.10.007

      Abstract

      Objective

      To examine the characteristics and effectiveness of lifestyle interventions for gestational diabetes mellitus (GDM) in pregnancy and the postpartum period to prevent Type 2 diabetes.

      Data Sources

      We conducted searches in seven databases, including Ovid MEDLINE, CINAHL, Ovid Embase, Cochrane Central, Web of Science, Ovid PsycInfo, and ProQuest Dissertations and Theses for articles published from inception to January 2021.

      Study Selection

      We included articles on controlled intervention studies in which researchers evaluated a lifestyle intervention provided during pregnancy and the postpartum period for women with or at risk for GDM that were published in English.

      Data Extraction

      Twelve articles that were reports of seven studies met the inclusion criteria. In some cases, more than one article was selected from the same study. For example, articles reported different outcomes from the same study. We extracted data with the use of a data collection form and compared and synthesized data on study design, purpose, sample, intervention characteristics, recruitment and retention, and outcomes.

      Data Synthesis

      All seven studies focused on weight management and/or healthy lifestyle behaviors (diet and physical activity). Outcomes included glucose regulation, weight, lifestyle behaviors, and knowledge. The interventions varied in duration/dosage, strategies, and modes of delivery. In four studies, researchers reported interventions that had significant effects on improving glucose regulation and/or weight change. Some characteristics from the four effective interventions included goal setting, individualized care, and good retention rates. In the other three studies, limitations included low rates of participant retention, lack of personalized interventions, and limited population diversity or lack of culturally sensitive care.

      Conclusion

      Lifestyle interventions provided during and after pregnancy to reduce the risk associated with GDM have the potential to improve outcomes. Health care counseling to promote healthy lifestyle behaviors related to the prevention of Type 2 diabetes is needed at different stages of maternity care for women with GDM. Additional high-quality studies are needed to address the limitations of current studies.

      Keywords

      To read this article in full you will need to make a payment
      AWHONN Member Login
      AWHONN Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Amason J.S.
        • Lee S.-Y.
        • Aduddell K.
        • Hewell S.W.
        • Van Brackle L.
        Pilot feasibility study of an educational intervention in women with gestational diabetes.
        Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2016; 45: 515-527https://doi.org/10.1016/j.jogn.2016.04.003
        • American College of Obstetricians and Gynecologists
        ACOG practice bulletin no. 190: Gestational diabetes mellitus.
        Obstetrics & Gynecology. 2018; 131: e49-e64https://doi.org/10.1097/aog.0000000000002501
      1. Aroda, V. R., Christophi, C. A., Edelstein, S. L., Zhang, P., Zhuo, X., Herman, W. H., ... Diabetes Prevention Program Research Group. (2015). The effect of lifestyle intervention and metformin on preventing or delaying diabetes among women with and without gestational diabetes: The Diabetes Prevention Program Outcomes study 10-year follow-up. Journal of Clinical Endocrinology & Metabolism, 100(4), 1646–1653. https://doi.org/10.1210/jc.2014-3761

        • Beck C.
        • McSweeney J.C.
        • Richards K.C.
        • Roberson P.K.
        • Tsai P.F.
        • Souder E.
        Challenges in tailored intervention research.
        Nursing Outlook. 2010; 58: 104-110https://doi.org/10.1016/j.outlook.2009.10.004
        • Berry D.C.
        • Hall E.G.
        • Neal M.N.
        • Adatorwovor R.
        • Schwartz T.A.
        • Stuebe A.
        Results of the optimizing outcomes in women with gestational diabetes mellitus and their infants, a cluster randomized, controlled pilot study: Lessons learned.
        Journal of the National Black Nurses Association. 2016; 27: 1-10
        • Berry D.C.
        • Neal M.
        • Hall E.G.
        • Schwartz T.A.
        • Verbiest S.
        • Bonuck K.
        • Stuebe A.M.
        Rationale, design, and methodology for the optimizing outcomes in women with gestational diabetes mellitus and their infants study.
        BMC Pregnancy and Childbirth. 2013; 13 (Article 184)https://doi.org/10.1186/1471-2393-13-184
        • Bgeginski R.
        • Ribeiro P.A.B.
        • Mottola M.F.
        • Ramos J.G.L.
        Effects of weekly supervised exercise or physical activity counseling on fasting blood glucose in women diagnosed with gestational diabetes mellitus: A systematic review and meta-analysis of randomized trials.
        Journal of Diabetes. 2017; 9: 1023-1032https://doi.org/10.1111/1753-0407.12519
        • Brown J.
        • Alwan N.A.
        • West J.
        • Brown S.
        • McKinlay C.J.D.
        • Farrar D.
        • Crowther C.A.
        Lifestyle interventions for the treatment of women with gestational diabetes.
        Cochrane Database of Systematic Reviews. 2017; https://doi.org/10.1002/14651858.CD011970.pub2
        • Burkart S.
        • Marcus B.H.
        • Pekow P.
        • Rosal M.C.
        • Manson J.E.
        • Braun B.
        • Chasan-Taber L.
        The impact of a randomized controlled trial of a lifestyle intervention on postpartum physical activity among at-risk Hispanic women: Estudio PARTO.
        PLOS ONE. 2020; 15 (Article e0236408)https://doi.org/10.1371/journal.pone.0236408
        • Chasan-Taber L.
        • Marcus B.H.
        • Rosal M.C.
        • Tucker K.L.
        • Hartman S.J.
        • Pekow P.
        • Markenson G.
        Estudio Parto: Postpartum diabetes prevention program for Hispanic women with abnormal glucose tolerance in pregnancy: A randomised controlled trial—Study protocol.
        BMC Pregnancy and Childbirth. 2014; 14 (Article 100)https://doi.org/10.1186/1471-2393-14-100
        • Cheung N.W.
        • Blumenthal C.
        • Smith B.J.
        • Hogan R.
        • Thiagalingam A.
        • Redfern J.
        • Chow C.K.
        A pilot randomised controlled trial of a text messaging intervention with customisation using linked data from wireless wearable activity monitors to improve risk factors following gestational diabetes.
        Nutrients. 2019; 11 (Article 590)https://doi.org/10.3390/nu11030590
        • Dall T.M.
        • Yang W.
        • Halder P.
        • Pang B.
        • Massoudi M.
        • Wintfeld N.
        • Hogan P.F.
        The economic burden of elevated blood glucose levels in 2012: Diagnosed and undiagnosed diabetes, gestational diabetes mellitus, and prediabetes.
        Diabetes Care. 2014; 37: 3172-3179https://doi.org/10.2337/dc14-1036
        • Dasgupta K.
        • Terkildsen Maindal H.
        • Kragelund Nielsen K.
        • O’Reilly S.
        Achieving penetration and participation in diabetes after pregnancy prevention interventions following gestational diabetes: A health promotion challenge.
        Diabetes Research and Clinical Practice. 2018; 145: 200-213https://doi.org/10.1016/j.diabres.2018.04.016
        • Deputy N.P.
        • Kim S.Y.
        • Conrey E.J.
        • Bullard K.M.
        Prevalence and changes in preexisting diabetes and gestational diabetes among women who had a live birth—United States, 2012–2016.
        MMWR. Morbidity & Mortality Weekly Report. 2018; 67: 1201-1207https://doi.org/10.15585/mmwr.mm6743a2
        • Farrar D.
        • Simmonds M.
        • Bryant M.
        • Sheldon T.A.
        • Tuffnell D.
        • Golder S.
        • Lawlor D.A.
        Hyperglycaemia and risk of adverse perinatal outcomes: Systematic review and meta-analysis.
        BMJ. 2016; 354 (Article i4694)https://doi.org/10.1136/bmj.i4694
        • Ferrara A.
        • Hedderson M.M.
        • Albright C.L.
        • Brown S.D.
        • Ehrlich S.F.
        • Caan B.J.
        • Quesenberry Jr., C.P.
        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.
        BMC Pregnancy and Childbirth. 2014; 14 (Article 21)https://doi.org/10.1186/1471-2393-14-21
        • Ferrara A.
        • Hedderson M.M.
        • Albright C.L.
        • Ehrlich S.F.
        • Quesenberry Jr., C.P.
        • Peng T.
        • Crites Y.
        A pregnancy and postpartum lifestyle intervention in women with gestational diabetes mellitus reduces diabetes risk factors: A feasibility randomized control trial.
        Diabetes Care. 2011; 34: 1519-1525https://doi.org/10.2337/dc10-2221
        • Ferrara A.
        • Hedderson M.M.
        • Brown S.D.
        • Albright C.L.
        • Ehrlich S.F.
        • Tsai A.L.
        • Quesenberry Jr., C.P.
        The comparative effectiveness of diabetes prevention strategies to reduce postpartum weight retention in women with gestational diabetes mellitus: The Gestational Diabetes’ Effects on Moms (GEM) cluster randomized controlled trial.
        Diabetes Care. 2016; 39: 65-74https://doi.org/10.2337/dc15-1254
        • Fulton B.D.
        Health care market concentration trends in the United States: Evidence and policy responses.
        Health Affairs. 2017; 36: 1530-1538https://doi.org/10.1377/hlthaff.2017.0556
        • Goveia P.
        • Cañon-Montañez W.
        • Santos D.P.
        • Lopes G.W.
        • Ma R.C.W.
        • Duncan B.B.
        • Schmidt M.I.
        Lifestyle intervention for the prevention of diabetes in women with previous gestational diabetes mellitus: A systematic review and meta-analysis.
        Frontiers in Endocrinology. 2018; 9 (Article 583)https://doi.org/10.3389/fendo.2018.00583
        • Grossetta Nardini H.K.
        • Wang L.
        The Yale MeSH analyzer.
        • Guariguata L.
        • Linnenkamp U.
        • Beagley J.
        • Whiting D.R.
        • Cho N.H.
        Global estimates of the prevalence of hyperglycaemia in pregnancy.
        Diabetes Research and Clinical Practice. 2014; 103: 176-185https://doi.org/10.1016/j.diabres.2013.11.003
        • Guo J.
        • Chen J.L.
        • Whittemore R.
        • Whitaker E.
        Postpartum lifestyle interventions to prevent type 2 diabetes among women with history of gestational diabetes: A systematic review of randomized clinical trials.
        Journal of Women’s Health. 2016; 25: 38-49https://doi.org/10.1089/jwh.2015.5262
        • Hedderson M.
        • Ehrlich S.
        • Sridhar S.
        • Darbinian J.
        • Moore S.
        • Ferrara A.
        Racial/ethnic disparities in the prevalence of gestational diabetes mellitus by BMI.
        Diabetes Care. 2012; 35: 1492-1498https://doi.org/10.2337/dc11-2267
        • Hedeager Momsen A.M.
        • Høtoft D.
        • Ørtenblad L.
        • Friis Lauszus F.
        • Krogh R.H.A.
        • Lynggaard V.
        • Vinther Nielsen C.
        Diabetes prevention interventions for women after gestational diabetes mellitus: An overview of reviews.
        Endocrinology, Diabetes and Metabolism. 2021; 4 (Article e00230)https://doi.org/10.1002/edm2.230
        • Hsu W.C.
        • Araneta M.R.G.
        • Kanaya A.M.
        • Chiang J.L.
        • Fujimoto W.
        BMI cut points to identify at-risk Asian Americans for type 2 diabetes screening.
        Diabetes Care. 2015; 38: 150-158https://doi.org/10.2337/dc14-2391
        • Huvinen E.
        • Koivusalo S.B.
        • Meinila J.
        • Valkama A.
        • Tiitinen A.
        • Rono K.
        • Eriksson J.G.
        Effects of a lifestyle intervention during pregnancy and first postpartum year: Findings from the RADIEL study.
        Journal of Clinical Endocrinology & Metabolism. 2018; 103: 1669-1677https://doi.org/10.1210/jc.2017-02477
        • Janett R.S.
        • Yeracaris P.P.
        Electronic medical records in the American health system: Challenges and lessons learned.
        Ciencia & Saude Coletiva. 2020; 25: 1293-1304https://doi.org/10.1590/1413-81232020254.28922019
        • Jones E.J.
        • Fraley H.E.
        • Mazzawi J.
        Appreciating recent motherhood and culture: A systematic review of multimodal postpartum lifestyle interventions to reduce diabetes risk in women with prior gestational diabetes.
        Maternal and Child Health Journal. 2017; 21: 45-57https://doi.org/10.1007/s10995-016-2092-z
        • Kaiser Permanente
        Fast facts.
        • LaManna J.B.
        • Quelly S.B.
        After gestational diabetes: An overlooked care transition in primary care.
        Journal for Nurse Practitioners. 2020; 16: 319-323https://doi.org/10.1016/j.nurpra.2020.01.016
        • Li N.
        • Yang Y.
        • Cui D.
        • Li C.
        • Ma R.C.W.
        • Li J.
        • Yang X.
        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.
        Obesity Reviews. 2020; 22 (Article e13122)https://doi.org/10.1111/obr.13122
        • Li Z.
        • Cheng Y.
        • Wang D.
        • Chen H.
        • Chen H.
        • Ming W.K.
        • Wang Z.
        Incidence rate of type 2 diabetes mellitus after gestational diabetes mellitus: A systematic review and meta-analysis of 170,139 women.
        Journal of Diabetes Research, 2020. 2020; (Article 3076463)https://doi.org/10.1155/2020/3076463
        • Lim S.
        Preventing type 2 diabetes in women with previous gestational diabetes: Reviewing the implementation gaps for health behavior change programs.
        Seminars in Reproductive Medicine. 2021; 38: 377-383https://doi.org/10.1055/s-0040-1722315
        • Locke E.A.
        • Latham G.P.
        The development of goal setting theory: A half century retrospective.
        Motivation Science. 2019; 5: 93-105https://doi.org/10.1037/mot0000127
        • Makama M.
        • Awoke M.A.
        • Skouteris H.
        • Moran L.J.
        • Lim S.
        Barriers and facilitators to a healthy lifestyle in postpartum women: A systematic review of qualitative and quantitative studies in postpartum women and healthcare providers.
        Obesity Reviews. 2021; 22 (Article e13167)https://doi.org/10.1111/obr.13167
        • Michie S.
        • West R.
        • Sheals K.
        • Godinho C.A.
        Evaluating the effectiveness of behavior change techniques in health-related behavior: A scoping review of methods used.
        Translational Behavioral Medicine. 2018; 8: 212-224https://doi.org/10.1093/tbm/ibx019
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • the PRISMA Group
        Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.
        PLOS Medicine. 2009; 6 (Article e1000097)https://doi.org/10.1371/journal.pmed.1000097
        • National Heart, Lung, and Blood Institute
        Study quality assessment tools.
        • Nielsen K.K.
        • Kapur A.
        • Damm P.
        • de Courten M.
        • Bygbjerg I.C.
        From screening to postpartum follow-up – The determinants and barriers for gestational diabetes mellitus (GDM) services, a systematic review.
        BMC Pregnancy and Childbirth. 2014; 14 (Article 41)https://doi.org/10.1186/1471-2393-14-41
        • Palnati M.
        • Marcus B.H.
        • Pekow P.
        • Rosal M.C.
        • Manson J.E.
        • Chasan-Taber L.
        The impact of a lifestyle intervention on postpartum weight retention among at-risk Hispanic women.
        American Journal of Preventive Medicine. 2021; 61: 44-54https://doi.org/10.1016/j.amepre.2021.02.005
        • Phelan S.
        Pregnancy: A “teachable moment” for weight control and obesity prevention.
        American Journal of Obstetrics & Gynecology. 2010; 202: 135.E1-135.E8https://doi.org/10.1016/j.ajog.2009.06.008
        • Song C.
        • Lyu Y.
        • Li C.
        • Liu P.
        • Li J.
        • Ma R.C.
        • Yang X.
        Long-term risk of diabetes in women at varying durations after gestational diabetes: A systematic review and meta-analysis with more than 2 million women.
        Obesity Reviews. 2018; 19: 421-429https://doi.org/10.1111/obr.12645
        • Sterne J.A.C.
        • Savović J.
        • Page M.J.
        • Elbers R.G.
        • Blencowe N.S.
        • Boutron I.
        • Higgins J.P.T.
        RoB 2: A revised tool for assessing risk of bias in randomised trials.
        BMJ. 2019; 366 (Article l4898)https://doi.org/10.1136/bmj.l4898
        • Swann C.
        • Rosenbaum S.
        • Lawrence A.
        • Vella S.A.
        • McEwan D.
        • Ekkekakis P.
        Updating goal-setting theory in physical activity promotion: A critical conceptual review.
        Health Psychology Review. 2021; 15: 34-50https://doi.org/10.1080/17437199.2019.1706616
        • Teperi J.
        • Porter M.E.
        • Vuorenkoski L.
        • Baron J.F.
        The Finnish health care system: A value-based perspective.
        • Van Ryswyk E.
        • Middleton P.
        • Shute E.
        • Hague W.
        • Crowther C.
        Women’s views and knowledge regarding healthcare seeking for gestational diabetes in the postpartum period: A systematic review of qualitative/survey studies.
        Diabetes Research and Clinical Practice. 2015; 110: 109-122https://doi.org/10.1016/j.diabres.2015.09.010
        • Vounzoulaki E.
        • Khunti K.
        • Abner S.C.
        • Tan B.K.
        • Davies M.J.
        • Gillies C.L.
        Progression to type 2 diabetes in women with a known history of gestational diabetes: Systematic review and meta-analysis.
        BMJ. 2020; 369 (Article m1361)https://doi.org/10.1136/bmj.m1361
        • Wilkinson S.A.
        • Lim S.S.
        • Upham S.
        • Pennington A.
        • O’Reilly S.L.
        • Asproloupos D.
        • Dunbar J.A.
        Who’s responsible for the care of women during and after a pregnancy affected by gestational diabetes?.
        Medical Journal of Australia. 2014; 201: S78-S81https://doi.org/10.5694/mja14.00251
        • Yamamoto J.M.
        • Kellett J.E.
        • Balsells M.
        • García-Patterson A.
        • Hadar E.
        • Solà I.
        • Corcoy R.
        Gestational diabetes mellitus and diet: A systematic review and meta-analysis of randomized controlled trials examining the impact of modified dietary interventions on maternal glucose control and neonatal birth weight.
        Diabetes Care. 2018; 41: 1346-1361https://doi.org/10.2337/dc18-0102

      Biography

      Shuyuan Huang, MPH, MSN, RN, is a PhD candidate, Yale School of Nursing, Orange, CT.

      Biography

      Cherlie Magny-Normilus, PhD, FNP-BC, is a research scholar, Connell School of Nursing, Boston College, Chestnut Hill, MA.

      Biography

      Erin McMahon, CNM, EdD, FACNM, is a clinical assistant professor, College of Nursing, The University of Arizona, Tucson, AZ.

      Biography

      Robin Whittemore, PhD, APRN, FAAN, is a professor, Yale School of Nursing, Orange, CT.