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Ukke GG, Boyle JA, Reja A, Lee WK, Chen M, Ko MSM, Alycia C, Kwon J, Lim S. Lifestyle Interventions to Prevent Type 2 Diabetes in Women with a History of Gestational Diabetes: A Systematic Review and Meta-Analysis through the Lens of Health Equity. Nutrients 2023; 15:4666. [PMID: 37960319 PMCID: PMC10649749 DOI: 10.3390/nu15214666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellites is one of the health problems disproportionally affecting people with low socioeconomic statuses. Gestational diabetes mellites increases the risk of type 2 diabetes by up to ten-fold for women. Lifestyle interventions prevent type 2 diabetes in women with prior gestational diabetes. However, it is unknown if similar effectiveness can be expected for all population subgroups. OBJECTIVE This study aims to assess the prevention of type 2 diabetes in women with prior gestational diabetes using population characteristics according to the PROGRESS (place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, and social capital) criteria. METHODS MEDLINE, CINAHL, EMBASE, PubMed, PsycINFO, Web of Science, and EBM Reviews databases were searched for interventional studies of diet, physical activity, or behavioural interventions published up to 21 February 2023. Random effects subgroup meta-analysis was conducted to evaluate the association of population characteristics and intervention effects. RESULTS All studies were conducted in high-income countries or middle-income countries. Two-thirds of the studies reported on race/ethnicity and education level. Less than one-third reported on place (urban/rural), occupation, and socioeconomic status. None reported on religion or social capital. Studies from high-income countries (MD = -1.46; 95% CI: -2.27, -0.66, I2 = 70.46, p < 0.001) showed a greater reduction in bodyweight compared with the studies conducted in middle-income countries (MD = -0.11; 95% CI: -1.12, 0.89, I2 = 69.31, p < 0.001) (p for subgroup difference = 0.04). CONCLUSION There are significant equity gaps in the evidence for the prevention of type 2 diabetes in women with prior gestational diabetes due to reports on population characteristics being poor. Interventions may be less effective in reducing bodyweight in women from middle-income countries compared to high-income countries. Collecting and analysing data related to equity is needed to understand the effect of lifestyle interventions on type 2 diabetes for different population subgroups.
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Affiliation(s)
- Gebresilasea Gendisha Ukke
- Health Systems and Equity, Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, VIC 3128, Australia; (G.G.U.); (J.A.B.)
| | - Jacqueline A. Boyle
- Health Systems and Equity, Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, VIC 3128, Australia; (G.G.U.); (J.A.B.)
| | - Ahmed Reja
- School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa 9086, Ethiopia;
| | - Wai Kit Lee
- Faculty of Medicine, Nursing and Health Sciences, Monash University, 264 Ferntree Gully Rd, Notting Hill, VIC 3168, Australia; (W.K.L.); (C.A.)
| | - Mingling Chen
- Monash Centre for Health Research and Implementation, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, VIC 3168, Australia;
| | - Michelle Shi Min Ko
- MD Programme, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore;
| | - Chelsea Alycia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, 264 Ferntree Gully Rd, Notting Hill, VIC 3168, Australia; (W.K.L.); (C.A.)
| | - Jane Kwon
- Diabetes Victoria, Suite G01/15-31 Pelham St, Carlton, VIC 3053, Australia;
| | - Siew Lim
- Health Systems and Equity, Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, VIC 3128, Australia; (G.G.U.); (J.A.B.)
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Prina E, Ceccarelli C, Abdulmalik JO, Amaddeo F, Cadorin C, Papola D, Tol WA, Lund C, Barbui C, Purgato M. Task-sharing psychosocial interventions for the prevention of common mental disorders in the perinatal period in low- and middle-income countries: A systematic review and meta-analysis. Int J Soc Psychiatry 2023; 69:1578-1591. [PMID: 37183793 DOI: 10.1177/00207640231174451] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
AIM to assess the efficacy of psychosocial interventions delivered through task-sharing approaches for preventing perinatal common mental disorders among women in low- and middle-income countries. METHODS We conducted a systematic review of randomized controlled trials following a prespecified protocol registered in the Open Science Framework (osf.io/qt4y3). We searched MEDLINE, Web of Science, PsycINFO, and Cochrane Central Register of Controlled Trials (CENTRAL) through June 2022. Two reviewers independently extracted the data and evaluated the risk of bias of included studies using the Cochrane risk of bias tool. We performed random-effects meta-analyses and rated the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS We included 23 studies with 24,442 participants. At post-intervention, task-shared psychosocial interventions, were effective in preventing the development of mental disorders in general (RR 0.57, 95% CI [0.35, 0.91]), and specifically depression (RR 0.51, 95% CI [0.35, 0.75]), but not anxiety disorders (RR 0.46, 95% CI [0.06, 3.33]). Similarly, psychosocial interventions reduced psychological distress (SMD -1.32, 95% CI [-2.28, -0.35]), and depressive symptoms (SMD -0.50, 95% CI [-0.80, -0.16]), and increased parenting self-efficacy (SMD -0.76, 95% CI [-1.13, -0.38]) and social support (SMD -0.72, 95% CI [-1.22, -0.22]). No effect was detected for anxiety symptoms at post-intervention. At follow-up the beneficial effects of interventions progressively decreased. CONCLUSIONS Psychosocial interventions delivered through the task-sharing modality are effective in preventing perinatal common mental disorders and fostering positive mental health among women in low- and middle-income countries. However, our findings are tentative, due to the low number of preventative intervention strategies considering outcomes as the incidence of mental disorders, especially in the long-term. This evidence supports calls to implement and scale up psychosocial prevention interventions for perinatal common mental disorders in low- and middle-income countries.
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Affiliation(s)
- Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Caterina Ceccarelli
- Global Program Expert Group on Mental Health and Psychosocial Support, SOS Children's Villages, Milan, Italy
| | | | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Camilla Cadorin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Davide Papola
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
- Cochrane Global Mental Health, University of Verona, Italy
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Wietse A Tol
- Department of Public Health, University of Copenhagen, Denmark
- Athena Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Crick Lund
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
- Cochrane Global Mental Health, University of Verona, Italy
| | - Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
- Cochrane Global Mental Health, University of Verona, Italy
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Zhong Q, Chen Y, Luo M, Lin Q, Tan J, Xiao S, Willey JA, Chen JL, Whittemore R, Guo J. The 18-month efficacy of an Intensive LifeStyle Modification Program (ILSM) to reduce type 2 diabetes risk among rural women: a cluster randomized controlled trial. Global Health 2023; 19:6. [PMID: 36703168 PMCID: PMC9881320 DOI: 10.1186/s12992-023-00910-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/20/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Many lifestyle interventions have demonstrated efficacy up to one-year follow-up, yet maintaining improvements at longer-term follow-up is a well-recognized worldwide challenge, especially in underserved areas. The purpose of this study is to compare the 18-month efficacy of an Intensive LifeStyle Modification Program to usual care in reducing the risk for type 2 diabetes (T2D) among women with a history of gestational diabetes mellitus (GDM). METHODS We conducted a two-arm, cluster randomized controlled trial among women with a history of GDM in China. A total of 16 towns (clusters) in two distinct rural areas in south-central China were randomly selected (8 towns per area) and assigned (1:1) to the intervention (Intensive LifeStyle Modification Program) or control (usual care) group with stratification in the two rural areas. The strategies for maintaining intervention effects were used (including setting recursive goals and providing a supportive environment, etc.) under the guidance of social cognitive theory. The primary outcome was a change in T2D risk; secondary outcomes included glycemic, weight-related, behavioral, and psychological variables. All outcomes were collected at baseline, 6, and 18 months. All participants entered the intention-to-treat analysis. Data were analyzed via generalized estimation equation models (accounting for clusters) at the individual level, with subgroup analysis included in the model. RESULTS The sample included 320 women from 16 clusters (20 women per cluster). At 18 months, the intervention group demonstrated a significant improvement in T2D risk score, fasting blood glucose, body mass index (BMI), waist circumference, intention to eat low glycemic index food, perceived stress, quality of life in psychological and environmental domains, and social support over time (p < 0.05) based on the intention-to-treat analysis set. Subgroup analysis showed a significant interaction effect on T2D risk score in subgroups of different BMI, waist circumference, and blood glucose (p < 0.05). CONCLUSIONS Over 18 months, the Intensive LifeStyle Modification Program reduced T2D risk among rural women with a history of GDM in China. Women who were overweight, had high abdominal adiposity, or had blood glucose intolerance benefited more from this intervention. This program serves as a potential diabetes prevention model for women with a history of GDM in low-resource settings worldwide. TRIAL REGISTRATION Registered on Chinese Clinical Trial Registry (ChiCTR1800015023) on 1st March 2018, http://www.chictr.org.cn/showproj.aspx?proj=25569.
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Affiliation(s)
- Qinyi Zhong
- grid.216417.70000 0001 0379 7164Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, 410013 Hunan China
- grid.5379.80000000121662407Manchester Centre for Health Psychology, School of Health Science, University of Manchester, Manchester, Greater Manchester M13 9PL UK
| | - Yao Chen
- grid.216417.70000 0001 0379 7164Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, 410013 Hunan China
| | - Mengchun Luo
- Maternal and Child Health Hospital of Yongding, Zhangjiajie, Hunan 427000 People’s Republic of China
| | - Qian Lin
- grid.216417.70000 0001 0379 7164Xiangya School of Public Health, Central South University, Changsha, Hunan 410013 People’s Republic of China
| | - Jianghong Tan
- grid.501248.aZhuzhou Central Hospital, Zhuzhou, Hunan 412000 People’s Republic of China
| | - Shuiyuan Xiao
- grid.216417.70000 0001 0379 7164Xiangya School of Public Health, Central South University, Changsha, Hunan 410013 People’s Republic of China
| | - James Allen Willey
- grid.266102.10000 0001 2297 6811Department of Family and Community Medicine, University of California, San Francisco, CA 94118 USA
| | - Jyu-Lin Chen
- grid.266102.10000 0001 2297 6811School of Nursing, University of California, San Francisco, CA 94118 USA
| | - Robin Whittemore
- grid.47100.320000000419368710School of Nursing, Yale University, New Haven, CT 06520 USA
| | - Jia Guo
- grid.216417.70000 0001 0379 7164Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, 410013 Hunan China
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Li C, Gao Y, Luo T, Qin S, Yao X, Wen Y, Wang X, Zhang J, Zhong Q, Shi H, Liu J. Effects of low-GI biscuits as pre-loads or mid-meal snacks on post-prandial glycemic excursions in women with recent gestational diabetes: A protocol for a randomized crossover trial and an extended tailored intervention. Front Nutr 2023; 10:1122102. [PMID: 37032785 PMCID: PMC10076760 DOI: 10.3389/fnut.2023.1122102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/01/2023] [Indexed: 04/11/2023] Open
Abstract
Background Increased post-prandial glycemic excursions contribute to the development of diabetes and have been observed in women with recent gestational diabetes mellitus (GDM) and with normal glucose tolerance at post-partum. As a convenient meal replacement, low-GI biscuits are helpful for improving glycemic excursions in patients with type 2 diabetes. However, it is unknown whether low-GI biscuits as pre-loads or mid-meal snacks have a better effect in diminishing post-prandial glycemic excursions from the individual level in women with recent GDM. Therefore, the aim of this trial is to tailor a better dietary strategy utilizing low-GI biscuits (Fitmeal) to improve post-prandial glycemic excursions through within-subject comparison in such a population and observe the long-term effect of a tailored dietary approach in glycemic control. Methods We have designed a two-phase trial including a randomized, crossover, non-blinded trial in the first phase, followed by a 4-week tailored intervention in the second phase. A total of 52 post-partum women with recent GDM will be allocated into four meal plans: (1) Fitmeal pre-load 30 min before standard lunch meal (P+L), (2) Fitmeal as a mid-meal snack 2 h before standard lunch meal (S+L), (3) isocaloric standard control with co-ingestion of Fitmeal and standard lunch meal (CL) at the same time, and (4) placebo control with 200 ml of water taken 30 min before standard lunch meal (W + L), on four consecutive days. Acute post-prandial glycemic response (PGR) measured by continuous glucose monitoring (CGM) will be compared among the four meals. In the second phase, all participants will receive a 4-week tailored intervention using Fitmeal as pre-loads or mid-meal snacks based on within-subject PGR results from the first phase. Glycemic metrics, dietary behaviors, and psychosocial factors (e.g., quality of life, self-efficacy, perceived stress, and depression) will be examined at baseline and end-point. Discussion This trial is expected to optimize the use of low-GI biscuits as pre-loads or mid-meal snacks in improving individual post-prandial glycemic excursions among women with recent GDM. Furthermore, the findings of this study will provide novel information on how to deliver an effective dietary intervention at the individual level and guide future clinical practice of medical nutrition therapy for diabetes prevention. Trial registration number Chinese clinical trial registry, ChiCTR2200060923.
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Affiliation(s)
- Chunrong Li
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
- Women Health Department, Chengdu Jintang District Maternal and Child Health Hospital, Chengdu, Sichuan, China
| | - Yan Gao
- Sichuan Provincial Hospital for Women and Children, Affiliated Women and Children's Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Tongyong Luo
- Sichuan Provincial Hospital for Women and Children, Affiliated Women and Children's Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Shiji Qin
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Xue Yao
- Healthcare Department, Chengdu Jinjiang District Maternal and Child Health Hospital, Chengdu, Sichuan, China
| | - Ye Wen
- Chengdu Tianyi Cuisine Nutritional Food Co., Ltd., Chengdu, Sichuan, China
| | - Xue Wang
- Sichuan Provincial Hospital for Women and Children, Affiliated Women and Children's Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Jing Zhang
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Qiong Zhong
- Women Health Department, Chengdu Jintang District Maternal and Child Health Hospital, Chengdu, Sichuan, China
| | - Hao Shi
- Healthcare Department, Chengdu Jinniu District Maternal and Child Health Hospital, Chengdu, Sichuan, China
| | - Jing Liu
- Sichuan Provincial Hospital for Women and Children, Affiliated Women and Children's Hospital of Chengdu Medical College, Chengdu, Sichuan, China
- *Correspondence: Jing Liu
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Shang J, Dolikun N, Tao X, Zhang P, Woodward M, Hackett ML, Henry A. The effectiveness of postpartum interventions aimed at improving women’s mental health after medical complications of pregnancy: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2022; 22:809. [PMID: 36329395 PMCID: PMC9632104 DOI: 10.1186/s12884-022-05084-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022] Open
Abstract
Background Postpartum mental disorders including depression and anxiety are common. Medical complications of pregnancy, such as preeclampsia and gestational diabetes, are thought to increase the risk of mental disorders postpartum. However, it is unclear which interventions may be effective for preventing and/or treating postpartum mental disorders following a medically complicated pregnancy. We aimed to systematically review published literature on the effectiveness of postpartum interventions to improve women’s mental health after medical complications of pregnancy. Methods Systematic review (PROSPERO: CRD42021220030) was performed. Eligibility criteria: (1) randomized controlled trials (RCTs), published 1st Jan 2001-12th August 2021 (2) outcome measures reported on postpartum mental disorders (3) participants had ≥ 1 medical complication during pregnancy (4) intervention entirely postpartum or contained a postpartum component (5) full-text available in English or Chinese. Risk of bias was assessed using the Revised Cochrane Criteria Risk of Bias. Random effects inverse-variance weighted meta-analysis was used to pool the individual standardized mean differences (SMD) in depression or anxiety scores between intervention and control groups. Results Of 5928 studies screened, 9 met inclusion criteria, and were based on non-pharmaceutical, combined lifestyle interventions that began shortly after childbirth, or as part of extended care packages beginning during pregnancy. Of these, 2 were rated as low risk of bias, 1 with some concerns, and 6 were at high risk. Meta-analysis was performed for 8 studies using standardized measures of depression and 7 for anxiety. There were statistically significant reductions in depression (SMD − 1.48; 95%CI: -2.41 to -0.55), and anxiety scores (SMD − 1.98; 95%CI: -3.03 to -0.94) in intervention versus control groups. Considerable heterogeneity was noted for pooled depression (I2 = 97.9%, p < 0.05), and anxiety (I2 = 96.8%, p < 0.05) results. Conclusion Limited intervention studies aimed at improving postpartum mental disorders after medically complicated pregnancy were found, most with a high risk of bias. There was some evidence to suggest that postpartum depression and anxiety scores improved after early intervention. However, in general the current quality of evidence is low. Further, high-quality, interventional research is required in this understudied field. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05084-1.
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