Diabetes prevention in women with previous gestational diabetes

Abstract

Gestational diabetes mellitus is a risk factor for future diabetes, a condition largely preventable by healthy eating, increased physical activity and weight management. Postpartum women with young children face many barriers to adopting healthy lifestyle programs including time constraints, multiple commitments, tiredness and resuming work. Clearly, to prevent diabetes occurring health professionals need to understand how to help post-partum women adopt healthy lifestyles. Behaviour change occurs in five stages and matching healthy lifestyle information to stage of change can promote readiness to change. The aim of the current study was to identify whether a stage-matched intervention could promote diabetes risk reduction behaviours in a cohort of women with previous GDM in the Goulburn Murray catchment area. A total of 210 eligible women, identified from medical records as GDM in the past five years were invited to participate in a healthy lifestyle program incorporating stage-matched information reinforced with telephone contact or to receive routine information only.

Data were collected via a mailed health behaviour questionnaire incorporating validated tools; the Active Australia Survey, Stage of Change tool and Fat and Fibre questionnaire at baseline and post-intervention. At follow-up women answered a series of open-ended questions describing the promoters of and the barriers to behaviour change. Results were coded and analysed using Statistical Package for the Social Sciences (Version 14). Seventy-seven women (mean age 35 years) agreed to participate and were randomly assigned to a treatment or control group. Eighty-eight percent completed the six-month assessment. The attrition rate was similar in both groups. There was a positive trend towards increased readiness to be active (progression of one or more stages, p< 0.05) in the intervention group compared to standard information only. There was no difference between groups in progression of stage readiness to reduce fat intake or lose weight. Both groups increased the total amount of activity undertaken by approximately 60 minutes per week and the proportion of women meeting activity guidelines increased to a similar extent in each group. There was minimal difference between the groups for weight loss or reducing fat intake. The women stressed the importance of having a goal, especially a health goal, and strong social support as important promoters of health behaviour change. In contrast, low mood, emotional eating, tiredness, lack of time and support reduced the likelihood that behaviour change would occur.

Conclusion: It is possible to implement and meaningfully evaluate an intervention incorporating stage-matched information and regular telephone reminder calls for women with a history of GDM. Despite the small sample size, this intervention can increase readiness to be more active compared to routine health promotion information. However, the intervention was unable to produce any difference between the groups in engagement in any of the diabetes risk reduction behaviours measured. Further research is needed to explore these findings in a larger population, such as with a multi-centre study. The intervention should be enhanced with strategies to address social support, post-natal depression, self-efficacy for behaviour change, mood and emotional eating.