Download PDF
Am J Perinatol 2016; 33(12): 1145-1151
DOI: 10.1055/s-0036-1585085
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Randomized Clinical Trial of an Intensive Behavior Education Program in Gestational Diabetes Mellitus Women Designed to Improve Glucose Levels on the 2-Hour Oral Glucose Tolerance Test

Celeste P. Durnwald
1   Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
,
Michael J. Kallan
2   Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
,
Kelly C. Allison
3   Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
,
Mary D. Sammel
2   Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
,
Susan Wisch
1   Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
,
Michal Elovitz
1   Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
,
Samuel Parry
1   Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
› Author Affiliations
Further Information

Publication History

25 May 2016

28 May 2016

Publication Date:
11 July 2016 (online)

    Permissions and Reprints

Abstract

Objective To evaluate whether women with gestational diabetes mellitus (GDM) enrolled in an intensive behavior education program (IBEP) demonstrate lower mean fasting glucose levels on the 2-hour 75 g oral glucose tolerance test (2-hour OGTT) at 6 to 12 weeks postpartum compared with women who undergo routine GDM management.

Study Design A prospective randomized controlled trial of women diagnosed with GDM was conducted. Exclusion criteria were GDM diagnosis ≥ 33 weeks or < 20 weeks. Women were randomly assigned to one of two treatment arms: (1) routine GDM management or (2) an IBEP. Women underwent a 2-hour OGTT at 6 to 12 weeks postpartum. Fisher exact test, t-test, and Wilcoxon rank sum test were used as appropriate.

Results Of the 101 women randomized, 49 were assigned to IBEP and 52 received routine GDM management. There was no difference in mean fasting and 2-hour glucose levels on the postpartum 2-hour OGTT between the IBEP and routine management group (88.5 ± 22.9 mg/dL vs. 85.2 ± 13.3 mg/dL, p = 0.49 and 109.8 ± 38.5 mg/dL vs. 109.4 ± 40.8 mg/dL, p = 0.97, respectively).

Conclusion GDM women enrolled in a healthy lifestyle intervention program did not demonstrate lower glucose values on the postpartum 2-hour OGTT.

Keywords

gestational diabetes mellitus - lifestyle intervention - 2-hour oral glucose tolerance test - impaired glucose tolerance

Note

The findings of this article were presented at the Society for Maternal-Fetal Medicine's Annual Meeting, oral concurrent session 5: DM and Metabolism on February 5, 2016 and correspond to abstract #973. This abstract was the award-winning abstract for oral concurrent session 5: DM and metabolism. This project received financial support from the Penn Presbyterian George L. and Emily McMichael Harrison Fund for Research in Obstetrics and Gynecology, University of Pennsylvania. This randomized clinical trial was registered at ClinicalTrials.gov. Identifier: NCT01858233.


 

  • References

  • 1 Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 2009; 373 (9677) 1773-1779
    CrossrefPubMedGoogle Scholar
  • 2 Lee AJ, Hiscock RJ, Wein P, Walker SP, Permezel M. Gestational diabetes mellitus: clinical predictors and long-term risk of developing type 2 diabetes: a retrospective cohort study using survival analysis. Diabetes Care 2007; 30 (4) 878-883
    CrossrefPubMedGoogle Scholar
  • 3 Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care 2002; 25 (10) 1862-1868
    CrossrefPubMedGoogle Scholar
  • 4 Kwak SH, Choi SH, Jung HS , et al. Clinical and genetic risk factors for type 2 diabetes at early or late post partum after gestational diabetes mellitus. J Clin Endocrinol Metab 2013; 98 (4) E744-E752
    CrossrefPubMedGoogle Scholar
  • 5 Knowler WC, Barrett-Connor E, Fowler SE , et al; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346 (6) 393-403
    CrossrefPubMedGoogle Scholar
  • 6 Ratner RE, Christophi CA, Metzger BE , et al; Diabetes Prevention Program Research Group. Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. J Clin Endocrinol Metab 2008; 93 (12) 4774-4779
    CrossrefPubMedGoogle Scholar
  • 7 Aroda VR, Christophi CA, Edelstein SL , et al; Diabetes Prevention Program Research Group. 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. J Clin Endocrinol Metab 2015; 100 (4) 1646-1653
    CrossrefPubMedGoogle Scholar
  • 8 Tuomilehto J, Lindström J, Eriksson JG , et al; Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344 (18) 1343-1350
    CrossrefPubMedGoogle Scholar
  • 9 Halperin IJ, Feig DS. The role of lifestyle interventions in the prevention of gestational diabetes. Curr Diab Rep 2014; 14 (1) 452
    CrossrefPubMedGoogle Scholar
  • 10 Skouteris H, Morris H, Nagle C, Nankervis A. Behavior modification techniques used to prevent gestational diabetes: a systematic review of the literature. Curr Diab Rep 2014; 14 (4) 480
    CrossrefPubMedGoogle Scholar
  • 11 Yin YN, Li XL, Tao TJ, Luo BR, Liao SJ. Physical activity during pregnancy and the risk of gestational diabetes mellitus: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med 2014; 48 (4) 290-295
    CrossrefPubMedGoogle Scholar
  • 12 Russo LM, Nobles C, Ertel KA, Chasan-Taber L, Whitcomb BW. Physical activity interventions in pregnancy and risk of gestational diabetes mellitus: a systematic review and meta-analysis. Obstet Gynecol 2015; 125 (3) 576-582
    CrossrefPubMedGoogle Scholar
  • 13 Thangaratinam S, Rogozińska E, Jolly K , et al. Interventions to reduce or prevent obesity in pregnant women: a systematic review. Health Technol Assess 2012; 16 (31) iii-iv , 1–191
    PubMedGoogle Scholar
  • 14 Tanentsapf I, Heitmann BL, Adegboye AR. Systematic review of clinical trials on dietary interventions to prevent excessive weight gain during pregnancy among normal weight, overweight and obese women. BMC Pregnancy Childbirth 2011; 11: 81
    CrossrefPubMedGoogle Scholar
  • 15 Oostdam N, van Poppel MN, Wouters MG, van Mechelen W. Interventions for preventing gestational diabetes mellitus: a systematic review and meta-analysis. J Womens Health (Larchmt) 2011; 20 (10) 1551-1563
    Google Scholar
  • 16 Ferrara A, Hedderson MM, Albright CL , et al. 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 (7) 1519-1525
    CrossrefPubMedGoogle Scholar
  • 17 Reinhardt JA, van der Ploeg HP, Grzegrzulka R, Timperley JG. lmplementing lifestyle change through phone-based motivational interviewing in rural-based women with previous gestational diabetes mellitus. Health Promot J Austr 2012; 23 (1) 5-9
    CrossrefPubMedGoogle Scholar
  • 18 Retnakaran R, Qi Y, Sermer M, Connelly PW, Hanley AJ, Zinman B. Beta-cell function declines within the first year postpartum in women with recent glucose intolerance in pregnancy. Diabetes Care 2010; 33 (8) 1798-1804
    CrossrefPubMedGoogle Scholar
  • 19 Gunderson EP, Hedderson MM, Chiang V , et al. Lactation intensity and postpartum maternal glucose tolerance and insulin resistance in women with recent GDM: the SWIFT cohort. Diabetes Care 2012; 35 (1) 50-56
    CrossrefPubMedGoogle Scholar
  • 20 Jang HC. Gestational diabetes in Korea: incidence and risk factors of diabetes in women with previous gestational diabetes. Diabetes Metab J 2011; 35 (1) 1-7
    CrossrefPubMedGoogle Scholar
  • 21 Al Mamun A, Mannan M, O'Callaghan MJ, Williams GM, Najman JM, Callaway LK. Association between gestational weight gain and postpartum diabetes: evidence from a community based large cohort study. PLoS ONE 2013; 8 (12) e75679
    CrossrefPubMedGoogle Scholar
  • 22 Smith BJ, Cinnadaio N, Cheung NW, Bauman A, Tapsell LC, van der Ploeg HP. Investigation of a lifestyle change strategy for high-risk women with a history of gestational diabetes. Diabetes Res Clin Pract 2014; 106 (3) e60-e63
    CrossrefPubMedGoogle Scholar
  • 23 Phelan S. Pregnancy: a “teachable moment” for weight control and obesity prevention. Am J Obstet Gynecol 2010; 202 (2) 135.e1-135.e8
    CrossrefPubMedGoogle Scholar
  • 24 Ferrara A, Ehrlich SF. Strategies for diabetes prevention before and after pregnancy in women with GDM. Curr Diabetes Rev 2011; 7 (2) 75-83
    CrossrefPubMedGoogle Scholar
  • 25 Jones EJ, Roche CC, Appel SJ. A review of the health beliefs and lifestyle behaviors of women with previous gestational diabetes. J Obstet Gynecol Neonatal Nurs 2009; 38 (5) 516-526
    CrossrefPubMedGoogle Scholar
  • 26 Chasan-Taber L. Lifestyle interventions to reduce risk of diabetes among women with prior gestational diabetes mellitus. Best Pract Res Clin Obstet Gynaecol 2015; 29 (1) 110-122
    CrossrefPubMedGoogle Scholar
  • 27 Ferrara A, Peng T, Kim C. Trends in postpartum diabetes screening and subsequent diabetes and impaired fasting glucose among women with histories of gestational diabetes mellitus: A report from the Translating Research Into Action for Diabetes (TRIAD) Study. Diabetes Care 2009; 32 (2) 269-274
    CrossrefPubMedGoogle Scholar
  • 28 Schaefer-Graf UM, Buchanan TA, Xiang AH, Peters RK, Kjos SL. Clinical predictors for a high risk for the development of diabetes mellitus in the early puerperium in women with recent gestational diabetes mellitus. Am J Obstet Gynecol 2002; 186 (4) 751-756
    CrossrefPubMedGoogle Scholar
  • 29 Pérez-Ferre N, Del Valle L, Torrejón MJ , et al. Diabetes mellitus and abnormal glucose tolerance development after gestational diabetes: A three-year, prospective, randomized, clinical-based, Mediterranean lifestyle interventional study with parallel groups. Clin Nutr 2015; 34 (4) 579-585
    CrossrefPubMedGoogle Scholar
  • 30 Greaves CJ, Sheppard KE, Abraham C , et al; IMAGE Study Group. Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions. BMC Public Health 2011; 11: 119
    CrossrefPubMedGoogle Scholar
  • 31 Baker MK, Simpson K, Lloyd B, Bauman AE, Singh MA. Behavioral strategies in diabetes prevention programs: a systematic review of randomized controlled trials. Diabetes Res Clin Pract 2011; 91 (1) 1-12
    CrossrefPubMedGoogle Scholar
  • 32 Lipscombe LL, Banerjee AT, McTavish S , et al. Readiness for diabetes prevention and barriers to lifestyle change in women with a history of gestational diabetes mellitus: rationale and study design. Diabetes Res Clin Pract 2014; 106 (1) 57-66
    CrossrefPubMedGoogle Scholar