Lifestyle interventions for type 2 diabetes prevention in women with prior gestational diabetes: A systematic review and meta-analysis of behavioural, anthropometric and metabolic outcomes

Abstract

Purpose: To systematically review lifestyle interventions for women with prior Gestational Diabetes Mellitus (GDM) to report study characteristics, intervention design and study quality and explore changes in 1) diet, physical activity and sedentary behaviour; 2) anthropometric outcomes and; 3) glycaemic control and diabetes risk.

Methods: Databases (Web of Science, CCRCT, EMBASE and Science DIRECT) were searched (1980 to April 2014) using keywords for controlled or pre-post design trials of lifestyle intervention targeting women with previous GDM reporting at least one behavioural, anthropometric or diabetes outcome. Selected studies were narratively synthesized with anthropometric and glycaemic outcomes synthesized using meta-analysis.

Results: Three of 13 included studies were rated as low bias risk. Recruitment rates were poor but study retention good. Six of 11 studies reporting on physical activity reported favourable intervention effects. All six studies reporting on diet reported favourable intervention effects. In meta-analysis, significant weight-loss was attributable to one Chinese population study (WMD = - 1.06 kg (95% CI = - 1.68, - 0.44)). Lifestyle interventions did not change fasting blood glucose (WMD = - 0.05 mmol/L, 95% CI = - 0.21, 0.11) or type 2 diabetes risk.

Conclusions: Lack of methodologically robust trials gives limited evidence for the success of lifestyle interventions in women with prior GDM. Recruitment into trials is challenging.

Keywords: Gestational diabetes; Lifestyle; Review.

Fig. 1

Flow of search and selection process. Notes. ^aMay include duplicates of some records identified though the cited reference search had already been considered following the database search. ^bIn-pregnancy interventions were excluded if the outcomes were reported in-pregnancy only. We considered interventions that recruited/began in pregnancy if the outcomes were postpartum. ^c14 authors were contacted to check for peer-reviewed published manuscripts. Seven did not respond, four advised no published information was available, two linked us to papers already identified and one provided a new paper. ^dFour authors were contacted to request information regarding the subset of GDM women from their sample and five to request further information for completeness of data extraction. Information was not provided in six cases, resulting in four articles being excluded from the review.

Fig. 2

Meta-analysis of weight loss.

Fig. 3

Meta-analysis of fasting blood glucose change.