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Promoting Postpartum Weight Loss in GDM


 

NEW ORLEANS — Several ongoing trials aim to address the limited success of standard interventions to reduce postpartum weight gain among women who had gestational diabetes mellitus, according to Dr. Lucinda England.

One trial at Kaiser Permanente Northern California recruits women during pregnancy and helps them in the postpartum period to reach their prepregnancy weights plus an additional 5% weight loss for those who were overweight before pregnancy. The intervention includes 3 in-person counseling sessions and 13 phone counseling sessions for up to 9 months following delivery, said Dr. England of the division of reproductive health at the Centers for Disease Control and Prevention.

In a study funded by the CDC, researchers at Brigham and Women's Hospital, Boston, are developing and evaluating a diabetes prevention program-style intervention that has been modified for postpartum women, Dr. England said at the annual scientific sessions of the American Diabetes Association.

A gestational diabetes initiative launched in New York City in 2006 uses birth certificate data from vital records to identify women with the condition. The New York City Department of Health and Mental Hygiene mails a letter to the mother outlining the risks of gestational diabetes to the mother and child, the importance of screening after delivery, and recommended lifestyle changes. Also included is a letter that the woman can take to her personal physician that contains information on screening for diabetes post partum. Other materials sent include health bulletins on weight loss, diabetes, and trans fats, as well as a guide to fitness and nutrition programs in specific neighborhoods.

“We don't yet know how to best adapt lifestyle interventions for this population,” Dr. England said.

Women with gestational diabetes face a six- to sevenfold increased risk of diabetes in the future. Previous interventions aimed at diet and physical activity appear to have only modest effects on short-term postpartum weight loss, she said. “Addressing barriers such as maternal fatigue, time constraints, and lack of child care may be critical to the success of these programs.”

The CDC estimates that 5% of pregnancies are complicated by gestational diabetes, which means about 200,000 women each year are affected. A small percentage of these women have undiagnosed preexisting diabetes; these women can be identified for early treatment through postpartum testing. The remaining women, many of whom have prediabetes, might benefit from diabetes prevention interventions, Dr. England said.

In a 2007 Cochrane review, the impact of diet, exercise, or both were compared with usual care for weight reduction in postpartum women in six trials. Diet interventions included dietary advice through group meetings, telephone calls, mail correspondence, individual dietary counseling, or prescription of a calorie-restricted diet. Exercise interventions included counseling and structured exercise programs with supervised exercise (Cochrane Database Syst. Rev. 2007;CD005627[doi:10.1002/14651858.CD005627.pub2

In a single trial of exercise alone in 33 postpartum women, no weight loss was achieved. In a single trial of diet alone in 45 postpartum women, a 1.7-kg weight loss was achieved, which reached statistical significance. In four trials of diet and exercise combined in 169 postpartum women, a 2.9-kg weight loss was achieved, which also reached statistical significance. However, Dr. England emphasized, “these trials were small.”

She said she had no conflicts of interest to disclose.

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