Identifying postpartum intervention approaches to prevent type 2 diabetes in women with a history of gestational diabetes

Division for Research and Education in Complementary and Integrative Medical Therapies, Harvard Medical School, Boston, MA, USA.
BMC Pregnancy and Childbirth (Impact Factor: 2.19). 03/2011; 11(1):23. DOI: 10.1186/1471-2393-11-23
Source: PubMed


Women who develop gestational diabetes mellitus (GDM) have an increased risk for the development of type 2 diabetes. Despite this "window of opportunity," few intervention studies have targeted postpartum women with a history of GDM. We sought perspectives of women with a history of GDM to identify a) barriers and facilitators to healthy lifestyle changes postpartum, and b) specific intervention approaches that would facilitate participation in a postpartum lifestyle intervention program.
We used mixed methods to gather data from women with a prior history of GDM, including focus groups and informant interviews. Analysis of focus groups relied on grounded theory and used open-coding to categorize data by themes, while frequency distributions were used for the informant interviews.
Of 38 women eligible to participate in focus groups, only ten women were able to accommodate their schedules to attend a focus group and 15 completed informant interviews by phone. We analyzed data from 25 women (mean age 35, mean pre-pregnancy BMI 28, 52% Caucasian, 20% African American, 12% Asian, 8% American Indian, 8% refused to specify). Themes from the focus groups included concern about developing type 2 diabetes, barriers to changing diet, and barriers to increasing physical activity. In one focus group, women expressed frustration about feeling judged by their physicians during their GDM pregnancy. Cited barriers to lifestyle change were identified from both methods, and included time and financial constraints, childcare duties, lack of motivation, fatigue, and obstacles at work. Informants suggested facilitators for lifestyle change, including nutrition education, accountability, exercise partners/groups, access to gyms with childcare, and home exercise equipment. All focus group and informant interview participants reported access to the internet, and the majority expressed interest in an intervention program delivered primarily via the internet that would include the opportunity to work with a lifestyle coach.
Time constraints were a major barrier. Our findings suggest that an internet-based lifestyle intervention program should be tested as a novel approach to prevent type 2 diabetes in postpartum women with a history of GDM.

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Available from: Jacinda Nicklas, Feb 19, 2015
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    • "Lack of time and/or energy was a common barrier mentioned in all studies [29,62,64,70-73] and so was lack of child care support [62,70-73]. Other barriers identified in the studies included not feeling well and/or emotional distress [72,73]: lack of motivation [70,71]; financial barriers [70,71]; other domestic responsibilities such as cooking [72]; lack of knowledge [62,64]: lack of understanding about GDM [62]; lack of social support [64,70-72] lack of health care provider support [62]; feeling of solitude, dullness and isolation from family and friends [62,70]; poor body image [70]; bad weather [70]; considering oneself to be too young to be on a restricted diet [29]; obstacles at work [71]; unsuitable local neighbourhood or no access to exercise equipment [64,71]; cultural expectations e.g. needs of women come last in the family [70,72]; and lack of enjoyment of physical activity [64]. "
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    ABSTRACT: Gestational diabetes mellitus (GDM) - a transitory form of diabetes first recognised during pregnancy complicates between < 1% and 28% of all pregnancies. GDM has important short and long-term health consequences for both the mother and her offspring. To prevent adverse pregnancy outcomes and to prevent or delay, future onset of type 2 diabetes in mother and offspring, timely detection, optimum treatment, and preventive postpartum care and follow-up is necessary. However the area remains grossly under prioritised. To investigate determinants and barriers to GDM care from initial screening and diagnosis, to prenatal treatment and postpartum follow-up, a PubMed database search to identify quantitative and qualitative studies on the subject was done in September 2012. Fifty-eight relevant studies were reviewed. Adherence to prevailing GDM screening guidelines and compliance to screening tests seems sub-optimal at best and arbitrary at worst, with no clear or consistent correlation to health provider, health system or client characteristics. Studies indicate that most women express commitment and motivation for behaviour change to protect the health of their unborn baby, but compliance to recommended treatment and advice is fraught with challenges, and precious little is known about health system or societal factors that hinder compliance and what can be done to improve it. A number of barriers related to health care provider/system and client characteristics have been identified by qualitative studies. Immediately following a GDM pregnancy many women, when properly informed desire and intend to maintain healthy lifestyles to prevent future diabetes, but find the effort challenging. Adherence to recommended postpartum screening and continued lifestyle modifications seems even lower. Here too, health care provider, health system and client related determinants and barriers were identified. Studies reveal that sense of self-efficacy and social support are key determinants. The paper identifies and discusses determinants and barriers for GDM care, fully recognising that these are highly dependent on the context.
    Full-text · Article · Jan 2014 · BMC Pregnancy and Childbirth
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    • "Results of these focus groups share common features as well as differences with the focus group and informant interview study we performed in women with a history of gestational diabetes mellitus (GDM) where women were recruited via fliers and through doctors’ offices [7]. Similar motivators included the potential for healthy changes to impact the entire family and the postpartum period as a “window of opportunity” for lifestyle change. "
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    • "The author further claimed that if women have support for exercise from family and friends, both in the form of verbal encouragement and companionship during exercise, they will more likely initiate and maintain a regular exercise program. This assertion has also been withheld recently by Nicklas et al. [20] who reported that finding an exercise buddy or a group (including group exercise classes) facilitated exercise participation among postpartum women. Gyms and community groups could facilitate physical activity for mothers of newborns by scheduling classes or group activities for the women together [4, 20]. "
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