Nonpharmacological interventions to prevent type 2 diabetes in women diagnosed with gestational diabetes mellitus: a systematic overview Mothers After Gestational Diabetes in Australia Diabetes Prevention Program (MAGDA-DPP) post-natal intervention: study protocol for a randomized controlled trial 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 lmplementing lifestyle change through phone-based motivational interviewing in rural-based women with previous gestational diabetes mellitus. Gestational Diabetes Mellitus Can Be Prevented by Lifestyle Intervention: The Finnish Gestational Diabetes Prevention Study (RADIEL) What are the most effective behaviour change techniques to promote physical activity and/or reduce sedentary behaviour in inactive adults? A systematic review protocol Estudio Parto: postpartum diabetes prevention program for hispanic women with abnormal glucose tolerance in pregnancy: a randomised controlled trial – study protocol Adherence to a lifestyle programme in overweight/obese pregnant women and effect on gestational diabetes mellitus: a randomized controlled trial 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 Physical activity, sedentary behaviors and risk of gestational diabetes mellitus: a population-based cross-sectional study in Tianjin, China. A Randomised Controlled Trial to Reduce Sedentary Time in Young Adults at Risk of Type 2 Diabetes Mellitus: Project STAND (Sedentary Time ANd Diabetes) Tianjin Gestational Diabetes Mellitus Prevention Program: study design, methods, and 1-year interim report on the feasibility of lifestyle intervention program. Can a Low–Glycemic Index Diet Reduce the Need for Insulin in Gestational Diabetes Mellitus? Effect of intensive counselling on the quality of dietary fats in pregnant women at high risk of gestational diabetes mellitus. A Randomised Controlled Trial to Delay or Prevent Type 2 Diabetes after Gestational Diabetes: Walking for Exercise and Nutrition to Prevent Diabetes for You Optimizing healthy gestational weight gain in women at high risk of gestational diabetes: a randomized controlled trial. A Pregnancy and Postpartum Lifestyle Intervention in Women With Gestational Diabetes Mellitus Reduces Diabetes Risk Factors Interaction between rs10830963 polymorphism in MTNR1B and lifestyle intervention on occurrence of gestational diabetes Primary Prevention of Gestational Diabetes Mellitus and Large-for-Gestational-Age Newborns by Lifestyle Counseling: A Cluster-Randomized Controlled Trial Physical activity and sedentary behaviors associated with risk of progression from gestational diabetes mellitus to type 2 diabetes mellitus: a prospective cohort study. Results From a European Multicenter Randomized Trial of Physical Activity and/or Healthy Eating to Reduce the Risk of Gestational Diabetes Mellitus: The DALI Lifestyle Pilot Psychosocial Factors Related to Diet Among Women with Recent Gestational Diabetes Opportunities for Intervention Diabetes mellitus and abnormal glucose tolerance development after gestational diabetes: A three-year, prospective, randomized, clinical-based, Mediterranean lifestyle interventional study with parallel groups.
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 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 . 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 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 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 Introduction Large proportions of the population are not meeting recommended levels of physical activity and have increasingly sedentary lifestyles . Low levels of physical activity are predictive of poor health outcomes and time spent sedentary is related to a host of risk factors independently of physical activity levels . Building an evidence base of the best approaches to intervene in the lifestyles of inactive individuals is crucial in preventing long-term disease , disability and higher mortality rates . Methods and analysis Systematic search es will be conducted on all relevant data bases ( eg , PubMed , Scopus , CINAHL , PsycINFO ) . Studies will be included if they assess interventions aim ed at changing physical activity or sedentary behaviour levels in adults ( over 18 ) who are inactive and do not suffer from chronic conditions . Studies must also be r and omised controlled trials ( RCTs ) , have a primary outcome of physical activity or sedentary behaviour , and measure outcomes at least 6 months after intervention completion . Studies will be coded using the Behaviour Change Technique ( BCT ) taxonomy v1 and Template for Intervention Description and Replication ( TIDieR ) guidelines . 2 review ers will independently screen full-text articles and extract data on study characteristics , participants , BCTs , intervention features and outcome measures . Study quality will also be assessed independently by 2 review ers using the Cochrane risk of bias tool . A meta- analysis will be considered if there is sufficient homogeneity across outcomes . GRADE criteria will be used to assess quality of evidence . Dissemination This will be the first review to systematic ally appraise interventions aim ed at changing the physical activity or sedentary behaviour of inactive individuals using RCT design s with a 6-month follow-up post-intervention . This review will better inform intervention design ers targeting inactive population s and inform the design of a future complex intervention . Review registration number This protocol was registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) on 17 October 2014 ( registration number : CRD42014014321 ) Background Diabetes and obesity have reached epidemic proportions in the U.S. with rates consistently higher among Hispanics as compared to non-Hispanic whites . Among Hispanic women diagnosed with gestational diabetes mellitus ( GDM ) , 50 % will go on to develop type 2 diabetes within 5 years of the index pregnancy . Although r and omised controlled trials among adults with impaired glucose tolerance have shown that diet and physical activity reduce the risk of type 2 diabetes , such programs have not been tested in high-risk postpartum women . The overall goal of this r and omised controlled trial is to test the efficacy of a culturally and linguistically modified , individually-tailored lifestyle intervention to reduce risk factors for type 2 diabetes and cardiovascular disease among postpartum Hispanic women with a history of abnormal glucose tolerance during pregnancy . Methods / Design Hispanic pregnant women who screen positive for GDM will be recruited and r and omly assigned to a Lifestyle Intervention ( n = 150 ) or a Health & Wellness ( control ) Intervention ( n = 150 ) . Multimodal contacts ( i.e. , in-person , telephone , and mailed material s ) will be used to deliver the intervention from late pregnancy ( 29 weeks gestation ) to 12 months postpartum . Targets of the intervention are to achieve Institute of Medicine Guidelines for postpartum weight loss ; American Congress of Obstetrician and Gynecologist guidelines for physical activity ; and American Diabetes Association guidelines for diet . The intervention draws from Social Cognitive Theory and the Transtheoretical Model and addresses the specific cultural and environmental challenges faced by low-income Hispanic women . Assessment s will be conducted at enrollment , and at 6-weeks , 6-months , and 12-months postpartum by trained bicultural and bilingual personnel blinded to the intervention arm . Efficacy will be assessed via postpartum weight loss and biomarkers of insulin resistance and cardiovascular risk . Changes in physical activity and diet will be measured via 7-day actigraph data and three unannounced 24-hour dietary recalls at each assessment time period . Discussion Hispanic women are the fastest growing minority group in the U.S. and have the highest rates of sedentary behavior and postpartum diabetes after a diagnosis of GDM . This r and omised trial uses a high-reach , low-cost strategy that can readily be translated into clinical practice in underserved and minority population s . Trial registration This study aims to determine whether the prescription of a detailed lifestyle programme in overweight/obese pregnant women influences the occurrence of gestational diabetes ( GDM ) , and if this kind of prescription increases the adherence to a healthier lifestyle in comparison to st and ard care . The study was design ed as a r and omized controlled trial , with open allocation , enrolling women at 9 - 12 weeks of pregnancy with a BMI ≥ 25 kg/m2 . The women assigned to the Intervention group ( I = 96 ) received a hypocaloric , low-glycaemic , low-saturated fat diet and physical activity recommendations . Those assigned to the St and ard Care group ( SC = 95 ) received lifestyle advices regarding healthy nutrition and exercise . Follow-up was planned at the 16th , 20th , 28th and 36th weeks . A total of 131 women completed the study ( I = 69 , SC = 62 ) . The diet adherence was higher in the I ( 57.9 % ) than in the SC ( 38.7 % ) group . GDM occurred less frequently in the I ( 18.8 % ) than in the SC ( 37.1 % , P = 0.019 ) group . The adherent women from either groups showed a lower GDM rate ( 12.5 % vs. 41.8 % , P < 0.001 ) . After correcting for confounders , the GDM rate was explained by allocation into the I group ( P = 0.034 ) and a lower BMI category ( P = 0.039 ) . The rates of hypertension , preterm birth , induction of labour , large for gestational age babies and birthweight > 4000 g were significantly lower in I group . The incidence of small for gestational age babies was not different . These findings demonstrate that the adherence to a personalized , hypocaloric , low-glycaemic , low-saturated fat diet started early in pregnancy prevents GDM occurrence , in women with BMI ≥ 25 kg/m2 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 OBJECTIVE Physical activity in a nonpregnant state or before pregnancy reduces the risk of  type 2 diabetes  and is also associated with reduced risk of gestational diabetes mellitus ( GDM ) . However , it is uncertain whether physical activity during pregnancy reduces the risk of GDM . DESIGN AND METHODS Using an established universal screening system in Tianjin , China , we prospect ively recruited 11 450 pregnant women within the 12th gestational week from 2010 to 2012 . These women underwent a 50-g 1-h glucose challenge test ( GCT ) at 24 - 28 weeks of gestation and a 75-g 2-h oral glucose tolerance test if GCT glucose ≥7.8mmol/L. GDM was defined according to the International Association of Diabetes and Pregnancy Study Group 's criteria .  Self-reported physical activity  in the last month was collected at GCT time using a vali date d question naire . RESULTS GDM developed in 7.3 % ( n=840 ) of the women . Women with GDM were less likely to be engaged in moderate-to-high physical activity during pregnancy than those without ( 79.8 % vs 81.6 % , P=0.191 ) .  Moderate-to-high physical  activity during pregnancy was associated with decreased risk of GDM ( multivariable odds ratio ( OR ) : 0.81 , 95 % confidence interval ( CI ) : 0.67 - 0.97 ) . Sitting at home for 2 - 4h per day and > 4h per day were associated with significantly increased risk of GDM ( multivariable OR of sitting time for 2 - 4h vs < 2h : 1.59 , 95 % CI : 1.18 - 2.15 ; OR of sitting time for > 4h vs < 2h : 1.73 , 95 % CI : 1.22 - 2.43 ) . CONCLUSIONS Increased physical activity during pregnancy was associated with reduced GDM risk , whereas sedentary lifestyle was associated with increased GDM risk among Chinese pregnant women Aims Type 2 diabetes mellitus ( T2DM ) , a serious and prevalent chronic disease , is traditionally associated with older age . However , due to the rising rates of obesity and sedentary lifestyles , it is increasingly being diagnosed in the younger population . Sedentary ( sitting ) behaviour has been shown to be associated with greater risk of cardio-metabolic health outcomes , including T2DM . Little is known about effective interventions to reduce sedentary behaviour in younger adults at risk of T2DM . We aim ed to investigate , through a r and omised controlled trial ( RCT ) design , whether a group-based structured education workshop focused on sitting reduction , with self-monitoring , reduced sitting time . Methods Adults aged 18–40 years who were either overweight ( with an additional risk factor for T2DM ) or obese were recruited for the Sedentary Time ANd Diabetes ( ST AND ) RCT . The intervention programme comprised of a 3-hour group-based structured education workshop , use of a self-monitoring tool , and follow-up motivational phone call . Data were collected at three time points : baseline , 3 and 12 months after baseline . The primary outcome measure was accelerometer-assessed sedentary behaviour after 12 months . Secondary outcomes included other objective ( activPAL ) and self-reported measures of sedentary behaviour and physical activity , and biochemical , anthropometric , and psycho-social variables . Results 187 individuals ( 69 % female ; mean age 33 years ; mean BMI 35 kg/m2 ) were r and omised to intervention and control groups . 12 month data , when analysed using intention-to-treat analysis ( ITT ) and per- protocol analyses , showed no significant difference in the primary outcome variable , nor in the majority of the secondary outcome measures . Conclusions A structured education intervention design ed to reduce sitting in young adults at risk of T2DM was not successful in changing behaviour at 12 months . Lack of change may be due to the brief nature of such an intervention and lack of focus on environmental change . Moreover , some participants reported a focus on physical activity rather than reductions in sitting per se . The habitual nature of sedentary behaviour means that behaviour change is challenging . Trial Registration Controlled-Trials.com IS RCT OBJECTIVE To assess whether lifestyle intervention can reduce type 2  diabetes risk in women with prior GDM in the Tianjin Gestational Diabetes Mellitus ( GDM ) Prevention Program . METHODS 1180 women who were diagnosed with GDM from 2005 to 2009 were r and omly assigned to either a lifestyle intervention ( n=586 ) or a control group ( n=594 ) . Major elements of the intervention include six face-to-face meetings with study dietitians in the first year , and two additional sessions and two telephone calls in second year . RESULTS During the first year , average body weight loss in the first 404 subjects was 1.40 kg ( 2.1 % ) in the intervention group vs 0.21 kg ( 0.3 % ) in the control group ( P=0.001 ) , and the decrease was more significant among baseline overweight women ( body bass index [ BMI ] ≥24 kg/m² ) in the intervention ( 2.91 kg/4.2 % ) compared with that in the control group ( 0.51 kg/0.7 % ) ( P<0.001 ) . In addition , women in the intervention group , compared with those in the control group , have decreased BMI , body fat , waist circumference , and plasma insulin levels , and have improved behaviors including increased leisure time activity and dietary fiber intake and decreased sedentary time and fat consumptions . CONCLUSION The interim results support the efficacy and feasibility of the lifestyle intervention program OBJECTIVE A low – glycemic index diet is effective as a treatment for individuals with diabetes and has been shown to improve pregnancy outcomes when used from the first trimester . A low – glycemic index diet is commonly advised as treatment for women with gestational diabetes mellitus ( GDM ) . However , the efficacy of this advice and associated pregnancy outcomes have not been systematic ally examined . The purpose of this study was to determine whether prescribing a low – glycemic index diet for women with GDM could reduce the number of women requiring insulin without compromise of pregnancy outcomes . RESEARCH DESIGN AND METHODS All women with GDM seen over a 12-month period were considered for inclusion in the study . Women ( n = 63 ) were r and omly assigned to receive either a low – glycemic index diet or a conventional high-fiber ( and higher glycemic index ) diet . RESULTS Of the 31 women r and omly assigned to a low – glycemic index diet , 9 ( 29 % ) required insulin . Of the women r and omly assigned to a higher – glycemic index diet , a significantly higher proportion , 19 of 32 ( 59 % ) , met the criteria to commence insulin treatment ( P = 0.023 ) . However , 9 of these 19 women were able to avoid insulin use by changing to a low – glycemic index diet . Key obstetric and fetal outcomes were not significantly different . CONCLUSIONS Using a low – glycemic index diet for women with GDM effectively halved the number needing to use insulin , with no compromise of obstetric or fetal outcomes As part of a feasibility study to prevent gestational diabetes mellitus ( GDM ) , we evaluated the effect of an intensive dietary therapy on quality of diet , weight gain and birth weight in women at high risk of GDM . Women with risk factors for GDM ( n 54 ) were r and omly assigned from April 2005 to May 2006 to a  lifestyle intervention group ( n 27 ) including dietary advice six times during pregnancy or to a close follow-up group ( n 27 ) in a community-based setting in Finl and . Dietary intake was recorded three times during pregnancy using 4 d food records . The main outcome was the incidence of GDM . The secondary outcomes were the changes in nutrient intake , weight gain and birth weight . Overall , seventeen ( 65 % ) women in the intervention group and eighteen ( 69 % ) women in the close follow-up group returned all three food records . PUFA intake increased ( P = 0·008 ) during pregnancy in the intervention as compared to the close follow-up group . There were no clear differences in the changes of saturated fat or fibre intake between the groups . Intensive dietary education result ed in a somewhat lower weight gain during pregnancy ( P = 0·062 ) and higher birth weights of the infants ( P = 0·047 ) without an effect on macrosomia as compared to the close follow-up group . Individualised counselling by a clinical nutritionist as part of a lifestyle intervention improved the quality of dietary fat intake in pregnant women at high risk of GDM Aims . To develop a program to support behaviour changes for women with a history of Gestational Diabetes Mellitus ( GDM ) and a Body Mass Index ( BMI ) > 25 kg/m2 to delay or prevent Type 2 Diabetes Mellitus . Methods . Women diagnosed with GDM in the previous 6 to 24 months and BMI > 25 kg/m2 were r and omized to an intervention ( I ) ( n = 16 ) or a control ( C ) ( n = 15 ) group . The intervention was a pedometer program combined with nutrition coaching , with the primary outcome increased weight loss in the intervention group . Secondary outcomes included decreased waist and hip measurements , improved insulin sensitivity and body composition , increased physical activity , and improved self-efficacy in eating behaviours . Results . Median ( IQR ) results were as follows : weight : I −2.5 ( 2.3 ) kg versus C + 0.2 ( 1.6 ) kg ( P = 0.009 ) , waist : I −3.6 ( 4.5 ) cm versus C −0.1 ( 3.6 ) cm ( P = 0.07 ) , and hip : I −5.0 ( 3.3 ) cm versus C −0.2 ( 2.6 ) cm ( P = 0.002 ) . There was clinical improvement in physical activity and eating behaviours and no significant changes in glucose metabolism or body composition . Conclusion . A pedometer program and nutrition coaching proved effective in supporting weight loss , waist circumference , physical activity , and eating behaviours in women with previous GDM OBJECTIVE Optimizing gestational weight gain ( GWG ) in early pregnancy is of clinical and public health importance , especially in higher risk pregnancies . DESIGN AND METHODS In a robustly design ed , r and omized controlled trial , 228 pregnant women at risk of developing gestational diabetes mellitus ( GDM ) were allocated to either control ( written health information only ) or intervention ( four-session lifestyle program ) . All women received st and ard maternal care . Measures were completed at 12 - 15 and 26 - 28 weeks gestation . Measures included anthropometrics ( weight and height ) , physical activity ( pedometer and International Physical Activity Question naire ) , question naires ( risk perception ) , and GDM screening . RESULTS The mean ( SD ) age [ 31.7 ( 4.5 ) and 32.4 ( 4.7 ) years ] and body mass index [ BMI ; 30.3 ( 5.9 ) and 30.4 ( 5.6 ) kg/m(2 ) ] were similar between control and intervention groups , respectively . By 28 weeks , GWG was significantly different between control and intervention groups [ 6.9 ( 3.3 ) vs. 6.0 ( 2.8 ) kg , P < 0.05 ] . When stratified according to baseline BMI , overweight women in the control group gained significantly more weight compared to overweight women in the intervention group [ 7.8 ( 3.4 ) vs. 6.0 ( 2.2 ) kg , P < 0.05 ] , yet in obese women , GWG was similar in both groups . Physical activity levels declined by 28 weeks gestation overall ( P < 0.01 ) ; however , the intervention group retained a 20 % higher step count compared to controls [ 5,203 ( 3,368 ) vs. 4,140 ( 2,420 ) steps/day , P < 0.05 ] . Overall , GDM prevalence was 22.8 % [ Corrected ] , with a trend toward less cases in the intervention group ( P = 0.1 ) . CONCLUSIONS Results indicate that a low-intensity lifestyle intervention , integrated with antenatal care , optimizes healthy GWG and attenuates physical activity decline in early pregnancy . Efficacy in limiting weight gain was greatest in overweight women and in high-risk ethnically diverse women 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 Aims /hypothesisThe aim of this study was to assess the interaction between melatonin receptor 1B gene ( MTNR1B ) rs10830963 polymorphism and lifestyle intervention during pregnancy on occurrence of  gestational diabetes mellitus ( GDM ) in high-risk women . Methods This is a secondary analysis of the r and omised controlled gestational diabetes prevention trial ‘ RADIEL ’ , conducted between 2008 and 2014 in four maternity hospitals in southern Finl and . A total of 226 women with a history of GDM and /or a pre-pregnancy BMI ≥ 30 kg/m2 were enrolled at < 20 weeks of gestation ( mean 13 weeks ) and r and omised into an intervention group receiving counselling on diet , physical activity and weight control and a control group receiving st and ard antenatal care . The main outcome was incidence of GDM , defined as one or more pathological glucose values in a st and ard 75 g 2-h OGTT . The MTNR1B rs10830963 was genotyped for further analyses . Results No significant differences were found in the genotype distribution between the intervention and the control group . A significant interaction was observed between the rs10830963 genotypes and the lifestyle intervention on age-adjusted occurrence of gestational diabetes ( p = 0.038 ) . Among women homozygous for the C allele of rs10830963 , the OR for GDM was significantly lower in the intervention group than in the control group ( OR 0.16 [ 95 % CI 0.03 , 0.85 ] , p = 0.014 ) . This difference was not seen in women heterozygous ( OR 0.88 [ 95 % CI 0.32 , 2.41 ] , p = 0.798 ) or homozygous ( OR 2.25 [ 95 % CI 0.34 , 14.69 ] , p = 0.384 ) for the risk allele G. Conclusions /interpretationIn women at high risk of GDM , only those not carrying the risk allele G benefited from the lifestyle intervention . Our results indicate that certain genetic risk variants may modify the effectiveness of  lifestyle interventions . This may provide important information when planning GDM prevention studies in the future In a cluster-r and omized trial , Riitta Luoto and colleagues find that counseling on diet and activity can reduce the birthweight of babies born to women at risk of developing  gestational diabetes mellitus ( GDM  ) , but fail to find an effect on GDM IMPORTANCE Women with a history of gestational diabetes mellitus ( GDM ) are at substantially increased risk of type 2 diabetes mellitus ( T2DM ) . The identification of important modifiable factors could help prevent T2DM in this high-risk population . OBJECTIVE To examine the role of physical activity and television watching and other sedentary behaviors  , and changes in these behaviors in the progression from GDM to T2DM . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study of 4554 women from the Nurses ' Health Study II who had a history of GDM , as part of the ongoing Diabetes & Women 's Health Study . These women were followed up from 1991 to 2007 . EXPOSURES Physical activity and television watching and other sedentary behaviors  were assessed in 1991 , 1997 , 2001 , and 2005 . MAIN OUTCOMES AND MEASURE Incident T2DM identified through self-report and confirmed by supplemental question naires . RESULTS We documented 635 incident T2DM cases during 59,287 person-years of follow-up . Each 5-metabolic equivalent hours per week ( MET-h/wk ) increment of total physical activity , which is equivalent to 100 minutes per week of moderate-intensity physical activity , was related to a 9 % lower risk of T2DM ( adjusted relative risk [ RR ] , 0.91 ; 95 % CI , 0.88 - 0.94 ) ; this inverse association remained significant after additional adjustment for body mass index ( BMI ) . Moreover , an increase in physical activity was associated with a lower risk of developing T2DM . Compared with women who maintained their total physical activity levels , women who increased their total physical activity levels by 7.5 MET-h/wk or more ( equivalent to 150 minutes per week of moderate-intensity physical activity ) had a 47 % lower risk of T2DM ( RR , 0.53 ; 95 % CI , 0.38 - 0.75 ) ; the association remained significant after additional adjustment for BMI . The multivariable adjusted RRs ( 95 % CIs ) for T2DM associated with television watching of 0 to 5 , 6 to 10 , 11 to 20 , and 20 or more hours per week were 1 ( reference ) , 1.28 ( 1.04 - 1.59 ) , 1.41 ( 1.11 - 1.79 ) , and 1.77 ( 1.28 - 2.45 ) , respectively ( P value for trend < .001 ) ; additional adjustment for BMI attenuated the association . CONCLUSIONS AND RELEVANCE Increasing physical activity may lower the risk of progression from GDM to T2DM . These findings suggest a hopeful message to women with a history of GDM , although they are at exceptionally high risk for T2DM , promoting an active lifestyle may lower the risk OBJECTIVE Ways to prevent gestational diabetes mellitus ( GDM ) remain unproven . We compared the impact of three lifestyle interventions ( healthy eating [ HE ] , physical activity [ PA ] , and both HE and PA [ HE+PA ] ) on GDM risk in a pilot multicenter r and omized trial . RESEARCH DESIGN AND METHODS Pregnant women at risk for GDM ( BMI ≥29 kg/m2 ) from nine European countries were invited to undertake a 75-g oral glucose tolerance test before 20 weeks ' gestation . Those without GDM were r and omized to HE , PA , or HE+PA . Women received five face-to-face and four optional telephone coaching sessions , based on the principles of motivational interviewing . A gestational weight gain ( GWG ) < 5 kg was targeted . Coaches received st and ardized training and an intervention toolkit . Primary outcome measures were GWG , fasting glucose , and insulin sensitivity ( HOMA ) at 35–37 weeks . RESULTS Among the 150 trial participants , 32 % developed GDM  by 35–37 weeks and 20 % achieved GWG < 5 kg . HE women had less GWG ( −2.6 kg [ 95 % CI −4.9 , −0.2 ] ; P = 0.03 ) and lower fasting glucose ( −0.3 mmol/L [ −0.4 , −0.1 ] ; P = 0.01 ) than those in the PA group at 24–28 weeks . HOMA was comparable . No significant differences between HE+PA and the other groups were observed . CONCLUSIONS An antenatal HE intervention is associated with less GWG and lower fasting glucose compared with PA alone . These findings require a larger trial for confirmation but support the use of early HE interventions in obese pregnant women Purpose This study investigated  postpartum dietary behaviors  among women with recent gestational diabetes mellitus ( GDM ) , the cognitive and social factors related to these , and preferred types of lifestyle support , in order improve the development of diabetes prevention strategies for this group . Methods Participants were a r and om sample of 226 women diagnosed with GDM in the prior 6 to 24 months .  Telephone surveys were used to evaluate  dietary behaviors , self-efficacy , social support , perceived barriers to healthy eating , and preferred methods of lifestyle support .  Results Only 5 % of the respondents consumed 5 servings/day of vegetables and 44 % consumed 2 or more servings/day of fruit . Fried food was eaten at least twice per week by 26 % of women and 50 % usually consumed full-fat milk . Higher vegetable consumption was associated with self-efficacy to cook healthy foods , reporting that a healthy diet is not a difficult change and that dislike of healthy foods by other household members is not a barrier . Fruit consumption was positively related to self-efficacy when busy and when not reporting a dislike of healthy foods by others at home . Advice from a dietitian and telephone support from a health educator were the most preferred forms of health assistance . Conclusions Dietary risks factors are prevalent among women with recent GDM .  Confidence and skills in cooking healthy foods , along with family food preferences and time pressures , are important influences on eating habits . Dietary change programs , informed by the beliefs and circumstances of this high-risk population , need to be developed BACKGROUND & AIMS Women with prior gestational diabetes mellitus ( GDM ) have a high risk of developing type 2 diabetes mellitus ( DM2 ) in later life . The study aim was to evaluate the efficacy of a lifestyle intervention for the prevention of glucose disorders ( impaired fasting glucose , impaired glucose tolerance or DM2 ) in women with prior GDM . METHODS A total of 260 women with prior GDM who presented with normal fasting plasma glucose at six to twelve weeks postpartum were r and omized into two groups : a Mediterranean lifestyle intervention group ( n = 130 ) who underwent an educational program on nutrition and a monitored physical activity program and a control group ( n = 130 ) with a conventional follow-up . A total of 237 women completed the three-year follow-up ( 126 in the intervention group and 111 in the control group ) . Their glucose disorders rates , clinical and metabolic changes and rates of adherence to the Mediterranean lifestyle were analyzed . RESULTS Less women in the intervention group ( 42.8 % ) developed glucose disorders at the end of the three-year follow-up period compared with the control group ( 56.75 % ) , p < 0.05 . The multivariate analysis indicated a reduction in the rate of glucose disorders with a BMI of less than 27 kg/m(2 ) ( OR 0.28 ; 0.12 - 0.65 ; p < 0.003 ) , low fat intake pattern ( OR 0.30 ; 0.13 - 0.70 ; p < 0.005 ) , low saturated fat pattern ( OR 0.30 ; 0.13 - 0.69 ; p < 0.005 ) and healthy fat pattern ( OR 0.34 ; 0.12 - 0.94 ; p < 0.04 ) . CONCLUSIONS Lifestyle intervention was effective for the prevention of glucose disorders in women with prior GDM . Body weight gain and an unhealthy fat intake pattern were found to be the most predictive factors for the development of glucose disorders . Current Controlled trials : IS RCT N24165302 . http://www.controlled-trials.com/is rct n/pf/24165302
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 .