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Internet program reported to benefit women with gestational diabetes

The study authors note that retention of excess weight after delivery is a major risk factor for long-term obesity
The study authors note that retention of excess weight after delivery is a major risk factor for long-term obesity
Robin Wulffson, MD

Gestational diabetes is a not uncommon problem encountered by pregnant women. It is associated with increased risks of complications for the mother and developing infant. Many women with gestational diabetes have a weight problem after delivery and face an increased risk of developing type 2 diabetes. A new study has found that an Internet program can be beneficial for these women. The findings were published in the September edition of the journal Obstetrics & Gynecology. The study was led by researchers at Brigham and Women’s Hospital in Boston Massachusetts.

The study authors note that retention of excess weight after delivery is a major risk factor for long-term obesity. Previous studies have reported an association between postpartum weight retention at 6 months and 1 year postpartum with future overweight and obesity. They explain that women with prior gestational diabetes have a seven-fold increased risk of developing type 2 diabetes within 10 years postpartum; thus, they are extremely vulnerable to the effects of postpartum weight retention. Recommendations for women with a history of gestational diabetes include weight loss if overweight or obese; however, women with prior gestational diabetes are no more likely to engage in healthy lifestyle behaviors or return to pre-pregnancy weight than women without a history of the disease.

The National Institutes of Health has developed the Diabetes Prevention Program, which demonstrated that an intensive, face-to-face lifestyle intervention could achieve weight loss and reduce incidence of type 2 diabetes in middle-aged adults at high risk, including women with a remote GDM history; however, face-to-face lifestyle intervention studies in postpartum women have had limited success. The authors noted that they and others have reported on barriers to lifestyle modification in women with gestational diabetes, including lack of time and energy, competing work and family demands, and lack of child care. Thus, they were of the opinion that Web-based technology could be a more effective method to help these women. Therefore, they adapted the Diabetes Prevention Program into a Web-based lifestyle intervention modified for postpartum women. They conducted a randomized trial of the Web-based lifestyle intervention program, Balance after Baby, to decrease postpartum weight retention in women with recent gestational diabetes.

The investigators randomly assigned 75 women with recent gestational diabetes to either the Balance after Baby program delivered over the first postpartum year or to a control group. Primary outcome measurements were change in body weight at 12 months from (1) first postpartum measured weight; and (2) self-reported pre-pregnancy weight.

The researchers found that there were no significant differences in baseline characteristics between groups including age, body mass index, race, and income status. Women assigned to the Balance after Baby program (36 women; three lost to follow-up) lost an average of 2.8 kg (6.2 lbs) from 6 weeks to 12 months postpartum; in contrast, the control group (39 women; one lost to follow-up) gained an average of 0.5 kg (1.1 lb). Women in the intervention were closer to pre-pregnancy weight at 12 months postpartum (average change −0.7 kg (1.5 lb) compared to women in the control group.

The authors concluded that a Web-based lifestyle modification program for women with recent gestational diabetes decreased postpartum weight retention.

Take home message

This small study reports that an Internet program based on a face-to-face intervention can benefit women with gestational diabetes. Many women do not have the time or energy to travel to a face-to-face interview after they deliver. Apparently, this Internet intervention is currently not available to the general public. Hopefully, it will appear in the near future.

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