Table 2 Findings from the follow-up studies regarding cardiovascular risk
Author Year published Country | Study design and GDM definition | Aim of study | Population | Intervention | Outcomes measured | Key findings |
|---|---|---|---|---|---|---|
- Ferrara et al.[24] - 2016 - USA | - Cluster RCT 44 facilities - Carpenter and Coustan criteria | - Comparing effectiveness of diabetes prevention strategies regarding postpartum weight retention | - 2280 women with previous GDM - Int.: 1087. Con.: 1193 - 84% retention rate for the 12-month survey - In intervention group, 50.3% completed one or more telephone session, 15.3% all 13 | - Diabetes Prevention Program derived lifestyle intervention: gestational weight gain recommendations sent by mail and 13 telephone sessions between 6 weeks and 6 months postpartum - Control group received standard care: mailed reminder of postpartum diabetes screening and general lifestyle advice - Follow-up: 12 months | - Primary: Proportion of women meeting postpartum weight goals (reaching pregravid weight if pregravid BMI < 25 or losing 5% of pregravid weight if BMI ≥ 25.0) - Secondary: postpartum changes in daily total energy intake, percentage of calories from fat, physical activity, hypertension and depression | - Odds ratio for meeting weight goals 1.28 [95% CI 1.10, 1.47]. Greater increase in vigorous physical activity in intervention group: mean difference 15.4 min/week [4.9, 25.8]. No significant differences for other secondary outcomes |
- Holmes et al. [25] - 2018 - Northern Ireland | - Cluster RCT Two facilities - 2013 WHO/IADPSG- criteria | - Determining the effectiveness of a postpartum lifestyle intervention program for overweight women with previous GDM | - 60 overweight (BMI ≥ 25) women with previous GDM. Int.: 29. Con.: 31 mean BMI 34.1 ± 6.3 in intervention group, 33.6 ± 5.4 in control group - In total 15 patient withdrawals | - A 1-h educational session at 6 weeks postpartum, free voucher for 3-month membership in commercial weight management organization, pedometer and intermittent follow-up with health educator via telephone/text message - Control group received standard care alone: educational DVD provided routinely when diagnosed with GDM - Follow-up: 6 months | - Primary: weight loss at 6 months Secondary: blood glucose, waist circumference, BMI | - Significant difference in reduction of weight (− 4.5 kg [− 8.1, − 0.9]), BMI and waist circumference. No significant difference in glucose measurements |
- McManus et al. [27] - 2018 - Canada | - RCT - Not explicitly defined | - Evaluate the impact a postpartum healthy living program for women with recent GDM | - 170 overweight (predicted postpartum BMI ≥ 25) women with history of GDM - Int.: 89. Con.: 81. - 63 partners, results presented separately - 57% of included women completed the 12-month follow-up | - One-on-one healthy living-seminar, invitation to 1-h weekly walking group. Access to informational web-site. Automatic e-mail - Control group were provided with a hand-out from the Canadian Diabetes Association - Follow-up: 12 months | - Primary: Percentage of women reaching postpartum weight goal (losing ≥ 7% of postpartum weight) - Secondary included HbA1c, waist circumference, lifestyle habits, program participation, and engagement | - No significant differences for neither primary outcome nor waist circumference, HbA1c, physical activity, or diet |
- O’Reilly et al. [28] - 2016 - Australia | - RCT - Australasian Diabetes in Pregnancy Society criteriaa | - Evaluate a diabetes prevention program tailored to the needs of young mothers with previous GDM in the first postpartum year | - 573 women with previous GDM - Int.: 284. Con.: 289 - Only 10% of women attended all sessions. Loss to follow-up 27% (int.) and 21% (con.) | - One individual session, five group sessions, two telephone sessions consisting of diabetes risk assessment, diet and physical activity advice, stress management, etc. - Control group: usual care (not specified) - Follow-up: 12 months | - Primary: fasting blood glucose, weight, and waist circumference at 12 months - Secondary: changes in lifestyle parameters, depression scores, and CVD risk factors | - A 1 kg weight difference between the groups at 12 months was the only significant finding |
- Lee et al. [26] - 2022 - Malaysia | - RCT - 2013 World Health Organization criteria | - Evaluate a system-based, postpartum intervention for women with GDM, aiming to reduce the incidence of diabetes and improve postnatal metabolic profiles | - 298 women with previous GDM - Int.: 130. Con.: 168. - Loss to follow-up: 54.2% | - One session of individualized health education during pregnancy (GW 36), booklet on diabetes prevention, five educational sessions postpartum, including one session with counseling by dietician and physiotherapist 6 weeks postpartum - Control group: standard care (group therapy on diet and physical activity during pregnancy - Follow-up: 2 years | - Primary: progression to T2DM - Secondary: changes in glucose levels, blood pressure, weight, lipid profiles | - No significant difference in primary outcome - For secondary outcomes only significant for diastolic blood pressure and triglycerides |
- Rautio et al. [29] - 2014 - Finland | - Interventional cohort study - Not explicitly defined for previous GDM | - Comparing CVD risk profile and effect of a 1-year lifestyle intervention program in at-risk women ≤ 45 years with and without previous GDM | - 265 women ≤ 45 years with high risk of T2DM (previous GDM, history of impaired fasting glucose, impaired glucose tolerance or coronary heart disease, who made a least one intervention visit - 115 previous GDM - 150 no previous GDM | - Group interventions (exercise/weight maintenance groups, lectures on diabetes and related topics) - Individual counseling on diet, physical activity, smoking, alcohol, etc. - Follow-up: 12 months | - Primary: glucose tolerance. - Secondary: other cardiovascular risk factors, such as weight/BMI, blood pressure, lipid profiles | - Women previous GDM were younger and had a better CVD risk profile at baseline than women with no GDM-history - Both groups saw improvements in certain CVD risk factors, but there were no significant differences between the 2 groups, except for LDL cholesterol (− 0.21 vs − 0.09, p = 0.014) |
- Shek et al. [30] - 2014 - China | - RCT - 1999 WHO criteria | - Assess whether lifestyle intervention can reduce risk of T2DM and metabolic syndrome in women with previous GDM | - 450 women with previous GDM and impaired glucose tolerance postpartum - Int.: 225. Con.: 225 - 6% loss to follow-up | - Individual counseling by dietician and later research nurse on dietary advice and exercise - Control: no treatment - Both groups were followed up twice at 3-monthly interval, then every 6 months - Follow-up: 36 months | - Primary: incidence of T2DM - Secondary: development of metabolic syndrome | - Not significant difference between the 2 groups for the primary outcome - No consistent, significant difference for the different parameters of metabolic syndrome |
- Tandon et al. [31] - 2022 - India, Sri Lanka and Bangladesh | - RCT - IADPSG criteria | - To examine whether a lifestyle intervention could prevent worsening glycemic status in South Asian women with recent GDM | - 1601 women with GDM within the previous 18 months - Int.: 800. Con.: 801. - 20.1% loss to follow-up | - Four 90-min group sessions with advice on diet and exercise. 2 individual sessions for overweight participants. Sessions were adapted to local context and resources - Control: standard care - Follow-up: 12 months | - Primary: deterioration of glycemic status - Secondary: blood pressure, weight, waist circumference, etc. | - No statistically significant changes between the 2 groups for neither primary nor secondary outcomes |
- Aroda et al. [32] - 2015 - USA | - RCT - Self-reported history of GDM | - Examine the effect of intensive lifestyle intervention and Metformin over 10 years on the risk of developing T2DM in women with and without a history of GDM | - 350 women with a history of GDM and 1416 parous women with no GDM history, with impaired glucose homeostasis and elevated BMI at time of enrolment - Mean time since index GDM pregnancy 12 years | - Intensive lifestyle intervention: 16-lesson core curriculum on diet, exercise and behavior modification aiming to achieve ≥ 7% weight loss and ≥ 150 min of moderate intensity physical activity per week - Later individual and group sessions to maintain any behavioral changes - Metformin group: 850 mg 1–2 times daily - Participants in placebo and metformin group received standard, non-intensive lifestyle advice - Follow-up: 10 years | - Incidence of T2DM | - In women with previous GDM, intensive lifestyle intervention reduced progression to diabetes compared to placebo by 35%. The corresponding figure for Metformin was 40% |
- Zilberman-Kravits et al. [33] - 2018 - Israel | - RCT - Not specified | - Examine the efficacy of a culturally tailored lifestyle intervention on risk profile for T2DM after GDM | - 180 women with previous GDM. - Int.: 103, con.: 77 - Jewish and Bedouin ethnicity - 39% loss to follow-up after 2 years | - Culturally tailored lifestyle intervention with three counseling sessions with a nurse, and then 2-4 group meetings with advice on physical activity, diet, etc. - Control group received information on the increased risk of subsequent GDM and overt diabetes associated with GDM but no additional counseling sessions - Follow-up: 2 years | - Primary: homeostasis model assessment insulin resistance (HOMA-IR) - Secondary: lipid profile | - Significantly reduced HOMA-IR-levels in intervention group and improved lipid profiles |
- Shyam et al. [34] - 2013 - Malaysia | - Randomized clinical trial. 2 different interventions, no control group - 2006 World Health Organization criteria | - Examining the effect of conventional dietary recommendations with and without the addition of low-GI education on glucose tolerance and body weight after GDM | - 77 women with previous GDM and one or more additional T2DM risk factors (BMI > 23, waist circumference > 80 cm, impaired glucose tolerance or impaired fasting glucose or a family history of T2DM) - 38 in conventional healthy dietary recommendations (CHDR) group - 39 in CHDR+Low-GI group - 19.4% withdrawal/drop-out | - Two diets with similar energy (max 1800 kcal/day) and macronutrient content but with different glycemic index - CHDR group received conventional dietary advice (low fat/refined sugar, high fiber, energy restriction). The CHDR+low-GI group received this advice but were additionally recommended to substitute high-GI foods with low-GI alternatives - Individual session with nutritionist at baseline, later two electronic interactions (either SMS or e-mail) per month - Participants were also recommended moderate physical activity for 30 m at least five times per week - Follow-up: 6 months | - Primary: 2 h 75 g OGTT glucose level - Secondary: fasting blood glucose, fasting serum insulin, weight/BMI, waist/hip circumference | - For the primary outcome, there was no significant reduction in 2h OGTT glucose level in the LGI group (− 0.2 mmol/l, p = 0.960), but the CHDR group saw a significant increase (0.8 mmol/l, p = 0.01), making the group difference statistically significant (p = 0.025) - For the secondary outcomes, there was a significant difference favoring LGI in BMI change and percentage of participants reaching weight goal |