Table 4 Findings from the reviews
Author Year Country | Types and number of included studies | Methods/participants | Aim of review | Outcomes assessed in review | Description of interventions | Results | |
|---|---|---|---|---|---|---|---|
- Edwards et al. [39] - 2022 - UK | - 30 articles included overall in review - 6 in a postpartum setting | - Scoping review - 6 databases searched: MEDLINE, CINAHL, Embase, Cochrane Library, Scopus, and TRIP - Women with known risk of GDM, currently having GDM or having had GDM previously - For the purpose of the present review, only the section focusing on postpartum studies was considered | - Examine the literature on mHealth as primary mode of preventing T2DM after GDM | - Efficacy not assessed, merely presenting the characteristics, content and implementation of the various mHealth technologies in the different studies, and whether these incorporated behavior change theory/techniques | - mHealth interventions, e.g., smartphone apps, wearable sensors, social media. Where mHealth was part of a broader intervention, it had to be considered the primary mode of intervention to be included in the review | - For the postpartum studies, no assessment of the efficacy ameliorating cardiovascular risk was presented in the review - Good engagement noted for two apps - The authors note a lack of studies were mHealth was the primary mode of intervention postpartum | |
- Gilinsky et al. [40] - 2015 - UK | - 13 studies included in systematic review - 5 in meta-analysis for weight outcomes - 4 included in meta-analysis for fasting blood glucose outcome | - Systematic review and meta-analysis - 4 databases searched: Web of Science, CCRCT, Embase, and Science DIRECT - Women with a previous GDM diagnosis | - Systematically review lifestyle interventions for women with previous GDM and assess changes in diet, physical activity, anthropometric outcomes and glycemic control and diabetes risk | - For systematic review: changes in activity, diet, and anthropometric outcomes For meta-analysis: weight loss, glycemic control, and T2DM risk | - Physical activity: 3 - Diet: 2 - Combination of diet and physical activity: 8 | - 6 of 11 studies with a physical activity intervention reported effect - All 6 studies on diet interventions reported a favorable effect - Meta-analysis showed significant weight loss effect: Weighted mean difference= -1.06 kg (95% CI = − 1.68, − 0.44, p < 0.0.1),, but this was attributable to the effect reported in one Chinese study [51] that was excluded from this review on the grounds of being a feasibility study/interim report - Not significant results for glycemic control or T2DM risk | |
- Goveia et al. [41] - 2018 - Brazil | - 15 RCTs included in systematic review - 14 included in the various meta-analyses: 8 for T2DM, 9 for fasting glucose, 7 for 2h glucose level, 10 for BMI, 9 for weight, and 7 for waist circumference | - Systematic review and meta-analysis - 5 databases searched: PubMed, Cochrane Central Register of Controlled Trials, Web of Science, and Embase -Women with a previous GDM diagnosis | - Systematically review RCTs with lifestyle interventions in a postpartum setting for women with previous GDM | - Primary: incidence of T2DM or changes in glycemia - Secondary: changes in weight or waist circumference | - Lifestyle interventions - 10 studies tested a combination of diet and exercise - 1 study diet, exercise, and breastfeeding - 3 studies exercise alone - 1 study diet alone | - 8 studies assessing incidence of T2DM showed a borderline significant risk reduction of 25% (RR = 0.75, 95% CI 0.55–1.03). No significant effect for the other glycemic measures. Small, but statistically significant reductions for weight (MD = –1.07 kg; 1.43–0.72), BMI (MD = –0.94; –1.79 –0.09), and waist circumference (MD = − 0.98 cm; − 1.75–0.21) | |
- Guo et al. [42] - 2016 - China/USA | - 12 RCTs included in systematic review | - Systematic review. - 11 databases searched: PubMed, Embase, CINAHL, Cochrane Reviews, CENTRAL, Scopus, PsycINFO, ERIC, Wan Fang Data, China Knowledge Resource Integrated Database, and VIP Data - Women with previous GDM | - Assess outcomes of RCTs concerning diabetes prevention with previous GDM | - Incidence of T2DM, insulin resistance and weight-related outcomes | - 6 studies a combination of diet and physical activity, (with or without psychosocial support measures) - 1 diet, physical activity, and breastfeeding - 3 exercise (with or without psychosocial support) - 2 diet (with or without psychosocial support) | - 10 studies reported on T2DM development; of these, 7 studies reported at least a small, positive effect - 5 studies with at least a small effect size on insulin resistance; for weight-related measures, the corresponding figure was 11 of the 12 studies | |
- Halligan et al. [43] - 2021 - UK | - 14 RCTs in systematic review, 6 included in meta-analyses | - Systematic review and meta-analysis - Five databases searched: Embase, MEDLINE, CINAHL, PsycINFO, and The Cochrane Library - Women with previous GDM | - Comparing the effectiveness of digital/telemedicine interventions with standard care | - Primary: weight and BMI for meta-analyses - Secondary: waist circumference, fasting plasma glucose, physical activity, and diet | - 6 studies where telephone contact was primary intervention - 4 webprogram/-platform - 1 smartphone app - 3 SMS | - For both weight (− 1.83 kg, 95% CI − 4.08–0.42, p = 0.11) and BMI (− 0.9, 95% CI − 1.89–0.09, p = 0.08), the meta-analysis favored intervention, but not statistically significant - For the secondary outcomes of the systematic review, there were no clear, statistically significant patterns | |
- Hedeager Momsen et al. [44] - 2021 - Denmark | - 18 systematic reviews included | - Overview of reviews, using the principles from the Joanna Briggs Institute (JBI) methodology - Six databases searched: Cochrane Library, PubMed, JBI, Embase, CINAHL, Web of Science - Women with previous GDM | - Presenting an overview of reviews for T2DM prevention interventions in women after GDM, in order to use this information for establishing local interventions | - Incidence of T2DM, encouragement of healthy behavioral changes and consequences for the woman’s own perception of increased T2DM risk | - 7 reviews primarily lifestyle (diet and/or physical activity) interventions - 6 reviews with both lifestyle and pharmacological interventions - 6 reviews also included breastfeeding promoting interventions - 1 review examining determinants for adherence to physical activity, as well as its effectiveness - 3 reviews on screening regimes | - Lifestyle, breastfeeding and pharmacological interventions all appeared to decrease the incidence of postpartum T2DM - Effects larger the earlier after labor it was implemented, and the longer it lasted | |
- Huang et al. [45] - 2022 - USA | - 7 controlled intervention studies, of which 6 RCTs and one with a quasi-experimental design | - Systematic review - 7 databases searched: MEDLINE, CINAHL, Embase, Cochrane Central, Web of Science, PsycINFO, and ProQuest Dissertations and Theses - Women with current or previous GDM | - Investigate the characteristics and effectiveness of lifestyle interventions both in pregnancy and postpartum for preventing T2DM after GDM | - Glucose regulation, weight, lifestyle behaviors, and knowledge | - The postpartum interventions were all lifestyle interventions (diet and/or physical activity) - Varying modes of delivery of interventions: individual in-person visits, telephone, group sessions, SMS, and multimodular | - Glucose regulation: 1 study showing significant effect, 3 without effect - Weight change: 3 with effect, 3 without effect - Physical activity: 3 with effect, 4 no effect - Diet: 2 with effect, 3 no effect | |
- Jones et al. [46] - 2017 - USA | - 10 RCTs | - Systematic review - 2 databases searched: MEDLINE and CINAHL - Women with previous GDM | - Synthesize knowledge and practices regarding postpartum, multimodular lifestyle interventions to reduce risk of T2DM | - Weight loss, diet, physical activity - Recruitment rates | - Multimodal lifestyle interventions -Telephone and mail primary modes of contact in 7 studies - Website primary mode of contact in 3 studies | - Individualized interventions may improve outcomes regarding postpartum weight loss and dietary quality - Not significant for physical activity - Low recruitment rates even for primarily home-based interventions | |
- Li et al. [47] - 2021 - China | - 15 RCTs, 4 with intervention during pregnancy, 11 with intervention postpartum included in systematic review and meta-analysis | - Systematic review and meta-analysis - 17 databases searched: PubMed, Web of Science, Cochrane Library, Embase, SpringerLink, Wiley Online Library, Science Direct, MEDLINE, JAMA, CNKI, Wanfang Med Online, Lancet, Nature, Science, NEMJ, and Google Scholar - Women with GDM in index pregnancy, where data on postpartum diabetes was available | - Assess the effects of lifestyle interventions during and after pregnancy to reduce the risk of postpartum T2DM after a GDM pregnancy | - Risk of postpartum T2DM | - Lifestyle interventions (diet and/or physical activity) | - Lifestyle interventions commenced within 3 years postpartum showed a 43% risk reduction compared to standard care: RR 0.57, 95% CI 0.42–0.78) | |
- Morton et al. [48] - 2014 - UK | - 11 studies included in systematic review - 6 RCTs, 4 comparative cohort studies, one open-label observational study | - Systematic review - 5 databases searched: MEDLINE, Embase, CINAHL, Maternity and Infant Care, Cochrane Library - Women with previous GDM | - Examine the effectiveness of interventions for delaying or preventing T2DM after a GDM pregnancy | - Effect on T2DM risk factors and incidence of T2DM | - 6 studies (3 RCTs and 3 observational cohort studies): lifestyle interventions (diet and/or physical activity) - 4 studies (3 RCTs and 1 observational study): pharmacological (1 RCT where it was combined with lifestyle intervention) - 2 breastfeeding | - Trials involving lifestyle interventions indicated that they might be beneficial, but there was no consistent, statistically significant effect across the trials | |
- Pedersen et al. [50] - 2017 - Denmark | - 10 RCTs included in systematic review - 4 trials in meta-analysis | - Systematic review and meta-analysis - Four databases searched: PubMed, Cochrane Library, Embase, CINAHL - Women with previous GDM | - Examine the effectiveness of behavioral interventions on preventing T2DM after GDM | - 5 incidence of T2DM - 6 effect on biomarkers of insulin resistance - 9 trials weight change - The 4 trials included in meta-analysis had T2DM incidence as outcome | - 8 studies combination of diet and physical activity - 1 physical activity only - 1 diet only | - All the trials included in meta-analysis showed a tendency for reduction of incidence of T2DM, but not statistically significant. The pooled analysis showed a statistically significant risk difference in intervention group vs control of − 5.02 per 100 (95% CI: − 9.24 to − 0.80) - Four trials showed a statistically significant effect on weight/BMI, five trials no significant effect - The outcomes concerning markers of insulin resistance were inconsistent | |
- Peacock et al. [49] - 2014 - Australia | - 30 studies included in systematic review | - Systematic review - Three databases searched: PubMed, CINAHL, and MEDLINE | - Examine strategies and programs aimed at reducing risk of T2DM after GDM and the barriers to participation as well as the role of midwives in such programs | - Incidence of T2DM, dietary behavior change, weight loss, physical activity | - Mainly lifestyle interventions (diet, activity, etc.). 1 with a pedometer and web-based educational module. 3 of the RCTs and 1 observational also included pharmacological intervention, of which one RCT and one observational looking exclusively at the effect of a pharmacological intervention | - 5 of the 8 RCTs and 3 of 5 observational studies reported positive results for the intervention concerning T2DM incidence or related risk factors | |