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Bélanger M, Dugas C, Perron J, St-Yves A, Rancourt-Bouchard M, John Weisnagel S, Robitaille J. Intention to adopt a healthy diet among women with and without a history of gestational diabetes: Constructs and beliefs from the theory of planned behavior. Prev Med Rep 2023; 35:102328. [PMID: 37559949 PMCID: PMC10407815 DOI: 10.1016/j.pmedr.2023.102328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/26/2023] [Accepted: 07/12/2023] [Indexed: 08/11/2023] Open
Abstract
Women with a history of gestational diabetes (GDM) have difficulty maintaining a healthy diet after delivery. The theory of planned behavior (TPB) is effective in identifying the determinants of adopting a healthy diet. The objectives were to identify the determinants of the intention to adopt a healthy diet among the TPB constructs in women with (GDM+) and without (GDM-) a history of GDM, and to identify the beliefs associated with these constructs. The study was conducted in Québec (Canada) between 2009 and 2017. Data from 213 GDM+ and 91 GDM- women were analyzed. Women completed a questionnaire on the determinants of intention to adopt a healthy diet, defined as adherence to 2007 Canada's Food Guide. The subjective norm and perceived behavioral control (PBC) constructs were associated with the intention to adopt a healthy diet among GDM+ women (β = 2.21 and β = 4.37, respectively, p < 0.0001), whereas among GDM- women, PBC was the only construct associated with intention (β = 0.78; p < 0.0001). More specifically among GDM+ women, the disapproval of a family member other than the partner (β = 1.49; p = 0.0005), not feeling capable of adopting a healthy diet with access to food treats (β = 1.58; p < 0.0001), lack of free time (β = 1.31; p = 0.002), lack of information about healthy eating (β = 1.02; p = 0.015) or lack of easy recipes to prepare (β = 0.84; p = 0.042) was associated with a lower intention to adopt a healthy diet. Overall, among GDM+ women, different beliefs related to the subjective norm and PBC could be targeted to improve the eating habits of this specific population.
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Affiliation(s)
- Mélissa Bélanger
- School of Nutrition, Université Laval, 2425 rue de l’Agriculture, Québec, Québec G1V 0A6, Canada
- Centre Nutrition, santé et société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, 2440 Boulevard Hochelaga, Québec, Québec G1V 0A6, Canada
- Endocrinology and Nephrology Axis, CHU de Quebec Research Center, 2705 Boulevard Laurier, Québec, Québec G1V 4G2, Canada
| | - Camille Dugas
- School of Nutrition, Université Laval, 2425 rue de l’Agriculture, Québec, Québec G1V 0A6, Canada
- Centre Nutrition, santé et société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, 2440 Boulevard Hochelaga, Québec, Québec G1V 0A6, Canada
- Endocrinology and Nephrology Axis, CHU de Quebec Research Center, 2705 Boulevard Laurier, Québec, Québec G1V 4G2, Canada
| | - Julie Perron
- Centre Nutrition, santé et société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, 2440 Boulevard Hochelaga, Québec, Québec G1V 0A6, Canada
| | - Annie St-Yves
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, Québec J1H 5N4, Canada
| | - Maryka Rancourt-Bouchard
- Centre Nutrition, santé et société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, 2440 Boulevard Hochelaga, Québec, Québec G1V 0A6, Canada
| | - S. John Weisnagel
- Endocrinology and Nephrology Axis, CHU de Quebec Research Center, 2705 Boulevard Laurier, Québec, Québec G1V 4G2, Canada
- Diabetes Research Unit, Laval University Medical Research Center, 2705 boulevard Laurier, Québec, Québec G1V 4G2, Canada
| | - Julie Robitaille
- School of Nutrition, Université Laval, 2425 rue de l’Agriculture, Québec, Québec G1V 0A6, Canada
- Centre Nutrition, santé et société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, 2440 Boulevard Hochelaga, Québec, Québec G1V 0A6, Canada
- Endocrinology and Nephrology Axis, CHU de Quebec Research Center, 2705 Boulevard Laurier, Québec, Québec G1V 4G2, Canada
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Lake AJ, Neven ACH, Williams A, O'Reilly SL, Hendrieckx C, Morrison M, Dunbar J, Teede H, Boyle JA, Speight J. Barriers to and enablers of type 2 diabetes screening among women with prior gestational diabetes: A systematic review update and qualitative synthesis applying the Theoretical Domains Framework. Diabet Med 2022; 39:e14772. [PMID: 34953147 DOI: 10.1111/dme.14772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/20/2021] [Indexed: 11/28/2022]
Abstract
AIMS Women with prior gestational diabetes have nearly 10 times the risk of developing type 2 diabetes. Postpartum screening for type 2 diabetes is recommended for early diagnosis and management, yet uptake is low. This work updates a previous systematic review and advances it through the application of the Theoretical Domains Framework (TDF) to synthesise personal-level factors impacting type 2 diabetes screening and the Capability, Opportunity, Motivation-Behaviour model (COM-B), to develop messaging recommendations for use in clinical practice and screening promotion interventions. METHODS We searched seven academic databases from September 2017 (prior review) to April 2021, reference lists and grey literature. Two reviewers independently screened articles against inclusion criteria (qualitative studies exploring factors impacting postpartum diabetes screening, any language) and extracted data. Using an inductive-deductive model, we coded determinants to the TDF and mapped onto the COM-B model. RESULTS We identified 38 eligible papers from 34 studies (N = 1291 participants). Most (71%) reported sample sizes of N ≥ 16. The ratio of barriers to enablers was three to one. Eight key TDF domains were identified. Evidence-based recommendations include addressing knowledge, risk perception, fear of diabetes diagnosis, low prioritisation of personal health and fatalism. The risk of bias was low and confidence in findings was moderate to high. A limitation was conceptual overlap between TDF domains, which we addressed via the study procedure. CONCLUSIONS The theoretical categorisation of determinants enables the development of messaging and interventions at the personal level, to promote women's uptake of postpartum type 2 diabetes screening.
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Affiliation(s)
- Amelia J Lake
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Adriana C H Neven
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Amelia Williams
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Sharleen L O'Reilly
- Centre for Physical Activity and Nutrition Research, Deakin University, Burwood, Victoria, Australia
- UCD Institute of Food and Health, School of Agriculture and Food Science, University College, Dublin, Ireland
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Melinda Morrison
- Diabetes Australia, Canberra, Australian Capital Territory, Australia
| | - James Dunbar
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
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Guo J, Long Q, Yang J, Lin Q, Wiley J, Chen JL. The Efficacy of an Intensive Lifestyle Modification Program on Psychosocial Outcomes among Rural Women with Prior Gestational Diabetes Mellitus: Six Months Follow-Up of a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041519. [PMID: 33562679 PMCID: PMC7915428 DOI: 10.3390/ijerph18041519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 11/25/2022]
Abstract
Women with prior gestational diabetes mellitus (GDM) are at a higher risk of type 2 diabetes and other health issues after delivery. They may have a lower quality of life (QoL), experience more medical-related stress, and need more support than those without it. This study aimed to examine the six-month efficacy of an intensive lifestyle modification program on perceived stress, social support, and QoL among women with prior GDM in rural China. A total of 320 women with prior GDM were randomly assigned to an intervention group (n = 160) and a control group (n = 160). Participants in the intervention group received an intensive lifestyle modification (ILSM) program, including a series of six biweekly face-to-face sessions and five biweekly phone sessions delivered by trained local health workers. The control group received the usual care. Data about perceived stress, social support, QoL, and HbA1c were collected at baseline, at three months, and at six-month follow-ups. Generalized estimating equation analysis was used to assess the efficacy of the intervention. There were significant improvements in the psychological domain (β = 0.479 ± 0.153, p = 0.002) and environmental domain (β = 0.462 ± 0.145, p = 0.001) of QoL over six months; there were significant group effects (β = −0.718 ± 0.280, p = 0.010) and time effects (β = 0.453 ± 0.211, p = 0.032) in physiological domain, and there were significant group effects in the social relations domain (β = −0.669 ± 0.321, p = 0.037). The ILSM group had a more pronounced downward trend in HbA1c than the control group (β = −0.050 ± 0.026, p = 0.059). The ILSM program can help women with GDM improve their psychological and environmental domain of QoL. It can be recommended as a form of health promotion for improving QoL among women with prior GDM in rural primary care settings in developing countries.
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Affiliation(s)
- Jia Guo
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (Q.L.); (J.Y.)
- Correspondence: ; Tel.: +86-138-7594-7418
| | - Qing Long
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (Q.L.); (J.Y.)
| | - Jundi Yang
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (Q.L.); (J.Y.)
| | - Qian Lin
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, Changsha 410078, China;
| | - James Wiley
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA 94143, USA;
| | - Jyu-Lin Chen
- School of Nursing, University of California, San Francisco, CA 94143, USA;
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Nicklas JM, Zera CA, Seely EW. Predictors of very early postpartum weight loss in women with recent gestational diabetes mellitus. J Matern Fetal Neonatal Med 2020; 33:120-126. [PMID: 30032681 PMCID: PMC6491245 DOI: 10.1080/14767058.2018.1487937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 06/08/2018] [Accepted: 06/08/2018] [Indexed: 01/09/2023]
Abstract
Objective: Women with gestational diabetes (GDM) have a 7-12-fold increased risk for developing type 2 diabetes later in life. Postpartum weight retention is highly predictive for future obesity, and further increases risk for type 2 diabetes. We sought to identify predictors of losing at least 75% of gestational weight gain by very early postpartum in women with recent GDM.Methods: We recruited women with GDM during pregnancy or just after delivery. Prepregnancy weight was self-reported at recruitment; gestational weight gain, mode of delivery, and insulin use were extracted from medical records. At a mean of 7.2 (±2.1) weeks postpartum we measured weight and height and administered questionnaires, including demographics, breastfeeding, Edinburgh Postnatal Depression Scale, sleep, Harvard Food Frequency, and the International Physical Activity Questionnaire. We modeled the odds of 75% loss of gestational weight gain at the study visit using multivariable logistic regression models and selected the model with the lowest Akaike information criterion (AIC) as our final model. Analyses were conducted using JMP 10-13 Pro (SAS Institute Inc.)Results: Seventy-five women with recent GDM were included in the study. The mean age of study participants was 33 (SD ±5) years old, of whom 57% were white, 30% were African American, and 20% of the women identified as Hispanic. The mean prepregnancy BMI was 31.4 kg/m2 (SD ±5.6) and the mean pregnancy weight gain was 12.5 kg (SD ±7.8). Fifty-two percent of participants lost at least 75% of their pregnancy weight gain by the early postpartum study visit. Thirty-seven women (49%) exceeded Institute of Medicine (IOM) guidelines for gestational weight gain. In a multivariate model adjusting for weeks postpartum at the time of the study visit, less gestational weight gain (OR 0.56; 95% CI 0.39-0.73), increased age (OR 1.48; 95% CI 1.13-2.20), and lack of insulin use during pregnancy (OR 0.08 for use of insulin; 95% CI 0.00-0.73) were associated with at least 75% postpartum weight loss. Prepregnancy BMI and sleep were not retained in the model. Race/ethnicity, education, breastfeeding, nulliparity, cesarean section, depressive symptoms, dietary composition, glycemic index, and physical activity did not meet criteria for inclusion in the model.Conclusions: A substantial proportion of women with recent GDM lost at least 75% of their gestational weight gain by early postpartum. Older women, those who did not use insulin during pregnancy and those who gained less weight during pregnancy were significantly more likely to have lost 75% of gestational weight by very early postpartum.
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Affiliation(s)
- Jacinda M. Nicklas
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital; Boston, MA
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Chloe A. Zera
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital
| | - Ellen W. Seely
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital; Boston, MA
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Ilo I, Ojukwu C, Okeke C, Okemuo A, Anekwu E, Ede S, Akinola T. Is mode of delivery a determinant of postpartum health-related quality of life in Nigerian Women? NIGERIAN JOURNAL OF MEDICINE 2020. [DOI: 10.4103/njm.njm_119_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Dennison RA, Ward RJ, Griffin SJ, Usher‐Smith JA. Women's views on lifestyle changes to reduce the risk of developing Type 2 diabetes after gestational diabetes: a systematic review, qualitative synthesis and recommendations for practice. Diabet Med 2019; 36:702-717. [PMID: 30723968 PMCID: PMC6563496 DOI: 10.1111/dme.13926] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2019] [Indexed: 12/16/2022]
Abstract
AIMS After gestational diabetes, many women exhibit behaviours that increase their risk of developing Type 2 diabetes. We aimed to systematically synthesize the literature that focuses on the views of women with a history of gestational diabetes on reducing their risk of developing diabetes postpartum through lifestyle and behaviour changes. METHODS We identified qualitative studies that examined the views of women with a history of gestational diabetes towards healthy eating and physical activity, Type 2 diabetes risk management or their experience of a diabetes prevention programme, and conducted a thematic synthesis to develop descriptive and then analytical themes. We also evaluated the quality of each study and the confidence that we had in our findings. RESULTS We included 21 articles after screening 23 160 citations and 129 full texts. We identified six themes of interacting influences on postpartum behaviour: role as mother and priorities; social support; demands of life; personal preferences and experiences; risk perception and information; and finances and resources (plus preferred format of interventions). These factors inhibited many women from addressing their own health, while they motivated others to persevere. We also developed 20 recommendations, most with high or moderate confidence, for effective promotion of healthy lifestyles in this population. CONCLUSIONS Many factors hinder healthy lifestyles after gestational diabetes, yet how women interpret them can motivate or prevent changes that reduce diabetes risk. As our recommendations emphasize, women's experiences and needs should be considered when designing strategies to promote healthier lifestyles in this population.
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Affiliation(s)
- R. A. Dennison
- Primary Care UnitDepartment of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - R. J. Ward
- Primary Care UnitDepartment of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - S. J. Griffin
- Primary Care UnitDepartment of Public Health and Primary CareUniversity of CambridgeCambridgeUK
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - J. A. Usher‐Smith
- Primary Care UnitDepartment of Public Health and Primary CareUniversity of CambridgeCambridgeUK
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Kilgour C, Bogossian F, Callaway L, Gallois C. Experiences of women, hospital clinicians and general practitioners with gestational diabetes mellitus postnatal follow-up: A mixed methods approach. Diabetes Res Clin Pract 2019; 148:32-42. [PMID: 30579804 DOI: 10.1016/j.diabres.2018.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/09/2018] [Accepted: 12/12/2018] [Indexed: 12/17/2022]
Abstract
PROBLEM Postnatal screening rates to detect type two diabetes following gestational diabetes are low. The quality of communication is an important element to consider in developing targeted strategies that support women in completing recommended follow-up care. AIMS To explore the communication perspectives, practices and preferences of women, hospital clinicians and general practitioners, to determine strategies that may promote completion of recommended postnatal GDM follow-up, in Queensland Australia. METHOD We used an exploratory, three-phase, mixed-methods approach, interpreted through intergroup communication theory. Phase one: convergent interviews explored perspectives of the communication experience in GDM care among new mothers (n = 13), hospital clinicians (n = 13) and general practitioners (n = 16). Phase two: a retrospective chart audit assessed current practice in postnatal discharge summaries of women (n = 86). Phase three: an online survey identified the preferences of general practitioners and hospital clinicians who provide maternity care in Queensland. Triangulation of the findings from the interviews, audit and surveys was used to clarify results and increase the robustness of the findings. RESULTS Three themes: Seeking information, Written hospital discharge summary (discharge summary) and Clarity of follow-up requirements, provide direction for pragmatic strategies to promote follow-up. Practical recommendations include continued discussion about care with women from the point of GDM diagnosis into the postnatal period; discharge summaries that give primacy to diagnosis and ongoing treatment; and provision of explicit directions for recommended testing and timing. IMPLICATIONS This research informs seven practical recommendations to help promote completion of recommended postnatal GDM follow-up.
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Affiliation(s)
- Catherine Kilgour
- The University of Queensland, Level 3, Chamberlain (Building 35), St Lucia 4072, Australia.
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8
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Sundarapperuma TD, Wijesinghe CJ, Hettiarachchi P, Wasalathanthri S. Perceptions on Diet and Dietary Modifications during Postpartum Period Aiming at Attenuating Progression of GDM to DM: A Qualitative Study of Mothers and Health Care Workers. J Diabetes Res 2018; 2018:6459364. [PMID: 30225269 PMCID: PMC6129353 DOI: 10.1155/2018/6459364] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/14/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a global concern. GDM mothers have a 7-fold relative risk of developing type 2 diabetes mellitus (T2DM) in their later life. User-friendly and culturally acceptable dietary interventions can minimize this risk. Therefore, this study aims at exploring the perceptions of GDM mothers and health care workers regarding factors that influence postpartum dietary practices aimed at attenuating the trajectory from GDM to DM. METHODS The study was conducted in selected MOH areas in three districts of Sri Lanka. Six focus group discussions were conducted with thirty mothers with a history of GDM and six in-depth interviews with six health care workers. The phenomenon of interest was to obtain inputs of two stakeholder groups on healthy food habits of GDM mothers during the postpartum period. Framework analysis was used to analyse the data. Data were coded using the analytical framework, abstracted from transcripts, and summarized verbatim in Microsoft Excel in a matrix comprised of one row per participant and one column per code. Finally, the matrix was reviewed intensely and themes were generated. RESULTS Overall, seven themes emerged from both cases: (1) myths and traditions specific to the postpartum period, (2) lack of motivation, (3) time pressure, (4) financial barriers, (5) negligence of mothers and families, (6) lack of awareness regarding GDM and its postpartum dietary recommendations, and (7) cultural barriers. CONCLUSIONS This study provides an insight into the existing knowledge, common practices, and attitudes regarding food habits among postpartum mothers with a history of GDM. Since the postpartum period is unique, identifying barriers is crucial when introducing dietary modification protocols in order to prevent or attenuate the progression of GDM to T2DM in these mothers. The knowledge gained will be used to introduce feasible, scientifically sound, and culturally acceptable postpartum dietary recommendations for GDM mothers.
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MESH Headings
- Adult
- Attitude of Health Personnel
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/physiopathology
- Diabetes Mellitus, Type 2/prevention & control
- Diabetes Mellitus, Type 2/psychology
- Diabetes, Gestational/diagnosis
- Diabetes, Gestational/diet therapy
- Diabetes, Gestational/physiopathology
- Diabetes, Gestational/psychology
- Diet, Healthy
- Disease Progression
- Female
- Health Behavior
- Health Knowledge, Attitudes, Practice
- Health Personnel/psychology
- Humans
- Maternal Nutritional Physiological Phenomena
- Mothers/psychology
- Nutritional Status
- Postpartum Period
- Pregnancy
- Protective Factors
- Qualitative Research
- Risk Factors
- Risk Reduction Behavior
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Johnson ST, Mladenovic AB, Mathe N, Davenport MH, Butalia S, Qiu W, Johnson JA. Healthy eating and active living after gestational diabetes mellitus (HEALD-GDM): Rationale, design, and proposed evaluation of a randomized controlled trial. Contemp Clin Trials 2017; 61:23-28. [PMID: 28700892 DOI: 10.1016/j.cct.2017.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 05/05/2017] [Accepted: 07/06/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a common complication in pregnancy and a significant risk factor for type 2 diabetes (T2D). Most women who have had GDM are not engaging in health behaviours known to reduce their risk for developing future T2D. The objective of this study is to evaluate the effectiveness of a lifestyle modification program targeting healthy eating and active living behaviours after a GDM pregnancy. METHOD This trial will randomize 100 women to either a lifestyle modification program or a control condition. Those allocated to the Healthy Eating and Active Living for Diabetes and Gestational Diabetes Mellitus (HEALD-GDM), program will receive a previously developed and tested 24-week program led by an Exercise Specialist at a local recreational facility. The original HEALD program will be tailored for women with GDM through the provision of complementary childcare at HEALD-GDM sessions and theory-guided peer-led telephone support. Our primary outcome is the 6-month change in objectively derived average daily moderate and vigorous physical activity. DISCUSSION Programs to increase physical activity in women with GDM should carefully consider and find ways to address known barriers specific to this population. We believe that our modified program may be successfully translated to women who have had GDM. CLINICAL TRIALS REGISTRATION NCT02483949.
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Affiliation(s)
- Steven T Johnson
- Centre for Nursing and Health Studies, Athabasca University, Athabasca, Alberta, Canada.
| | - Ana B Mladenovic
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
| | - Nonsikelelo Mathe
- Centre for Nursing and Health Studies, Athabasca University, Athabasca, Alberta, Canada.
| | - Margie H Davenport
- Faculty of Physical Education and Recreation, Alberta Diabetes Institute, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada.
| | - Sonia Butalia
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Weiyu Qiu
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
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Zulfiqar T, Lithander FE, Banwell C, Young R, Boisseau L, Ingle M, Nolan CJ. Barriers to a healthy lifestyle post gestational-diabetes: An Australian qualitative study. Women Birth 2017; 30:319-324. [PMID: 28169159 DOI: 10.1016/j.wombi.2016.12.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/25/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Overseas-born-women from certain ethnicities are at high risk of type-2 diabetes and related metabolic disorders. This study explored the barriers and facilitators to long-term healthy lifestyle recommendations among Australian-born and overseas-born-women who attended health promotion sessions at a tertiary Australian Hospital for gestational diabetes 3-4 years previously. METHOD Face-to-face semi-structured interviews were conducted. Data were analyzed to identify major themes and the differing experiences of both groups of women. FINDINGS Women in both groups faced many barriers to improve post-gestational-diabetes lifestyle. Women from both groups recalled healthy lifestyle recommendations for during pregnancy they received at the service, but had difficulty recalling the long-term lifestyle recommendations. Timing of the health information, non-reiteration of lifestyle recommendations, uncoordinated and fragmented health system support after childbirth were barriers faced by all women. Additional barriers for overseas-born women included the cultural competence of the health education material, their cultural preferences for food and physical activities and unsupportive family and partner. Both groups had excellent compliance with the first annual postnatal oral-glucose-tolerance-test. This was attributed to the personal motivation and health professional reminder. Women only reverted to the healthy lifestyles postnatally for weight loss. CONCLUSION A better understanding of the barriers to healthy lifestyle by women in their everyday lives will assist in the development of culturally appropriate health promotion guidelines and strategies. Constant un-fragmented postnatal engagement by the specialised diabetes clinics and primary health care services is crucial to sustain the healthy lifestyle in the long-term for women with previous gestational-diabetes.
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Affiliation(s)
- Tehzeeb Zulfiqar
- National Centre of Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia; ANU College of Medicine, Biology and Environment, Australian National University, Canberra, ACT, Australia.
| | - Fiona E Lithander
- NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, UK.
| | - Cathy Banwell
- National Centre of Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia.
| | - Rosemary Young
- ACT Health Diabetes Service, Canberra Hospital and Health Services, Canberra, ACT, Australia.
| | - Lynelle Boisseau
- ACT Health Diabetes Service, Canberra Hospital and Health Services, Canberra, ACT, Australia.
| | - Martha Ingle
- ACT Health Diabetes Service, Canberra Hospital and Health Services, Canberra, ACT, Australia.
| | - Christopher J Nolan
- ANU College of Medicine, Biology and Environment, Australian National University, Canberra, ACT, Australia; ACT Health Diabetes Service, Canberra Hospital and Health Services, Canberra, ACT, Australia.
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Postpartum glucose follow-up and lifestyle management after gestational diabetes mellitus: general practitioner and patient perspectives. J Diabetes Metab Disord 2016; 15:56. [PMID: 27981042 PMCID: PMC5142132 DOI: 10.1186/s40200-016-0282-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 11/29/2016] [Indexed: 12/25/2022]
Abstract
Background Incidence of type 2 diabetes is high after gestational diabetes mellitus (GDM). We aimed to evaluate the adherence to follow-up six-weeks postpartum visits in secondary care after GDM and glucose monitoring in primary care longer than 12–14 months after delivery and the years thereafter. In addition, we examined the women’s lifestyle after delivery. Methods A cross-sectional follow-up survey among women with a history of GDM and their general practitioners (GP). Rates of attendance at the six-weeks postpartum visit and glucose testing were obtained from hospital records, over the period 2011–2012. Rates of annual follow-up postpartum glucose testing were assessed by a survey among their GP’s. Lifestyle of the women on diet and exercise was assessed by questionnaire in 2015. Results In total 197 women were eligible for the study. Of these, 156 (79%) attended the six-weeks postpartum visit at the diabetes outpatient clinic and in 145 (93%) of these women glucose testing was performed. In total 77 (39%) women responded to the invitation to participate in this study and filled in the lifestyle questionnaire. About one third of the women met the recommendations for sufficient physical activity. A majority of them did not fulfil the Dutch guidelines on healthy diet – fruit intake 35.1%, vegetables intake 7.8%. Of the 74 invited GP’s, 61 responded (82%), only 12 (20%) reported that they had performed a follow-up glucose testing within >12–14 months postpartum. Of these women, five were tested only in the first year of follow-up, five also in the second year, and two were tested for three consecutive years. Conclusions Despite the high attendance rate of six-weeks postpartum visit and glucose testing, we observed low rates of longer-term follow-up regarding postpartum glucose testing. Moreover, we found a suboptimal adherence to healthy lifestyle for women with a history of GDM.
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Aluş Tokat M, Sancı M, Girgeç S, Kulhan NG, Özcan ÇY. Postpartum education and lifestyle changes for preventing type 2 diabetes in Turkish women with previous gestational diabetes: A retrospective study. Int J Nurs Pract 2016; 22:427-435. [PMID: 27492504 DOI: 10.1111/ijn.12452] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 04/11/2016] [Accepted: 04/30/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Women with previous gestational diabetes mellitus (GDM) have at least sevenfold increased risk for developing type 2 diabetes compared with non-GDM mothers. The risk can be decreased by self-care measures. AIM The aim of this study was to explore the postpartum education and lifestyle changes of Turkish women with previous GDM. METHOD This was a retrospective descriptive epidemiological study. A total of 111 women who had given birth within the previous 3-4 years were interviewed by telephone between December 2013 and April 2014. RESULTS The 83.8% of the women with GDM had not received education related to exercise, while 40.5% received no education regarding the importance of diet. More importantly, while 68.5% had been informed about testing blood glucose levels postpartum, a large majority, 69.3%, did not know for how long they would have had to continue testing their glucose levels. However, 31.3% of those who monitored their glucose levels had glucose intolerance. In terms of lifestyle changes, less than half of the women, 48.6%, had made changes in their diet and the majority, 51.4%, were inactive. CONCLUSION Women need access to sustained education and supportive counselling both to motivate and to minimize the risk of type 2 diabetes after GDM.
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Affiliation(s)
- Merlinda Aluş Tokat
- Obstetric and Gynecologic Nursing Department, Dokuz Eylul University Faculty of Nursing, Izmir, Turkey.
| | - Muzafer Sancı
- T.C Health Ministry Izmir Tepecik Maternity and Women Health Hospital, Izmir, Turkey
| | - Semra Girgeç
- Obstetric and Gynecologic Nursing Department, Izmir University School of Health, Izmir, Turkey
| | | | - Çiler Yeygel Özcan
- Konya Ticaret Odası Karatay University Scholl of Health Science, Izmir, Turkey
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O'Dea A, Tierney M, Danyliv A, Glynn LG, McGuire BE, Carmody LA, Newell J, Dunne FP. Screening for gestational diabetes mellitus in primary versus secondary care: The clinical outcomes of a randomised controlled trial. Diabetes Res Clin Pract 2016; 117:55-63. [PMID: 27329023 DOI: 10.1016/j.diabres.2016.04.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/22/2016] [Accepted: 04/16/2016] [Indexed: 01/19/2023]
Abstract
AIMS To examine the clinical outcomes of screening for gestational diabetes mellitus (GDM) in primary care versus secondary care, in the Irish healthcare system. DESIGN AND METHODS A parallel group randomised controlled trial (RCT) of screening for GDM in primary versus secondary care was used to examine (i) prevalence, (ii) gestational week of screen, (iii) time to access specialist care, and (iv) maternal and neonatal outcomes. In total 781 women were recruited for screening in primary care (n=391) or secondary care (n=390). RESULTS The prevalence of GDM and gestational week of screen were similar in both locations. There was a trend towards a longer time to access diabetes care in primary care (24days) versus secondary care (19days), a difference of 5days (p=0.09). Women screened in primary care also showed a trend towards a higher rate of large for gestational age (LGA) infants (20%) than those screened in secondary care (14.7%), (p=0.09). There were no differences between groups in maternal outcomes. CONCLUSIONS This RCT suggests that screening for GDM in secondary care may be associated with potentially faster time to access specialist antenatal diabetes care and possibly lower LGA rates. Further research is needed to clarify these findings and to improve the delay in accessing specialist care requires an urgent focus. Further research is needed to test these findings in other health systems.
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Affiliation(s)
- Angela O'Dea
- School of Medicine, National University of Ireland, Galway, Ireland.
| | - Marie Tierney
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Andriy Danyliv
- J.E. Cairnes School of Business & Economics, National University of Ireland, Galway, Ireland
| | - Liam G Glynn
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland; Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland
| | - Brian E McGuire
- Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland; School of Psychology, National University of Ireland, Galway, Ireland
| | - Louise A Carmody
- Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland
| | - John Newell
- HRB Clinical Research Facility, National University of Ireland, Galway, Ireland
| | - Fidelma P Dunne
- School of Medicine, National University of Ireland, Galway, Ireland; Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland
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Horan MK, Donnelly JM, McGowan CA, Gibney ER, McAuliffe FM. The association between maternal nutrition and lifestyle during pregnancy and 2-year-old offspring adiposity: analysis from the ROLO study. JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2016; 24:427-436. [PMID: 27695668 PMCID: PMC5025498 DOI: 10.1007/s10389-016-0740-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/25/2016] [Indexed: 11/26/2022]
Abstract
Aim To examine the association between maternal nutrition and lifestyle factors and offspring adiposity, using baseline and 2-year postpartum follow-up data from a randomised control trial of low glycaemic index diet. Subject and methods Food diaries and lifestyle questionnaires were completed during pregnancy and infant feeding and maternal lifestyle questionnaires 2 years postpartum for 281 mother and infant pairs from the ROLO study. Maternal anthropometry was measured throughout pregnancy and infant and maternal anthropometry was measured 2 years postpartum. Results Maternal 2 year postpartum body mass index (BMI) was positively associated with offspring BMI-for-age z-score (B = 0.105, p = 0.015). Trimester 2 saturated fat intake was positively associated with offspring subscapular:triceps skinfold ratio (B = 0.018, p = 0.001). Trimester 1 glycaemic index was also positively associated with offspring sum of subscapular and triceps skinfolds (B = 0.009, p = 0.029). Conclusions Maternal BMI 2 years postpartum was positively associated with offspring BMI. Pregnancy saturated fat intake was positively and polyunsaturated fat negatively associated with offspring adiposity. While further research is necessary, pregnancy and the postpartum period may be early opportunities to combat childhood obesity. Electronic supplementary material The online version of this article (doi:10.1007/s10389-016-0740-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mary K. Horan
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Jean M. Donnelly
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Ciara A. McGowan
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Eileen R. Gibney
- Science Centre – South, University College Dublin School Of Agriculture & Food Science, Belfield, Dublin 4 Ireland
| | - Fionnuala M. McAuliffe
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
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Perspectives on prevention of type 2 diabetes after gestational diabetes: a qualitative study of Hispanic, African-American and White women. Matern Child Health J 2016; 19:1526-34. [PMID: 25421329 DOI: 10.1007/s10995-014-1657-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Women with gestational diabetes (GDM) have a fivefold higher risk of developing type 2 diabetes (T2DM). Furthermore, Hispanic and African-American women are disproportionately affected by GDM, but their views on prevention of T2DM after gestational diabetes are largely unknown. We conducted semi-structured interviews with 23 women (8 Hispanic, 8 African-American, 7 non-Hispanic White) from two academic clinics in Chicago, IL. Interview questions elicited perspectives on prevention of T2DM; the interview protocol was developed based on the Health Belief Model. Two investigators applied template analysis to identify emergent themes. Women conceptualized risk for T2DM based on family history, health behaviors, and personal history of GDM. A subgroup of women expressed uncertainty about how GDM influences risk for T2DM. Women who described a strong link between GDM and T2DM often viewed the diagnosis as a cue to action for behavior change. T2DM was widely viewed as a severe condition, and desire to avoid T2DM was an important motivator for behavior change. Children represented both a key motivator and critical barrier to behavior change. Women viewed preventive care as important to alert them to potential health concerns. Identified themes were congruent across racial/ethnic groups. Diagnosis with GDM presents a potent opportunity for engaging women in behavior change. To fully harness the potential influence of this diagnosis, healthcare providers should more clearly link the diagnosis of GDM with risk for future T2DM, leverage women's focus on their children to motivate behavior change, and provide support with behavior change during healthcare visits in the postpartum period and beyond.
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Mukerji G, McTavish S, Glenn A, Delos-Reyes F, Price J, Wu W, Harvey P, Lipscombe LL. An Innovative Home-Based Cardiovascular Lifestyle Prevention Program for Women With Recent Gestational Diabetes: A Pilot Feasibility Study. Can J Diabetes 2015; 39:445-50. [PMID: 26482886 DOI: 10.1016/j.jcjd.2015.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 07/25/2015] [Accepted: 08/04/2015] [Indexed: 01/11/2023]
Affiliation(s)
- Geetha Mukerji
- Women's College Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Sarah McTavish
- Women's College Research Institute, Toronto, Ontario, Canada
| | - Andrea Glenn
- Women's College Research Institute, Toronto, Ontario, Canada
| | | | - Jennifer Price
- Women's College Hospital, Toronto, Ontario, Canada; Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Wei Wu
- Women's College Research Institute, Toronto, Ontario, Canada
| | - Paula Harvey
- Women's College Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Toronto, Ontario, Canada
| | - Lorraine L Lipscombe
- Women's College Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Toronto, Ontario, Canada
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Baptiste-Roberts K, Bronner Y, Nicholson WK. Adoption of a Healthy Lifestyle Following Gestational Diabetes Mellitus. Curr Nutr Rep 2015. [DOI: 10.1007/s13668-015-0135-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tierney M, O'Dea A, Danyliv A, Noctor E, McGuire B, Glynn L, Al-Imari H, Dunne F. Factors influencing lifestyle behaviours during and after a gestational diabetes mellitus pregnancy. Health Psychol Behav Med 2015. [DOI: 10.1080/21642850.2015.1073111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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The subjective impact of a diagnosis of gestational diabetes among ethnically diverse pregnant women: a qualitative study. Can J Diabetes 2014; 39:117-22. [PMID: 25512097 DOI: 10.1016/j.jcjd.2014.09.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 09/09/2014] [Accepted: 09/17/2014] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Women diagnosed with gestational diabetes mellitus (GDM) require enhanced medical care, social support and health behaviour changes to reduce the complications of pregnancy and future adverse health outcomes. Little is known about how a GDM diagnosis positively and negatively impacts women, especially those of diverse ethnic backgrounds. This qualitative study sought to gain insight into the reactions and experiences of multiethnic women diagnosed with GDM. METHODS A qualitative descriptive approach was used to analyze semistructured telephone interviews conducted with 19 pregnant women of diverse backgrounds who were diagnosed with GDM. Interviews were recorded and transcribed and then coded and analyzed using content analysis. RESULTS This study identified 2 main themes and several subthemes. First, women reported many negative effects of a GDM diagnosis, including heightened pressure to fulfill multiple roles, financial impact, and a disconnect between diabetes-prevention recommendations and their cultural practices. Second, a GDM diagnosis also had positive effects on many women. Women indicated being motivated to make health behaviour changes after a GDM diagnosis and viewed it as a wake-up call to modify their lifestyles. CONCLUSIONS To help pregnant women with self-management of gestational diabetes, healthcare providers should pay greater attention to the adverse effects of GDM on women, including role expectations, cultural issues and financial barriers. Healthcare providers also need to focus on the positive effects and capitalize on women's motivation to make lifestyle changes to reduce their future risk for diabetes.
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Peacock AS, Bogossian F, McIntyre HD, Wilkinson S. A review of interventions to prevent Type 2 Diabetes after Gestational Diabetes. Women Birth 2014; 27:e7-e15. [PMID: 25262356 DOI: 10.1016/j.wombi.2014.09.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 09/05/2014] [Accepted: 09/05/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Gestational Diabetes Mellitus (GDM) during pregnancy is a risk factor for the development of Type 2 Diabetes (T2DM) within 15 years, and prevention programmes have been problematic. QUESTION The aim of the study is to identify effective strategies and programmes to decrease the risk of T2DM in women who experience GDM, the barriers to participation, and the opportunities for midwives to assist women in prevention. METHODS English language, peer reviewed and professional literature published between 1998 and 2013 were searched. A systematic review of the literature was undertaken, included studies were then appraised for quality and finally findings of the studies were thematically analysed. FINDINGS This review identified that there are interventions that are effective, however most lifestyle changes are difficult to translate into everyday life. As the incidence of GDM is expected to rise, midwives' role in promoting long-term health behaviours requires further review. CONCLUSIONS Women need to overcome barriers and be supported in making the behavioural changes necessary to prevent T2DM following GDM. Midwives as the primary carers for women in pregnancy and childbirth are ideally positioned to educate women and engage them in lifestyle and behaviour programmes that prevent the onset of Type 2 Diabetes.
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Affiliation(s)
- Ann S Peacock
- School of Nursing and Midwifery, Faculty of Health Sciences, The University of Queensland, Herston Campus, Edith Cavell Building, Herston, QLD 4006, Australia; Mothers and Babies Theme, Mater Research, Mater Health Services, Raymond Terrace, South Brisbane, Brisbane, QLD 4101, Australia.
| | - Fiona Bogossian
- School of Nursing and Midwifery, Faculty of Health Sciences, The University of Queensland, Herston Campus, Edith Cavell Building, Herston, QLD 4006, Australia
| | - H David McIntyre
- Mater Clinical School, The University of Queensland, Australia; Mothers and Babies Theme, Mater Research, Mater Health Services, Raymond Terrace, South Brisbane, Brisbane, QLD 4101, Australia
| | - Shelley Wilkinson
- Mothers and Babies Theme, Mater Research, Mater Health Services, Raymond Terrace, South Brisbane, Brisbane, QLD 4101, Australia; Department of Nutrition & Dietetics, Mater Health Services, Raymond Terrace, South Brisbane, Brisbane, QLD 4101, Australia
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Hui AL, Sevenhuysen G, Harvey D, Salamon E. Barriers and coping strategies of women with gestational diabetes to follow dietary advice. Women Birth 2014; 27:292-7. [PMID: 25096174 DOI: 10.1016/j.wombi.2014.07.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 07/13/2014] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To understand barriers and coping strategies of women with gestational diabetes (GDM) to follow dietary advice. DESIGN Qualitative study. PARTICIPANTS Thirty women with GDM from the Winnipeg area participated. Each participant completed a Food Choice Map (FCM) semi-structured interview and a demographic questionnaire. MAJOR OUTCOME MEASURES Underlying beliefs of women with GDM and factors that hinder following dietary advice. ANALYSIS Qualitative data analyzed using constant comparative method to identify emergent themes of factors and beliefs that affected following dietary advice. Themes were categorized within the Integrative Model of Behavioral Prediction. RESULTS GDM women faced challenges and barriers when (1) personal food preference conflicted with dietary advice; (2) eating in different social environments where food choice and portions were out of control and food choice decisions were affected by social norms; (3) lack of knowledge and skills in dietary management and lack of a tailored dietary plan. CONCLUSIONS AND IMPLICATIONS Quick adaptation to dietary management in a short time period created challenges for women with GDM. Stress and anxiety were reported when women talked about following dietary advice. Tailored educational and mental health consultation with consideration of the barriers may promote dietary compliance and overall better health.
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Affiliation(s)
- Amy Leung Hui
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Gustaaf Sevenhuysen
- Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dexter Harvey
- Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth Salamon
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Horan MK, McGowan CA, Gibney ER, Donnelly JM, McAuliffe FM. Maternal diet and weight at 3 months postpartum following a pregnancy intervention with a low glycaemic index diet: results from the ROLO randomised control trial. Nutrients 2014; 6:2946-55. [PMID: 25057103 PMCID: PMC4113771 DOI: 10.3390/nu6072946] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 05/26/2014] [Accepted: 07/11/2014] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Pregnancy increases the risk of being overweight at a later time period, particularly when there is excessive gestational weight gain. There remains a paucity of data into the effect of low glycaemic index (GI) pregnancy interventions postpartum. AIM To examine the impact of a low glycaemic index diet during pregnancy on maternal diet 3 months postpartum. METHODOLOGY This analysis examined the diet, weight and lifestyle of 460 participants of the ROLO study 3 months postpartum. Questionnaires on weight, physical activity, breastfeeding, supplement use, food label reading and dietary habits were completed. RESULTS The intervention group had significantly greater weight loss from pre-pregnancy to 3 months postpartum than the control group (1.3 vs. 0.1 kg, p = 0.022). The intervention group reported greater numbers following a low glycaemic index diet (p < 0.001) and reading food labels (p = 0.032) and had a lower glycaemic load (GL) (128 vs. 145, p = 0.014) but not GI (55 vs. 55, p = 0.809) than controls. CONCLUSIONS Low GI dietary interventions in pregnancy result in improved health-behaviours and continued reported compliance at 3 months postpartum possibly through lower dietary GL as a result of portion control. Greater levels of weight loss from pre-pregnancy to 3 months postpartum in the intervention group may have important positive implications for overweight and obesity.
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Affiliation(s)
- Mary K Horan
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland.
| | - Ciara A McGowan
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland.
| | - Eileen R Gibney
- UCD Institute of Food and Health, University College Dublin, Dublin 4, Ireland.
| | - Jean M Donnelly
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland.
| | - Fionnuala M McAuliffe
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland.
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Morrison MK, Lowe JM, Collins CE. Australian women's experiences of living with gestational diabetes. Women Birth 2013; 27:52-7. [PMID: 24183603 DOI: 10.1016/j.wombi.2013.10.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 09/04/2013] [Accepted: 10/03/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to describe Australian women's reflections on the experience of having a pregnancy affected by GDM. METHODS Participants were women aged ≥18 years, diagnosed with GDM ≤3 years previously and registered with the National Diabetes Services Scheme. Data was collected from a cross-sectional written postal survey which included the opportunity for women to document their experiences of living with GDM. Thematic framework analysis was undertaken to determine underlying themes. RESULTS Of 4098 invited eligible women, 1372 consented to participate. Of these, 393 provided feedback on their experiences of living with GDM. Eight key themes emerged from the data (1) shock, fear and anxiety (8.9%), (2) uncertainty and scepticism (9.4%), (3) an opportunity to improve one's health (9.6%), (4) adapting to life with GDM (11.6%), (5) the need for support (17.2%), (6) better awareness (3.5%), (7) abandoned (14.9%), (8) staying healthy and preventing diabetes (13.7%). Women taking insulin were more likely to experience shock, fear or anxiety (p=0.001) and there was a trend towards women who spoke another language also being more likely to report this experience (p=0.061). Those diagnosed with GDM in a previous pregnancy (p=0.034) and younger women (p=0.054) were less likely to view the diagnosis as an opportunity to improve their health. CONCLUSIONS This study provides an insight into the experience of the pregnant woman diagnosed with GDM. It emphasises the importance of health professional support and provides insight into the challenges and opportunities for future diabetes risk reduction.
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Affiliation(s)
- Melinda K Morrison
- Education & Prevention Division, Australian Diabetes Council, Glebe, NSW 2037, Australia.
| | - Julia M Lowe
- University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada.
| | - Clare E Collins
- School of Health Sciences, University of Newcastle, HA12, Hunter Building, University Drive, Callaghan, NSW 2308, Australia.
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Kaiser B, Razurel C. Determinants of postpartum physical activity, dietary habits and weight loss after gestational diabetes mellitus. J Nurs Manag 2012; 21:58-69. [PMID: 23339495 DOI: 10.1111/jonm.12006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2012] [Indexed: 11/30/2022]
Abstract
AIM To describe the most significant findings of the studies that examined the prevalence and determinants of postpartum health behaviours (physical activity, dietary habits and/or weight loss) in patients with gestational diabetes mellitus (GDM). BACKGROUND Patients with gestational diabetes have a high risk of developing type 2 diabetes in the months after delivery. For this reason, GDM patients are encouraged to practice specific health behaviours during the postpartum period. It is important to identify the factors that may impact the adherence to these behaviours. EVALUATION Eighteen published research articles that examined postpartum health behaviours and/or their potential determinants in women diagnosed with GDM were selected from electronic databases. KEY ISSUES Physical activity and diet rarely meet the recommendations. Risk perception, health beliefs, social support and self-efficacy are the main factors identified as having an impact on the adoption of health behaviours. However, the cross-sectional nature of the studies and the lack of social, geographical and/or ethnic variety in the populations studied do not allow us to generalize the conclusions. IMPLICATIONS FOR NURSING MANAGEMENT This literature review reports all the information currently available that can enable nurses and midwives to engage in the evaluation and optimization of their interventions in GDM patients. Motivational interventions based on Social Cognitive Theory are proposed.
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Affiliation(s)
- Barbara Kaiser
- University of Applied Sciences Western Switzerland, 47 Avenue de Champel, Geneva, Switzerland.
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