|
1
|
Maghalian M, Jafarabadi MA, Abbasalizadeh F, Mohammad-Alizadeh-Charandabi S, Ghanbari-Homaie S, Mirghafourvand M. Validation of the Persian version of the summary of diabetes self-care activities scale (SDSCA) in pregnant women with gestational diabetes mellitus using a COSMIN methodology. BMC Endocr Disord 2025; 25:103. [PMID: 40251509 PMCID: PMC12007123 DOI: 10.1186/s12902-025-01931-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Accepted: 04/09/2025] [Indexed: 04/20/2025] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a condition with significant prenatal and postnatal implications. This study aimed to validate the Summary of Diabetes Self-Care Activities (SDSCA) measure in Iranian women with GDM, focusing on its psychometric properties. METHODS The Persian version of the SDSCA was evaluated in 180 Iranian women with GDM. Following COSMIN guidelines, the instrument was translated into Persian, and its psychometric properties were assessed, including content validity, face validity, construct validity, internal consistency, test-retest reliability, measurement error, responsiveness, and interpretability. Floor and ceiling effects were also examined. RESULTS The validity assessments showed strong content validity, with a Content Validity Index (CVI) of 0.93 and a Content Validity Ratio (CVR) of 0.97. Face validity yielded an impact score of 4.38. Exploratory factor analysis (EFA) identified three factors-diet, exercise, and blood sugar testing-accounting for 57.4% of the variance. Confirmatory factor analysis (CFA) confirmed the model's excellent fit (CFI = 1.00, TLI = 0.99, NFI = 0.98, RFI = 0.96). The reliability analysis showed a Cronbach's alpha of 0.78 and a McDonald's omega of 0.91, with an intraclass correlation coefficient (ICC) of 0.92 (95% CI: 0.83-0.96). Ceiling effects were observed for blood sugar testing (26.7%), while floor effects were noted for exercise (6.7%) and blood sugar testing (6.1%). The Minimal Important Change (MIC) of 2.68 units exceeded the Smallest Detectable Change (SDC) of 1.11 units, indicating the tool's ability to detect clinically meaningful changes. CONCLUSIONS The Persian version of the SDSCA demonstrates strong psychometric properties, including both reliability and validity, making it a suitable tool for assessing self-care behaviors in Iranian women with GDM. Its use in future research can enhance understanding of self-management in this population.
Collapse
Affiliation(s)
- Mahsa Maghalian
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- Cabrini Research, Cabrini Health, Melbourne, VIC, 3144, Australia
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, VIC 3800, Melbourne, Australia
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, 3168, Australia
| | - Fatemeh Abbasalizadeh
- Women's Reproductive Health Research Center, Department of Perinatology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Solmaz Ghanbari-Homaie
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Social determinants of Health Research Center, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
| |
Collapse
|
|
2
|
Simard L, Girard S, Lemoyne J, Babineau V, Ruchat SM. Physical activity during pregnancy: key beliefs to support intervention. Health Psychol Behav Med 2025; 13:2468841. [PMID: 40028491 PMCID: PMC11869338 DOI: 10.1080/21642850.2025.2468841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Accepted: 02/11/2025] [Indexed: 03/05/2025] Open
Abstract
Background Physical activity (PA) provides maternal and fetal health benefits, but only 27.5% of Canadian pregnant women meet PA recommendations. Theory-based interventions like the theory of planned behavior (TPB) are useful in explaining what drives behavior. The first objective of this study was to validate the TPB model to predict prenatal moderate-to-vigorous physical activity (MVPA), including testing of the novel interaction between intention and perceived behavioral control (PBC). The second objective was to identify which specific beliefs predict intention toward prenatal MVPA to support intervention. Method We used a prospective correlational design. Healthy pregnant women completed two electronic questionnaires: at baseline, to assess TPB constructs, and one month later, to assess MVPA practice. Structural equation modeling was conducted with Latent Moderated Structural Equations. The interaction was interpreted with the pick-a-point method and the Johnson-Neyman graphical method. Results The sample consists of 193 women (M age = 31.2±3.6). Results indicate that prenatal MVPA at one month was marginally predicted by intention (β = 0.149; p < 0.10) and PBC (β = 0.322; p < 0.05, MVPA R 2 = 20%), but when their interaction was added to the model, MVPA R 2 increased to 44%. Specifically, the relationship between intention and MVPA is stronger when PBC is high (0.5 standard deviation over the mean). In the full model including the interaction, attitude (β = 0.59; p < 0.001), subjective norm (β = 0.20; p < 0.01) and PBC (β = 0.26; p < 0.05) all made a significant contribution to predicting MVPA intention (R 2 = 88%). Finally, the following beliefs displayed significant indirect paths toward the intention of being physically active: behavioral beliefs: unlikely to be more tired and likely feel better mentally; normative beliefs: approval from friends and from mother/father; and control beliefs: being tired and missing social support. Conclusion Interventions aiming to promote regular MVPA during pregnancy should prioritized the six significant beliefs identified to significantly predict intention toward prenatal MVPA.
Collapse
Affiliation(s)
- Laurence Simard
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Stéphanie Girard
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Jean Lemoyne
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Véronique Babineau
- Department of Obstetrics and Gynecology of CIUSSS de la Mauricie et du Centre-du-Québec, affiliated with the Université de Montréal, Trois-Rivières, Canada
| | - Stephanie-May Ruchat
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| |
Collapse
|
|
3
|
Guo S, Liu D, Bi X, Feng Y, Zhang K, Jiang J, Wang Y. Barriers and facilitators to self-management among women with gestational diabetes: A systematic review using the COM-B model. Midwifery 2024; 138:104141. [PMID: 39178483 DOI: 10.1016/j.midw.2024.104141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/24/2024] [Accepted: 08/07/2024] [Indexed: 08/25/2024]
Abstract
BACKGROUND Gestational diabetes mellitus is a common complication during pregnancy, and its prevalence rates have increased dramatically in recent years. Treatment of gestational diabetes requires the active self-management, however, this can be challenging. Understanding the barriers and facilitators of adherence to self-management recommendations is essential for designing effective interventions. AIM To identify and synthesize barriers and facilitators to self-management of gestational diabetes reported by pregnant women. METHODS This was a mixed-methods systematic review, including qualitative, quantitative, and mixed-methods studies. A literature search was conducted in four databases (PubMed, Embase, CINAHL, and the Web of Science). Eligible studies explored the barriers and/or facilitators, experiences and/or perceptions to engage in self-management in women with gestational diabetes. The Capability, Opportunity, Motivation, Behaviour model was used to classify barriers and facilitators affecting self-management. RESULTS Thirty-six studies (23 qualitative, 11 quantitative, and 2 mixed-methods) met the inclusion criteria. We identified barriers and facilitators relating to capability (e.g., physical discomforts and constraints; lack of knowledge of GDM and self-management behaviours; forgetfulness), opportunity (e.g., limited education and resources; social support from family, friends, and peer groups; conflict with existing lifestyles or cultural norms), and motivation (e.g., perceived negative consequence of self-management behaviours or not perceived benefits; negative emotion; concern the health of the baby). CONCLUSION In this study, we identified the barriers and facilitators of self-management in women with gestational diabetes, which were explained by relevant theoretical models. Interventions should be developed with full consideration of these findings to ensure that pregnant women have the correct knowledge and confidence to self-manage their complications.
Collapse
Affiliation(s)
- Shujie Guo
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China; Department of Clinical Nursing, School of Nursing, Air Force Medical University, Xi'an, China
| | - Dongmei Liu
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Xiaoxuan Bi
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Yuxuan Feng
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Ke Zhang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Jingjing Jiang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Yanhong Wang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China.
| |
Collapse
|
|
4
|
Sundarapperuma TD, Hettiarachchi P, Wasalathanthri S, Wijesinghe CJ. Perspectives of stakeholders on the implementation of a dietary and exercise intervention for postpartum mothers with a history of gestational diabetes mellitus (GDM): a community-based qualitative study. Sci Rep 2024; 14:20780. [PMID: 39242616 PMCID: PMC11379962 DOI: 10.1038/s41598-024-71587-w] [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] [Accepted: 08/29/2024] [Indexed: 09/09/2024] Open
Abstract
Women with a history of Gestational diabetes mellitus (GDM) have a high risk of developing Type 2 diabetes mellitus (T2DM) in their future life. Lifestyle interventions are known to reduce this progression. The success of a lifestyle intervention mainly depends on its feasibility. Therefore, this study aimed to evaluate the feasibility of a lifestyle intervention programme aimed to attenuate the development of T2DM in mothers with a history of GDM. This qualitative phenomenological study was carried out in selected Medical offices of Health (MOH) areas in Sri Lanka. Postpartum mothers with a history of GDM who have undergone a comprehensive, supervised lifestyle intervention program for 1 year, their family members, and public health midwives (PHM) were recruited for this study. Focus group discussions (FGD) were carried out with mothers and PHM while In-depth interviews (IDI) were conducted with family members. Framework analysis was used for the analysis of data. A total of 94 participants (45 mothers, 40 healthcare workers, and 9 family members) participated in FGDs and IDIs to provide feedback regarding the lifestyle intervention. Sixteen sub-themes emerged under the following four domains; (1) Feelings and experiences about the lifestyle intervention programme for postpartum mothers with a history of GDM (2) Facilitating factors (3) Barriers to implementation and (4) Suggestions for improvement. Spouse support and continued follow-up were major facilitating factors. The negative influence of healthcare workers was identified as a major barrier to appropriate implementation. All participants suggested introducing continuing education programmes to healthcare workers to update their knowledge. The spouse's support and follow-ups played a pivotal role in terms of the success of the programme. Enhancing awareness of the healthcare workers is also essential to enhance the effectiveness of the programme. It is imperative to introduce a formal intervention programme for the postpartum management of mothers with a history of GDM. It is recommended that the GDM mothers should be followed up in the postpartum period and this should be included in the national postpartum care guidelines.
Collapse
Affiliation(s)
- Thamudi D Sundarapperuma
- Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Galle, 80000, Sri Lanka.
| | - Priyadarshika Hettiarachchi
- Department of Physiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, 11222, Sri Lanka
| | - Sudharshani Wasalathanthri
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, 00800, Sri Lanka
- Department of Preclinical Sciences, Faculty of Medicine, Kothalawala Defence University, Rathmalana, 10390, Sri Lanka
| | - Champa J Wijesinghe
- Department of Community Medicine, Faculty of Medicine, University of Ruhuna, Galle, 80000, Sri Lanka
| |
Collapse
|
|
5
|
Mehmood S, Ye C, Hanley AJ, Connelly PW, Sermer M, Zinman B, Retnakaran R. Impact of the diagnosis of gestational diabetes on maternal physical activity after pregnancy. Diabetes Obes Metab 2024; 26:1207-1215. [PMID: 38116699 DOI: 10.1111/dom.15415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023]
Abstract
AIM The diagnosis of gestational diabetes (GDM) identifies women who are at future risk of developing type 2 diabetes. However, it is unclear if diagnosing GDM thus motivates women to increase physical activity after pregnancy or if this medicalization has the opposite effect of decreasing activity, possibly reflecting assumption of a sick role. We thus sought to evaluate the impact of diagnosing GDM on changes in maternal physical activity after pregnancy. METHODS In this prospective cohort study, physical activity patterns were assessed by the Baecke questionnaire for the year before pregnancy and the first year postpartum in 405 white women comprising the following three gestational glucose tolerance groups: (a) those who did not have GDM (non-GDM; n = 247), (b) women with undiagnosed GDM (n = 46) and (c) those diagnosed with GDM (n = 112). RESULTS In the year before pregnancy, mean adjusted total physical activity progressively decreased from non-GDM to undiagnosed GDM to diagnosed GDM (p = .067). Conversely, at 1 year postpartum, total physical activity was highest in those who had been diagnosed with GDM (p = .02). Compared with non-GDM, diagnosed GDM predicted an increase in total physical activity from pre-pregnancy to 1 year postpartum (t = 2.3, p = .02) whereas undiagnosed GDM predicted a concurrent decrease in leisure-time activity (t = -2.74, p = .006). Accordingly, the mean adjusted increase in body mass index from pre-pregnancy to 1 year postpartum was lowest in those with diagnosed GDM (0.26 ± 0.25 kg/m2 ), highest in undiagnosed GDM (1.23 ± 0.38 kg/m2 ) and intermediate in non-GDM (0.89 ± 0.22 kg/m2 ) (overall p = .04). CONCLUSION Diagnosis of GDM leads to increased physical activity after pregnancy that may partially attenuate postpartum weight retention.
Collapse
Affiliation(s)
- Sadia Mehmood
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
| | - Chang Ye
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
| | - Anthony J Hanley
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
- Division of Endocrinology, University of Toronto, Toronto, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Philip W Connelly
- Division of Endocrinology, University of Toronto, Toronto, Canada
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Mathew Sermer
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Canada
| | - Bernard Zinman
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
- Division of Endocrinology, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
- Division of Endocrinology, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| |
Collapse
|
|
6
|
Nicklas JM, Pyle L, Soares A, Leiferman JA, Bull SS, Tong S, Caldwell AE, Santoro N, Barbour LA. The Fit After Baby randomized controlled trial: An mHealth postpartum lifestyle intervention for women with elevated cardiometabolic risk. PLoS One 2024; 19:e0296244. [PMID: 38194421 PMCID: PMC10775990 DOI: 10.1371/journal.pone.0296244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 12/03/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Postpartum women with overweight/obesity and a history of adverse pregnancy outcomes are at elevated risk for cardiometabolic disease. Postpartum weight loss and lifestyle changes can decrease these risks, yet traditional face-to-face interventions often fail. We adapted the Diabetes Prevention Program into a theory-based mobile health (mHealth) program called Fit After Baby (FAB) and tested FAB in a randomized controlled trial. METHODS The FAB program provided 12 weeks of daily evidence-based content, facilitated tracking of weight, diet, and activity, and included weekly coaching and gamification with points and rewards. We randomized women at 6 weeks postpartum 2:1 to FAB or to the publicly available Text4baby (T4B) app (active control). We measured weight and administered behavioral questionnaires at 6 weeks, and 6 and 12 months postpartum, and collected app user data. RESULTS 81 eligible women participated (77% White, 2% Asian, 15% Black, with 23% Hispanic), mean baseline BMI 32±5 kg/m2 and age 31±5 years. FAB participants logged into the app a median of 51/84 (IQR 25,71) days, wore activity trackers 66/84 (IQR 43,84) days, logged weight 17 times (IQR 11,24), and did coach check-ins 5.5/12 (IQR 4,9) weeks. The COVID-19 pandemic interrupted data collection for the primary 12-month endpoint, and impacted diet, physical activity, and body weight for many participants. At 12 months postpartum women in the FAB group lost 2.8 kg [95% CI -4.2,-1.4] from baseline compared to a loss of 1.8 kg [95% CI -3.8,+0.3] in the T4B group (p = 0.42 for the difference between groups). In 60 women who reached 12 months postpartum before the onset of the COVID-19 pandemic, women randomized to FAB lost 4.3 kg [95% CI -6.0,-2.6] compared to loss in the control group of 1.3 kg [95% CI -3.7,+1.1] (p = 0.0451 for the difference between groups). CONCLUSIONS There were no significant differences between groups for postpartum weight loss for the entire study population. Among those unaffected by the COVID pandemic, women randomized to the FAB program lost significantly more weight than those randomized to the T4B program. The mHealth FAB program demonstrated a substantial level of engagement. Given the scalability and potential public health impact of the FAB program, the efficacy for decreasing cardiometabolic risk by increasing postpartum weight loss should be tested in a larger trial.
Collapse
Affiliation(s)
- Jacinda M. Nicklas
- Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Laura Pyle
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, Colorado, United States of America
| | - Andrey Soares
- Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Jennifer A. Leiferman
- Department of Community and Behavioral Health, University of Colorado School of Public Health, Aurora, Colorado, United States of America
| | - Sheana S. Bull
- Department of Community and Behavioral Health, University of Colorado School of Public Health, Aurora, Colorado, United States of America
| | - Suhong Tong
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, Colorado, United States of America
| | - Ann E. Caldwell
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility & Reproductive Sciences, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Linda A. Barbour
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| |
Collapse
|
|
7
|
Horn CE, Seely EW, Levkoff SE, Isley BC, Nicklas JM. Postpartum women's experiences in a randomized controlled trial of a web-based lifestyle intervention following Gestational Diabetes: a qualitative study. J Matern Fetal Neonatal Med 2023; 36:2194012. [PMID: 36977603 DOI: 10.1080/14767058.2023.2194012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 03/17/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is associated with an increased maternal risk for the development of type 2 diabetes (T2DM). We previously demonstrated in a randomized trial that a web-based postpartum lifestyle intervention program, Balance After Baby, increased weight loss among postpartum women with recent pregnancies complicated by GDM. The aim of this analysis is to identify the impact of the intervention on study participants as assessed by exit interviews after completion of the 12 month study. METHODS We conducted structured exit interviews created with a concurrent-contextual design with subjects randomized to the intervention group at the conclusion of their participation (∼12 months) in the Balance After Baby study, with the objectives of 1) understanding the impact of the intervention on participants and their family members, 2) identifying which program components were most and least helpful, and 3) identifying the perceived best timing for diabetes prevention interventions in postpartum women with recent GDM. RESULTS Seventy-nine percent (26/33) of eligible intervention participants participated in interviews. Participants noted changes in diet and physical activity as a result of the intervention. Several components of the intervention, particularly the online modules and support from the lifestyle coach, were perceived by intervention participants to have had a positive effect on personal and familial lifestyle change, while other components were less utilized, including the community forum, YMCA memberships, and pedometers. Nearly all participants felt that the timing in the intervention study, beginning about 6 weeks postpartum, was ideal. DISCUSSION Results of this study identify the importance of individualized coaching, impact on family members, and demonstrate that postpartum women feel ready to make changes by 6 weeks postpartum. Findings from this study will help inform the development of future technologically-based lifestyle interventions for postpartum women with recent GDM.
Collapse
Affiliation(s)
- Christine E Horn
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Ellen W Seely
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sue E Levkoff
- College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Breanna C Isley
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jacinda M Nicklas
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
|
8
|
Alizadeh Pahlavani H. Possible roles of exercise and apelin against pregnancy complications. Front Endocrinol (Lausanne) 2022; 13:965167. [PMID: 36093083 PMCID: PMC9452694 DOI: 10.3389/fendo.2022.965167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/08/2022] [Indexed: 12/02/2022] Open
Abstract
The prevalence of maternal obesity during pregnancy is associated with the risk of gestational diabetes, preeclampsia, and cardiomyopathy. Environmental factors such as active lifestyles and apelin may lead to beneficial changes. In rats, apelin and exercise (45 to 65% VO2max for 6 to 9 weeks) during pregnancy increase brown adipose tissue (BAT) proteins such as Cidea, Elovl3, UCP1, PRDM16, and PGC-1α in males and females fetuses, while white adipose tissue (WAT) is reduced. In humans and animals, apelin and exercise stimulate the expression of the glucose transporters (GLUT1/2/4) in the muscle and adipose tissue through the PI3K/Akt and AMPK pathways. Hence, exercise and apelin may are known as regulators of energy metabolism and be anti-obesity and anti-diabetic properties. In mice, exercise also creates a short-term hypoxic environment in the pregnant mother, activating HIF-1, VEGF, and VEGFR, and increasing angiogenesis. Exercise and apelin also increase vasodilation, angiogenesis, and suppression of inflammation through the L-arginine/eNOS/NO pathway in humans. Exercise can stimulate the ACE2-Ang-(1-7)-Mas axis in parallel with inhibiting the ACE-Ang II-AT1 pathway. Exercise and apelin seem to prevent preeclampsia through these processes. In rats, moderate-intensity exercise (60 to 70% VO2max for 8 weeks) and apelin/APJ also may prevent pathological hypertrophy in pregnancy by activating the PI3K/Akt/mTOR/p70S6K pathway, PI3k-Akt-ERK1/2-p70S6K pathway, and the anti-inflammatory cytokine IL-10. Since pre-clinical studies have been more on animal models, future research with scientific guidelines should pay more attention to human specimens. In future research, time factors such as the first, second, and third trimesters of pregnancy and the intensity and duration of exercise are important variables that should be considered to determine the optimal intensity and duration of exercise.
Collapse
|
|
9
|
Tomioka Y. Relationship between physical activity and mental health in women after childbirth: a cross-sectional exploratory study. BMC Pregnancy Childbirth 2022; 22:430. [PMID: 35606714 PMCID: PMC9125919 DOI: 10.1186/s12884-022-04758-0] [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: 11/26/2021] [Accepted: 05/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background Physical activity (PA) is recommended for women after childbirth. However, it is unknown whether PA, such as housework and child-rearing, is associated with mental health. This study aimed to measure daily PA in women 2 months postpartum as well as investigate the relationship between daily PA and mental health. Methods In this cross-sectional quantitative exploratory study conducted between September 2017 and May 2018, 110 women were approached for participation. Mental health was evaluated using the General Health Questionnaire-28, and PA measurements were performed using accelerometers that the participants wore for 2 days. Welch’s t-test and linear regression analysis were performed to assess the relationship between PA and mental health. Results This study included 99 participants. The mean amount of daily activities from housework and child-rearing was 3.21 ± 1.14 metabolic equivalent of tasks (METs)-h/day and that of time spent sitting was at least 7.5 h/12.5 h. PA time spent in light child-rearing and housework activities was significantly longer among multiparous women than among primiparous women (t = − 3.41). PA time comprising the duration of moderate (3 METs) or more vigorous PA was 73 min/day. No significant relationship between mental health and PA was observed. However, the amount of daily activities tended to increase with an improvement in mental health. The amount of daily activities exceeded 3 METs-h/day regardless of the mental health status. Conclusions No significant relationship was found between the amount of daily activities and mental health. The former increased as the latter improved. The amount of daily activities met the standard recommended by the World Health Organization, regardless of the mental health status.
Collapse
Affiliation(s)
- Yumi Tomioka
- Faculty of Nursing, Toho University, 4-16-20 Omori-nishi, Ota-ku, Tokyo, 143-0015, Japan.
| |
Collapse
|
|
10
|
Smith R, Michalopoulou M, Reid H, Riches SP, Wango YN, Kenworthy Y, Roman C, Santos M, Hirst JE, Mackillop L. Applying the behaviour change wheel to develop a smartphone application 'stay-active' to increase physical activity in women with gestational diabetes. BMC Pregnancy Childbirth 2022; 22:253. [PMID: 35346075 PMCID: PMC8962081 DOI: 10.1186/s12884-022-04539-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/14/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Physical activity (PA) interventions are an important but underutilised component in the management of gestational diabetes mellitus (GDM). The challenge remains how to deliver cost effective PA interventions that have impact on individual behaviour. Digital technologies can support and promote PA remotely at scale. We describe the development of a behaviourally informed smartphone application (Stay-Active) for women attending an NHS GDM clinic. Stay-Active will support an existing motivational interviewing intervention to increase and maintain PA in this population. METHODS The behaviour change wheel (BCW) eight step theoretical approach was used to design the application. It provided a systematic approach to understanding the target behaviour, identifying relevant intervention functions, and specifying intervention content. The target behaviour was to increase and maintain PA. To obtain a behavioural diagnosis, qualitative evidence was combined with focus groups on the barriers and facilitators to PA in women with GDM. The findings were mapped onto the Capability Opportunity Motivation-Behaviour (COM-B) model and Theoretical Domains Framework to identify what needs to change for the target behaviour and linked to appropriate intervention functions. Finally, behaviour changes techniques (BCT) and modes of delivery that are most likely to serve the intervention functions were selected. Current evidence, patient focus groups and input from key stakeholders informed Stay-Active's development. RESULTS We found that psychological capability, reflective and automatic motivation, social and physical opportunity needed to change to increase PA in women with GDM. The four key intervention functions identified were Enablement, Education, Persuasion and Training. Stay-Active incorporates these four intervention functions delivering ten BCTs including: goal setting, credible source, self-monitoring, action planning, prompts and cues. The final design of Stay-Active delivers these BCTs via an educational resource centre, with goal setting and action planning features, personalised performance feedback and individualised promotional messages. CONCLUSION The BCW has enabled the systematic and comprehensive development of Stay-Active to promote PA in women with GDM within an NHS Maternity service. The next phase is to conduct a trial to assess the feasibility and acceptability of a multi-component intervention that combines Stay-Active with PA Motivational Interviewing.
Collapse
Affiliation(s)
- R Smith
- Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Windmill Road, Oxford, OX3 7LD, UK.
| | - M Michalopoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - H Reid
- Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Windmill Road, Oxford, OX3 7LD, UK
| | - S Payne Riches
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - Y N Wango
- Women's Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Y Kenworthy
- Women's Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - C Roman
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England
| | - M Santos
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England
| | - J E Hirst
- Women's Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, England
| | - L Mackillop
- Women's Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, England
| |
Collapse
|
|
11
|
He J, Chen X, Wang Y, Liu Y, Bai J. The experiences of pregnant women with gestational diabetes mellitus: a systematic review of qualitative evidence. Rev Endocr Metab Disord 2021; 22:777-787. [PMID: 33184736 DOI: 10.1007/s11154-020-09610-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 12/25/2022]
Abstract
Gestational diabetes mellitus (GDM) can have serious adverse effects on pregnant women and their fetuses. The purpose of this systematic review is to explore responses from women diagnosed with GDM and to describe their real-life experiences with self-management during pregnancy. The review provides insight into the physical, psychological, and social experiences of women with GDM; exploring these factors can help identify the challenges of glucose control and may provide targeted care and interventions to improve maternal and child health. Twelve databases were included in the initial article search, which was conducted on February 27, 2019. Two independent reviewers used the JBI Critical Appraisal Checklist for Qualitative Research for methodological validity to assess articles for study inclusion. The final synthesized findings were graded according to the ConQual approach for establishing confidence. Ten studies (totaling 223 pregnant women with GDM), originating from 6 different countries, were included in the review. Of the 223 women, 171 had one pregnancy affected by GDM and 52 had two or more pregnancies affected by GDM. Based on the findings from these studies, three main themes emerged, which were synthesized from 10 separate categories and 46 individual findings: beliefs about illness and health; life-changing experiences and healthy expectations; and difficulties and needs. Both positive and negative experiences of pregnant women with GDM can be understood as a process of "continuous struggle and change". Understanding the experiences of women diagnosed with GDM can provide health care professionals with more knowledge of how women experience GDM and develop feasible interventions to reduce the risk of developing type II diabetes.PROSPERO registration number CRD42019132065.
Collapse
Affiliation(s)
- Jing He
- School of Health Sciences, Wuhan University, No.115, Dong Hu Road, Wuhan, 430071, Hubei, China
| | - Xiaoli Chen
- School of Health Sciences, Wuhan University, No.115, Dong Hu Road, Wuhan, 430071, Hubei, China
| | - Yuchen Wang
- School of Health Sciences, Wuhan University, No.115, Dong Hu Road, Wuhan, 430071, Hubei, China
| | - Yanqun Liu
- School of Health Sciences, Wuhan University, No.115, Dong Hu Road, Wuhan, 430071, Hubei, China.
| | - Jinbing Bai
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, 30322, USA
| |
Collapse
|
|
12
|
Ana Y, Prafulla S, Deepa R, Babu GR. Emerging and Public Health Challenges Existing in Gestational Diabetes Mellitus and Diabetes in Pregnancy. Endocrinol Metab Clin North Am 2021; 50:513-530. [PMID: 34399959 DOI: 10.1016/j.ecl.2021.05.008] [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] [Indexed: 11/30/2022]
Abstract
We review the evidence available worldwide on the various challenges in the screening, management, prevention of gestational diabetes mellitus and diabetes in pregnancy. The use of multiple screening and diagnostic tests prescribed by numerous guidelines is challenging for practitioners. Also, sociocultural, demographic and economic challenges affect the prevention and care. Life-course perspectives need to be adopted, as well as an integrated approach in public health care is essential. Tackling these challenges at each phase of life-course, with development and adherence to the country-specific guidelines by practitioners can decrease the burden of gestational diabetes mellitus and diabetes in pregnancy.
Collapse
Affiliation(s)
- Yamuna Ana
- Public Health Foundation of India, IIPH-H, Bangalore Campus, SIHFW Premises, Beside Leprosy Hospital, 1st Cross, Magadi Road, Bangalore 560023, Karnataka, India
| | - Shriyan Prafulla
- Public Health Foundation of India, IIPH-H, Bangalore Campus, SIHFW Premises, Beside Leprosy Hospital, 1st Cross, Magadi Road, Bangalore 560023, Karnataka, India
| | - Ravi Deepa
- Public Health Foundation of India, IIPH-H, Bangalore Campus, SIHFW Premises, Beside Leprosy Hospital, 1st Cross, Magadi Road, Bangalore 560023, Karnataka, India
| | - Giridhara R Babu
- Lifecourse Epidemiology, Public Health Foundation of India, IIPH-H, Bangalore Campus, SIHFW Premises, Beside Leprosy Hospital, 1st Cross, Magadi Road, Bangalore 560023, Karnataka, India.
| |
Collapse
|
|
13
|
Palnati M, Marcus BH, Pekow P, Rosal MC, Manson JE, Chasan-Taber L. The Impact of a Lifestyle Intervention on Postpartum Weight Retention Among At-Risk Hispanic Women. Am J Prev Med 2021; 61:44-54. [PMID: 33994252 PMCID: PMC8217276 DOI: 10.1016/j.amepre.2021.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION This study assesses the impact of a culturally modified, motivationally targeted, individually tailored intervention on postpartum weight retention among Hispanic women with abnormal glucose tolerance during pregnancy. METHODS Estudio Parto (Project Aiming to Reduce Type twO diabetes) was an RCT conducted in Western Massachusetts (collected 2013‒2017, analyzed 2018-2020). Hispanic women with blood glucose ≥140 mg/dL (7.77 mmol/L) on routine nonfasting oral glucose challenge test were randomized to a Lifestyle Intervention (n=100) focusing on healthy exercise and diet or to a comparison Health and Wellness Intervention (n=104) with no mention of exercise or diet behavior changes. The primary outcome was change in weight, calculated as the difference between prepregnancy weight and 6-week, 6-month, and 12-month postpartum weight. The secondary outcome was achievement of weight reduction to prepregnancy weight if prepregnancy BMI was normal, or a 5% reduction if prepregnancy BMI was overweight/obese. RESULTS In intent-to-treat analyses, there were no significant differences in weight change pattern between the intervention arms across all follow-up timepoints (β=0.03, 95% CI= -3.38, 3.45). However, at 12 months postpartum, women in the Lifestyle Intervention arm had a statistically significant 2.5-fold higher odds of meeting the secondary weight reduction outcome (OR=2.52, 95% CI=1.09, 5.82) than women in the Health and Wellness arm. Regardless of intervention arm, women who reported higher levels of postpartum sports/exercise had a greater decrease in weight (β= -2.39, 95% CI= -4.66, -0.13, p=0.04) than women reporting lower levels. CONCLUSIONS In this randomized trial among Hispanic women, no significant overall differences in weight change pattern between intervention arms were observed. Higher levels of self-reported physical activity were associated with greater weight loss in both arms.
Collapse
Affiliation(s)
- Madhuri Palnati
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Bess H Marcus
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Penelope Pekow
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Milagros C Rosal
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lisa Chasan-Taber
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts.
| |
Collapse
|
|
14
|
Kundu S, Jharna DE, Banna MHA, Khan MSI. Factors associated with dietary diversity and physical activity of pregnant women in Bangladesh: A cross‐sectional study at an antenatal care setting. LIFESTYLE MEDICINE 2021. [DOI: 10.1002/lim2.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Satyajit Kundu
- Department of Biochemistry and Food Analysis Patuakhali Science and Technology University Patuakhali Bangladesh
| | - Dilruba Easmin Jharna
- Department of Biochemistry and Food Analysis Patuakhali Science and Technology University Patuakhali Bangladesh
| | - Md. Hasan Al Banna
- Department of Food Microbiology Patuakhali Science and Technology University Patuakhali Bangladesh
| | - Md Shafiqul Islam Khan
- Department of Food Microbiology Patuakhali Science and Technology University Patuakhali Bangladesh
| |
Collapse
|
|
15
|
Cole SF, Skaczkowski G, Wilson C. The role of illness perceptions and exercise beliefs in exercise engagement during treatment for cancer. Support Care Cancer 2021; 29:5065-5073. [PMID: 33594512 DOI: 10.1007/s00520-021-06055-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/07/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVES This study examined whether exercise beliefs and illness perceptions were associated with changes in exercise behaviour following a cancer diagnosis. DESIGN This study uses a cross-sectional survey of 366 adults with a diagnosis of cancer, who were currently receiving treatment. MAIN OUTCOME MEASURES The main outcome measures are symptom severity, pre- and post-morbid exercise levels, exercise beliefs, and illness perceptions. RESULTS The majority of participants decreased their level of exercise after diagnosis (Decreasers; 58.1%). Approximately a third increased participation (Increasers; 30.4%) and a small group maintained (Maintainers; 9.2%) their pre-diagnosis exercise levels. After controlling for symptom severity and time since cancer diagnosis, Decreasers reported lower Self-Efficacy for exercise, higher levels of belief in the Negative Impact on Cancer of exercise, lower levels of Personal Control, and less Emotional Representation of their illness, than Increasers. Decreasers also reported lower levels of Self-Efficacy for exercise than Maintainers. CONCLUSION The results suggest that identifying unhelpful beliefs about the relationship between exercise and illness during cancer treatment and improving confidence and control of exercise through psycho-educational intervention could be an effective strategy for preventing cancer patients decreasing exercise following their diagnosis.
Collapse
Affiliation(s)
- Siân F Cole
- Olivia Newton-John Cancer Wellness & Research Centre, Austin Hospital, Melbourne, Australia.
- School of Psychology, Charles Sturt University, Bathurst, Australia.
- , Heidelberg, Australia.
| | - Gemma Skaczkowski
- Olivia Newton-John Cancer Wellness & Research Centre, Austin Hospital, Melbourne, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Carlene Wilson
- Olivia Newton-John Cancer Wellness & Research Centre, Austin Hospital, Melbourne, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| |
Collapse
|
|
16
|
Harrison AL, Taylor NF, Frawley HC, Shields N. A consumer co-created infographic improves short-term knowledge about physical activity and self-efficacy to exercise in women with gestational diabetes mellitus: a randomised trial. J Physiother 2020; 66:243-248. [PMID: 33069606 DOI: 10.1016/j.jphys.2020.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/15/2020] [Accepted: 09/23/2020] [Indexed: 12/18/2022] Open
Abstract
QUESTION In women with gestational diabetes mellitus, does the addition of a consumer co-created infographic to usual education about gestational diabetes mellitus improve knowledge about physical activity and self-efficacy to exercise? DESIGN A randomised trial with concealed allocation, a blinded assessor and intention-to-treat analysis. PARTICIPANTS Sixty-nine women diagnosed with gestational diabetes mellitus. INTERVENTION In addition to gestational diabetes education, the experimental group received a paper copy of a consumer co-created infographic about physical activity during a gestational diabetes pregnancy. The control group received gestational diabetes education alone. OUTCOME MEASURES Participants completed outcome measures at baseline and again 1 week later. Knowledge of physical activity in a gestational diabetes mellitus pregnancy was assessed using a 19-item questionnaire modified to reflect current physical activity guidelines, with a total score from 0% (worst) to 100% (best). Self-efficacy was measured using the nine-item Self-Efficacy for Exercise Scale, with a total score from 0 (not confident) to 10 (very confident). RESULTS Provision of the infographic led to a clinically important between-group difference in knowledge (MD 12%, 95% CI 10 to 15) and self-efficacy (MD 2.5 units, 95% CI 1.9 to 3.0). CONCLUSION In women with gestational diabetes mellitus, short-term knowledge about physical activity and self-efficacy to exercise were improved when usual education was supplemented with a consumer co-created infographic that provided specific and relevant information about physical activity during a gestational diabetes mellitus pregnancy. TRIAL REGISTRATION ACTRN12619001207101.
Collapse
Affiliation(s)
- Anne L Harrison
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Australia; Physiotherapy Department, Werribee Mercy Hospital, Melbourne, Australia.
| | - Nicholas F Taylor
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Australia; Allied Health Clinical Research Office, Eastern Health, Melbourne, Australia
| | - Helena C Frawley
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Nora Shields
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Australia
| |
Collapse
|
|
17
|
Mao P, Jiang S, Guo J, Long Q, Zhang H, Chen JL. Do obesity and low levels of physical activity increase the risk for developing type 2 diabetes mellitus among women with prior gestational diabetes in rural China? Res Nurs Health 2020; 43:387-395. [PMID: 32515856 DOI: 10.1002/nur.22043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 03/22/2020] [Accepted: 05/19/2020] [Indexed: 12/15/2022]
Abstract
Moderate-to-vigorous intensity physical activity (MVPA) and obesity play important roles in the development of type 2 diabetes mellitus (T2DM) among women with prior gestational diabetes mellitus (GDM). Yet, how MVPA affects the risk of developing T2DM among women with prior GDM across the different categories of obesity indicators is unclear. This study aimed to describe the levels of postpartum abnormal glucose tolerance (AGT), obesity indicators (body mass index [BMI] and waist circumference [WC]), and MVPA and to explore the independent effect and joint effect of MVPA and obesity indicators (BMI and WC) on the risk for developing AGT among women with prior GDM in rural China. A total of 425 women with prior GDM were recruited from two county-level hospitals in Western and Eastern Hunan, China. Data were collected with self-reported measurements on sociodemographics and clinical factors as well as postpartum weight-related behaviors (physical activity and dietary intake). The 75-g oral glucose tolerance test, weight, height, and WC were measured on site. Binary logistic regression models and multiplitive interaction models were used to explore the independent and joint associations of BMI and MVPA as well as WC and MVPA on AGT, respectively. One-fifth (20.9%) of the sample women had AGT. The obesity indicators were significantly associated with an increased risk of postpartum AGT, but MVPA was not. In joint effect analyses, larger WC and insufficient MVPA were not significantly associated with increased risk of AGT compared with normal WC and sufficient MVPA (mutually adjusted odds ratio [OR], 1.43; 95% confidence interval [CI], 0.46-4.43; p > .05). In joint effect analyses of MVPA and BMI, the mutually adjusted OR for developing AGT in women who were obese and had insufficient MVPA was 4.49 (95% CI, 1.35-14.92; p < .05) compared with normal weight and sufficient MVPA. Adequate weight management and increased MVPA are warranted for Chinese women with prior GDM to prevent T2DM.
Collapse
Affiliation(s)
- Ping Mao
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shan Jiang
- Department of Clinical Nursing, Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jia Guo
- Department of Clinical Nursing, Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Qing Long
- Department of Clinical Nursing, Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Honghui Zhang
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, Chingsha, Hunan, China
| | - Jyu-Lin Chen
- Department of Family Nursing, School of Nursing, University of California, San Francisco, California
| |
Collapse
|
|
18
|
Tinius R, Nagpal TS, Edens K, Duchette C, Blankenship M. Exploring Beliefs About Exercise Among Pregnant Women in Rural Communities. J Midwifery Womens Health 2020; 65:538-545. [PMID: 32277590 DOI: 10.1111/jmwh.13080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Women who are pregnant in rural communities are disproportionally impacted by obesity and sedentary behavior, and this could be related to having negative beliefs about exercise during pregnancy, leading to inactivity. The purpose of this study was to identify self-reported beliefs about exercise among pregnant women in a rural community. METHODS Pregnant participants (N = 70) between 8 and 16 weeks' gestation were recruited from an obstetric clinic serving a rural population. An open-ended questionnaire addressing beliefs about exercise and based on the constructs of the theory of planned behavior was administered. Descriptive survey results were analyzed by calculating means and frequencies. Open-ended responses were assessed by inductive content analysis. RESULTS Commonly reported advantages of exercise during pregnancy included improved perinatal health outcomes and weight management. Commonly reported disadvantages included an increase in fatigue and concerns for maternal and fetal safety. Common facilitators of exercise included access to resources, free time or a decrease in demands from work, and support systems including family and friends. Common barriers to exercise included a lack of time, physical changes including feelings of nausea and fatigue, and lack of access to resources. DISCUSSION This study was the first to report beliefs about exercise during pregnancy in a rural setting. Responses in the current study suggest potential gaps in knowledge of evidence-based information regarding physical activity during pregnancy. Beliefs as well as reported barriers and facilitators of physical activity during pregnancy were similar those reported in other populations. In addition, access to resources (or lack of) appears to be an important facilitator (or barrier) among women in rural settings; thus, developing strategies designed to overcome this barrier, specifically in rural areas, is critically important. Future intervention strategies need to be tailored specifically to the needs of women living in rural areas.
Collapse
Affiliation(s)
- Rachel Tinius
- Exercise Science Program, School of Kinesiology, Recreation, and Sport, Western Kentucky University, Bowling Green, Kentucky
| | - Taniya Singh Nagpal
- School of Kinesiology, Faculty of Health Science, University of Western Ontario, London, Canada
| | - Kolbi Edens
- Exercise Science Program, School of Kinesiology, Recreation, and Sport, Western Kentucky University, Bowling Green, Kentucky
| | - Cathryn Duchette
- Exercise Science Program, School of Kinesiology, Recreation, and Sport, Western Kentucky University, Bowling Green, Kentucky
| | - Maire Blankenship
- School of Nursing and Allied Health, Western Kentucky University, Bowling Green, Kentucky
| |
Collapse
|
|
19
|
Walasik I, Kwiatkowska K, Kosińska Kaczyńska K, Szymusik I. Physical Activity Patterns among 9000 Pregnant Women in Poland: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051771. [PMID: 32182850 PMCID: PMC7084336 DOI: 10.3390/ijerph17051771] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 12/11/2022]
Abstract
The aim was to analyze the knowledge and experience of women regarding physical activity during their latest pregnancy. An anonymous questionnaire was completed electronically, in 2018, by 9345 women who gave birth at least once, with 52% of the women having performed exercises during pregnancy. Physically non-active respondents suffered from gestational hypertension (9.2% vs. 6.7%; p < 0.01) and gave birth prematurely (9% vs. 7%; p < 0.01) to newborns with a low birth weight significantly more often (6% vs. 3.6%; p < 0.001). Physically active women delivered vaginally more often (61% vs. 55%; p < 0.001) and were more likely to have a spontaneous onset of the delivery as compared with non-active women (73.8% vs. 70.7% p = 0.001). The women who were informed by gynaecologist about the beneficial influence of physical activity during pregnancy exercised significantly more often (67% vs. 44% p < 0.001). In addition, 13% of the women felt discrimination due to their physical activity during a pregnancy, 22% of respondents' physical activity was not accepted by their environment, and 39.1% of the women were told by others to stop physical exercise because it was bad for the baby's health. Physical activity during pregnancy is associated with improved fitness, decreased pregnancy ailments occurrence, and therefore influences the course of pregnancy and delivery in a positive way.
Collapse
Affiliation(s)
- Izabela Walasik
- Students Scientific Association at the 1st Department of Obstetrics and Gynecology, First Faculty of Medicine, Medical University of Warsaw, Plac Starynkiewicza 1/3, 02-015 Warsaw, Poland; (I.W.); (K.K.)
| | - Katarzyna Kwiatkowska
- Students Scientific Association at the 1st Department of Obstetrics and Gynecology, First Faculty of Medicine, Medical University of Warsaw, Plac Starynkiewicza 1/3, 02-015 Warsaw, Poland; (I.W.); (K.K.)
| | - Katarzyna Kosińska Kaczyńska
- 2nd Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, Marymoncka st. 99/103, 01-813 Warsaw, Poland
- 1st Department of Obstetrics and Gynecology, First Faculty of Medicine, Medical University of Warsaw, Plac Starynkiewicza 1/3, 02-015 Warsaw, Poland;
- Correspondence: ; Tel.: +48-22-56-90-274
| | - Iwona Szymusik
- 1st Department of Obstetrics and Gynecology, First Faculty of Medicine, Medical University of Warsaw, Plac Starynkiewicza 1/3, 02-015 Warsaw, Poland;
| |
Collapse
|
|
20
|
Burton C, Doyle E, Humber K, Rouxel C, Worner S, Colman R, Palmer S. The biopsychosocial barriers and enablers to being physically active following childbirth: a systematic literature review. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1632049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Catherine Burton
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Emily Doyle
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Kariss Humber
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Camille Rouxel
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Steffany Worner
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | | | - Shea Palmer
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| |
Collapse
|
|
21
|
Knippen KL, Sheu JJ, Oza-Frank R, McBride K, Dake J. Predictors of Health-Protective Behavior and Glycemia After Gestational Diabetes, NHANES 2007-2014. DIABETES EDUCATOR 2019; 45:408-419. [DOI: 10.1177/0145721719848447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose This study examined weight loss behavior and the prevalence of hyperglycemia unawareness (unknown high blood glucose) after gestational diabetes mellitus (GDM), within a nationally, representative sample. This study also examined social-demographic, psychosocial, provider communication, and health care access/utilization factors as predictors of A1C and health-protective behavior after GDM. Methods A secondary analysis of 2007-2014 National Health and Nutrition Examination Surveys (NHANES) data was conducted, including 205 women, aged 20 to 44 years, with a history of GDM, whose last live birth was in the past 10 years, excluding pregnant women and those with diabetes. Weighted bivariate, stepwise linear, and binary logistic regression analyses were conducted to examine correlates of A1C, weight change, weight loss attempt and behavior, diabetes screening, and physical activity. Results Hyperglycemia unawareness was associated with increased A1C and weight gain in the past year. Personal weight loss goal and perception of overweight increased the odds of weight loss attempt. Depressive symptoms were associated with weight gain over the past year. A third of the sample failed to have their glucose tested in the past 3 years. Two-thirds were never told about their personal risk for diabetes, but provider communication increased the odds of meeting weekly activity recommendations and glucose screening. Hispanic women and non-Hispanic black women were less likely to have had glucose screening than non-Hispanic white women. Conclusion Diabetes educators should address gaps in provider communication, while supporting psychosocial needs and reducing disparities to encourage health-protective behavior after GDM. The American Association of Diabetes Educators, 7 Self-Care Behaviors (AADE-7TM) provides an excellent framework for interventions to support health-protective behavior after GDM.
Collapse
Affiliation(s)
- Kerri Lynn Knippen
- Department of Public & Allied Health, Bowling Green State University, Bowling Green, Ohio
| | - Jiunn-Jye Sheu
- School of Population Health, University of Toledo, Toledo, Ohio
| | - Reena Oza-Frank
- Bureau of Maternal, Child and Family Health, Ohio Department of Health, Columbus, Ohio
| | | | - Joseph Dake
- School of Population Health, University of Toledo, Toledo, Ohio
| |
Collapse
|
|
22
|
Purno NH, Thorpe K, Mukerji G, Ray J, Lowe J, Feig DS, Lipscombe LL. Effect of postpartum glucose tolerance results on subsequent weight retention in women with recent gestational diabetes: A retrospective cohort study. Diabetes Res Clin Pract 2019; 151:169-176. [PMID: 31004671 DOI: 10.1016/j.diabres.2019.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/27/2019] [Accepted: 04/12/2019] [Indexed: 01/11/2023]
Abstract
AIMS Glucose tolerance normalizes postpartum in most women with gestational diabetes (GDM), which may provide false reassurance and decrease weight-reducing behaviours. We evaluated whether awareness of normal postpartum glucose tolerance was associated with higher weight retention than being unaware of glucose tolerance. METHODS This cohort study of women with GDM collected survey data during pregnancy and in the first and second postpartum year. We compared women who reported normal glucose tolerance ('aware, normal') in the first year to those reporting no testing or unsure of results ('unaware'). The primary outcome was self-reported weight in the second year compared between groups using multivariable linear regression. RESULTS Among 319 women, 110 (34.5%) were 'aware, normal'; 183 (57.4%) were 'unaware'; and 26 (8.2%) were 'aware, abnormal'. After adjusting for baseline weight and covariates, women with normal results had a mean 3.66 kg higher weight (CI 1.08-6.24 kg, p = 0.0056) by the second year than those unaware of results. CONCLUSIONS Women with GDM with normal postpartum glucose tolerance had significantly higher weight by the second year than those unaware of their results. Normal glucose tolerance after pregnancy may be misinterpreted as resolution of diabetes risk and decrease risk-reducing behaviours.
Collapse
Affiliation(s)
- Nabila H Purno
- Women's College Research Institute, Women's College Hospital, Toronto, Canada; Institute of Health Policy, Management and Evaluation/Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Kevin Thorpe
- Institute of Health Policy, Management and Evaluation/Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Geetha Mukerji
- Women's College Research Institute, Women's College Hospital, Toronto, Canada; Institute of Health Policy, Management and Evaluation/Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Sinai Health System, Toronto, Canada
| | - Joel Ray
- Institute of Health Policy, Management and Evaluation/Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
| | - Julia Lowe
- Women's College Research Institute, Women's College Hospital, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Denice S Feig
- Institute of Health Policy, Management and Evaluation/Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada; Sinai Health System, Toronto, Canada
| | - Lorraine L Lipscombe
- Women's College Research Institute, Women's College Hospital, Toronto, Canada; Institute of Health Policy, Management and Evaluation/Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada.
| |
Collapse
|
|
23
|
Parsons J, Sparrow K, Ismail K, Hunt K, Rogers H, Forbes A. A qualitative study exploring women's health behaviours after a pregnancy with gestational diabetes to inform the development of a diabetes prevention strategy. Diabet Med 2019; 36:203-213. [PMID: 30098217 DOI: 10.1111/dme.13794] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2018] [Indexed: 01/20/2023]
Abstract
AIM To inform targeted interventions for women with gestational diabetes mellitus (GDM) by exploring the factors that influence their health behaviours and their preferences for lifestyle support. METHODS Participants were women with previous GDM taken from a diverse inner-city UK population. Data collection involved focus groups (n = 35 women in six groups) and semi-structured interviews (n = 15 women). The transcribed data were analysed using framework analysis. RESULTS Eight themes relating to factors influencing health behaviour were identified: psychological legacy of pregnancy, relationships with healthcare professionals, physical impacts of pregnancy, social support and cultural norms, life-scheduling, understanding and risk perception, appetite regulation, and prioritization of the baby. The women's recommendations for intervention components included addressing the emotional stress of pregnancy; conveying personalized risk in a motivational way, adopting a family-centered approach, focusing on women's health rather than just the infant's, and developing flexible interventions. These recommendations were used to construct a model integrating the behaviour-regulating factors with a suggested framework for intervention. CONCLUSIONS This study identified some common drivers that may regulate the health behaviours of women following GDM, and recognized some ways to improve care to impact on this. Interventions for diabetes prevention in this population need to address factors at both the individual and systemic levels.
Collapse
Affiliation(s)
- J Parsons
- Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - K Sparrow
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
| | - K Ismail
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
| | - K Hunt
- Diabetes Research Group, Diabetes & Nutritional Sciences Division, King's College London, London, UK
| | - H Rogers
- Diabetes Research Group, Diabetes & Nutritional Sciences Division, King's College London, London, UK
| | - A Forbes
- Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| |
Collapse
|
|
24
|
Harrison AL, Taylor NF, Frawley HC, Shields N. Women with gestational diabetes mellitus want clear and practical messages from credible sources about physical activity during pregnancy: a qualitative study. J Physiother 2019; 65:37-42. [PMID: 30573442 DOI: 10.1016/j.jphys.2018.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/06/2018] [Accepted: 11/19/2018] [Indexed: 01/15/2023] Open
Abstract
QUESTIONS What are the attitudes of women diagnosed with gestational diabetes mellitus (GDM) towards physical activity during pregnancy? What are the perceived barriers to and enablers of physical activity during pregnancy in women with GDM? DESIGN A qualitative study with phenomenology and interpretative description as theoretical frameworks. PARTICIPANTS Pregnant women experiencing an uncomplicated singleton pregnancy, diagnosed with GDM, and aged 18 to 40 years were recruited using purposive sampling. METHOD Semi-structured interviews were recorded, transcribed verbatim and returned to participants for member checking. Three researchers independently and thematically analysed the qualitative data using an inductive method. Data were coded and compared, and themes were developed, discussed and defined. Recruitment continued until data saturation. Emergent themes were sent to participants and peer reviewed for confirmation. RESULTS The participants were 27 women, with mean age 32 years (SD 3), mean gestation 30 weeks (SD 5), mean pre-pregnancy body mass index 26 kg/m2 (SD 5), and born in 10 different countries. The process of communicating information about physical activity (messaging) was the main theme to emerge. Sub-themes included: wanting information about physical activity from credible sources; wanting clear, specific information about safe physical activity during a GDM pregnancy; receiving information at GDM diagnosis because this event triggered women's desire to be more physically active; understanding why physical activity is important to improving outcomes for themselves and their babies; and wanting information about flexible, convenient and practical physical activity options. CONCLUSION To feel confident and safe about being physically active during pregnancy, women with GDM wanted clear, simple and GDM-specific messages from credible sources. Health professionals can support women with a GDM pregnancy with targeted physical activity messages.
Collapse
Affiliation(s)
- Anne L Harrison
- School of Allied Health, La Trobe University, Melbourne, Australia; Physiotherapy Department, Werribee Mercy Hospital, Melbourne, Australia.
| | - Nicholas F Taylor
- School of Allied Health, La Trobe University, Melbourne, Australia; Allied Health Clinical Research Office, Eastern Health, Melbourne, Australia
| | - Helena C Frawley
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Centre for Allied Health Research and Education, Cabrini Health, Melbourne, Australia
| | - Nora Shields
- School of Allied Health, La Trobe University, Melbourne, Australia
| |
Collapse
|
|
25
|
Zilberman-Kravits D, Meyerstein N, Abu-Rabia Y, Wiznitzer A, Harman-Boehm I. The Impact of a Cultural Lifestyle Intervention on Metabolic Parameters After Gestational Diabetes Mellitus A Randomized Controlled Trial. Matern Child Health J 2018; 22:803-811. [PMID: 29411251 DOI: 10.1007/s10995-018-2450-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The prevalence of type 2 diabetes in Israel is increasing in all ethnic groups but most markedly in the Bedouin population. We aimed to assess the effects of a lifestyle change intervention on risk markers for type 2 diabetes after gestational diabetes mellitus (GDM). METHODS One hundred eighty Jewish and Bedouin post-GDM women were randomly assigned to a lifestyle intervention group (IG) or a control group (CG) starting 3-4 months after delivery. The IG participated in healthy lifestyle sessions led by a dietician and a sports instructor for 24 months after delivery. The IG participants had three individual 45-min counseling sessions and four 90-min group meetings (10 women each). The dietary and exercise recommendations were culturally adapted. The primary outcome of the study was HOMA-IR. We monitored clinical and chemical biomarkers 1 and 2 years after delivery. RESULTS After 1 and 2 years of intervention, the metabolic measures improved substantially. The intervention reduced the insulin, glucose and HOMA-IR levels in the IG compared with those in the CG (p < 0.001). CONCLUSIONS This novel culturally tailored lifestyle intervention program significantly improved the metabolic and morphometric indices measured 1 and 2 years after delivery. These results highlight and underscore the importance of effective lifestyle change education following GDM.
Collapse
Affiliation(s)
- Dana Zilberman-Kravits
- Nursing Department, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Yitshak Rager, 8410501, Beer Sheva, Israel.
| | - Naomi Meyerstein
- Department of Physiology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Yones Abu-Rabia
- Diabetes Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Arnon Wiznitzer
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women at the Rabin Medical Center, Petah Tikva, Israel
| | - Ilana Harman-Boehm
- Department of Internal Medicine and Diabetes Unit, Soroka University Medical Center, Beer Sheva, Israel
| |
Collapse
|
|
26
|
Harrison A. Critically Appraised Papers: An aerobic and resistance exercise program can improve glycaemic control in women with gestational diabetes mellitus [commentary]. J Physiother 2018; 64:124. [PMID: 29510898 DOI: 10.1016/j.jphys.2018.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 01/29/2018] [Indexed: 10/17/2022] Open
Affiliation(s)
- Anne Harrison
- Department of Physiotherapy, Werribee Mercy Hospital, Melbourne, Australia
| |
Collapse
|
|
27
|
Jones KE, Yan Y, Colditz GA, Herrick CJ. Prenatal counseling on type 2 diabetes risk, exercise, and nutrition affects the likelihood of postpartum diabetes screening after gestational diabetes. J Perinatol 2018; 38:315-323. [PMID: 29298984 PMCID: PMC5955833 DOI: 10.1038/s41372-017-0035-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 12/03/2017] [Accepted: 12/12/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Screening rates for type 2 diabetes after a pregnancy with gestational diabetes are inadequate. We aimed to determine how prenatal counseling on exercise, nutrition, and type 2 diabetes risk affects postpartum screening for diabetes. METHODS Using Pregnancy Risk Assessment Monitoring System data from Colorado (2009-2011) and Massachusetts (2012-2013), we performed multivariable logistic regression to examine the relationship between prenatal counseling and postpartum screening. RESULTS Among 556 women, prenatal counseling was associated with increased postpartum diabetes screening, after adjusting for age; parity; and receipt of Women, Infants, and Children (WIC) benefits (adjusted odds ratio (AOR) 3.0 [95% CI 1.4-6.5]). This effect was modified by race/ethnicity. Primiparity (AOR 2.2 [95% CI 1.2-4.1]) and advanced maternal age (AOR 2.2 [95% CI 1.2-3.8]) were associated with increased screening, and receiving WIC benefits was associated with decreased screening (AOR 0.5 [95% CI 0.3-0.9]). CONCLUSIONS In women with gestational diabetes, culturally appropriate counseling on future diabetes risk, nutrition, and exercise may enhance postpartum diabetes screening.
Collapse
Affiliation(s)
- Kai E Jones
- Washington University School of Medicine, St. Louis, MO, USA
| | - Yan Yan
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Cynthia J Herrick
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
- Division of Endocrinology, Metabolism and Lipid Research, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| |
Collapse
|
|
28
|
Feig DS, Berger H, Donovan L, Godbout A, Kader T, Keely E, Sanghera R. Diabetes and Pregnancy. Can J Diabetes 2018; 42 Suppl 1:S255-S282. [DOI: 10.1016/j.jcjd.2017.10.038] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
|
29
|
Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review. J Physiother 2018; 64:24-32. [PMID: 29289592 DOI: 10.1016/j.jphys.2017.11.012] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 11/13/2017] [Accepted: 11/15/2017] [Indexed: 12/11/2022] Open
Abstract
QUESTION What are the attitudes, barriers and enablers to physical activity perceived by pregnant women? DESIGN In a systematic literature review, eight electronic databases were searched: AMED, CINAHL, Embase, Joanna Briggs Institute, Medline, PsycInfo, SPORTDiscus (from database inception until June 2016) and PubMed (from 2011 until June 2016). Quantitative data expressed as proportions were meta-analysed. Data collected using Likert scales were synthesised descriptively. Qualitative data were analysed thematically using an inductive approach and content analysis. Findings were categorised as intrapersonal, interpersonal or environmental, based on a social-ecological framework. PARTICIPANTS Pregnant women. INTERVENTION Not applicable. OUTCOME MEASURES Attitudes and perceived barriers and enablers to physical activity during pregnancy. RESULTS Forty-nine articles reporting data from 47 studies (7655 participants) were included. Data were collected using questionnaires, interviews and focus groups. Meta-analyses of proportions showed that pregnant women had positive attitudes towards physical activity, identifying it as important (0.80, 95% CI 0.52 to 0.98), beneficial (0.71, 95% CI 0.58 to 0.83) and safe (0.86, 95% CI 0.79 to 0.92). This was supported by themes emerging in 15 qualitative studies that reported on attitudes (important, 12 studies; beneficial, 10 studies). Barriers to physical activity were predominantly intrapersonal such as fatigue, lack of time and pregnancy discomforts. Frequent enablers included maternal and foetal health benefits (intrapersonal), social support (interpersonal) and pregnancy-specific programs. Few environmental factors were identified. Little information was available about attitudes, barriers and enablers of physical activity for pregnant women with gestational diabetes mellitus who are at risk from inactivity. CONCLUSION Intrapersonal themes were the most frequently reported barriers and enablers to physical activity during pregnancy. Social support also played an enabling role. Person-centred strategies using behaviour change techniques should be used to address intrapersonal and social factors to translate pregnant women's positive attitudes into increased physical activity participation. REGISTRATION PROSPERO CRD42016037643. [Harrison AL, Taylor NF, Shields N, Frawley HC (2018) Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review. Journal of Physiotherapy 64: 24-32].
Collapse
|
|
30
|
Silfee VJ, Haughton CF, Kini N, Lemon SC, Rosal MC. Weight Perceptions and Weight-Related Behaviors among Low Income Postpartum Women. ACTA ACUST UNITED AC 2018; 4. [PMID: 31579301 DOI: 10.23937/2572-4010.1510022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background Minority and low-income women have higher rates of postpartum weight retention, contributing to increased rates of obesity in these populations. Weight perceptions may be an important factor contributing to the adoption of weight-management behaviors. The purpose of this study was to examine the relationships between weight perceptions and weight-related behaviors among overweight low-income women during postpartum enrolled in a weight loss intervention study. Methods This is a cross-sectional analysis of the Fresh Start study baseline data among overweight and obese low-income women during postpartum (N = 132). General linear regression models assessed the association between weight perceptions and energy intake, energy expenditure, self-monitoring, and self-regulation. Results Women who perceived themselves to be very overweight had significantly lower self-regulation (β = -4.0, SE = 1.6, p = 0.014) and higher energy expenditure (β = 1.3, SE = 0.7, p = 0.05) compared to women who perceived themselves to be moderately overweight or a little overweight. There were no significant associations between weight perceptions and self-monitoring or energy intake. Conclusions This study found that weight perceptions among these women are important factors to consider for weight loss. Future research should focus on investigating the impact of tailoring interventions to weight perceptions to impact engagement in weight-related behaviors in diverse low-income women during postpartum.
Collapse
Affiliation(s)
- Valerie J Silfee
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, USA
| | - Christina F Haughton
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, USA
| | - Nisha Kini
- European Medical and Clinical Division, Terumo Europe, Belgium
| | - Stephenie C Lemon
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, USA
| | - Milagros C Rosal
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, USA
| |
Collapse
|
|
31
|
Jelsma JGM, van Poppel MNM, Smith BJ, Cinnadaio N, Bauman A, Tapsell L, Cheung NW, van der Ploeg HP. Changing psychosocial determinants of physical activity and diet in women with a history of gestational diabetes mellitus. Diabetes Metab Res Rev 2018; 34. [PMID: 28843034 DOI: 10.1002/dmrr.2942] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 07/04/2017] [Accepted: 07/17/2017] [Indexed: 11/05/2022]
Abstract
BACKGROUND To investigate how a behavioural lifestyle intervention influences psychosocial determinants of physical activity and dietary behaviours in a population at risk of type 2 diabetes (T2DM). METHODS Fifty-nine women with a body mass index of ≥25 kg/m2 and a history of gestational diabetes mellitus (GDM) participated in a randomized controlled study. The intervention group (n = 29) received 2 face-to-face and 5 telephone lifestyle-counselling sessions with a health professional. The control group (n = 30) received care as usual. At baseline and 6 months, psychosocial determinants related to physical activity and diet were measured with a self-administrated questionnaire. Linear regression analyses were applied to test for intervention effects. RESULTS The intervention was effective in improving social support (β = 3.5, P < 0.001; β = 2.1, P = 0.02), modifying self-efficacy (β = -2.2, P = 0.02; β = -4.3, P < 0.001), and reducing barriers (β = -3.5, P = 0.01; β = -3.8, P = 0.01) for, respectively, physical activity and diet from baseline to 6-month follow-up in the intervention group compared with the control group. The intervention reduced the following barriers to a physically active lifestyle: lack of energy and lack of motivation. Physical activity barriers like lack of time and lack of childcare were unchanged. The intervention reduced the following barriers to a healthy diet: lack of time, costs, having unhealthy snacks at home, and having cravings for sweets. CONCLUSION This lifestyle intervention influenced psychosocial determinants relevant for overweight women with a history of gestational diabetes mellitus (GDM) in prevention of T2DM.
Collapse
Affiliation(s)
- Judith G M Jelsma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, The Netherlands
| | - Mireille N M van Poppel
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, The Netherlands
- Institute of Sport Science, University of Graz, Graz, Austria
| | - Ben J Smith
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Nancy Cinnadaio
- School of Medicine, IIlawarra Health and Medical Research Institute, University of Wollongong, New South Wales, Australia
| | - Adrian Bauman
- Sydney School of Public Health, University of Sydney, New South Wales, Australia
| | - Linda Tapsell
- School of Medicine, IIlawarra Health and Medical Research Institute, University of Wollongong, New South Wales, Australia
| | - N Wah Cheung
- Department of Diabetes and Endocrinology, Westmead Hospital, New South Wales, Australia
| | - Hidde P van der Ploeg
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center Amsterdam, The Netherlands
- Sydney School of Public Health, University of Sydney, New South Wales, Australia
| |
Collapse
|
|
32
|
Svensson L, Nielsen KK, Maindal HT. What is the postpartum experience of Danish women following gestational diabetes? A qualitative exploration. Scand J Caring Sci 2017; 32:756-764. [PMID: 28856697 DOI: 10.1111/scs.12506] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/19/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Women with gestational diabetes mellitus (GDM) receive acute but short-term care during pregnancy. There is less direct support during the postpartum period; women are offered general advice on how to follow a healthy lifestyle to avoid developing future type 2 diabetes. Observational studies suggest that a substantial proportion of women with prior GDM do not sustain recommended lifestyle changes postpartum. In a qualitative study, we examined how Danish women diagnosed with GDM experience the transition from a GDM-affected pregnancy to the postpartum period. METHODS Semistructured interviews with six women diagnosed with GDM. Data were analysed using qualitative content analysis. RESULTS A GDM diagnosis was accompanied by worries about the health of the woman's baby. This was also the driving force behind the women's motivation to engage in lifestyle changes during pregnancy. The outpatient treatment was perceived to be strict and associated with various challenges, including cravings and discomfort. After the delivery, taking care of the baby became the women's dominant focus. Social and emotional support from partners were needed to maintain motivation and prioritise a healthy lifestyle. The women's experience of the health system varied. However, in the postpartum period all the women experienced limited interaction and initiative from their healthcare providers in supporting them to engage in a healthy lifestyle. CONCLUSIONS This study identified barriers and facilitators to sustaining a healthy lifestyle postpartum. Efforts at multiple levels - including the individual, family and health system - are needed to facilitate and support a healthy lifestyle among women with prior GDM.
Collapse
Affiliation(s)
- Line Svensson
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Karoline Kragelund Nielsen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Helle Terkildsen Maindal
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| |
Collapse
|
|
33
|
Smith BJ, Cheung NW, Najnin N, Bauman A, Razee H, Blignault I, van der Ploeg HP. Reliability and Validity of Measures for Investigating the Determinants of Health Behaviors Among Women With a History of Gestational Diabetes. HEALTH EDUCATION & BEHAVIOR 2017; 45:43-51. [DOI: 10.1177/1090198117709315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ben J. Smith
- Monash University, Melbourne, Victoria, Australia
| | - N. Wah Cheung
- Westmead Hospital, Westmead, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | | | - Adrian Bauman
- University of Sydney, Sydney, New South Wales, Australia
| | - Husna Razee
- University of New South Wales, Kensington, New South Wales, Australia
| | - Ilse Blignault
- University of New South Wales, Kensington, New South Wales, Australia
| | | |
Collapse
|
|
34
|
Downs DS, Dinallo JM, Birch LL, Paul IM, Ulbrecht JS. Randomized Face-to-Face vs. Home Exercise Interventions in Pregnant Women with Gestational Diabetes. PSYCHOLOGY OF SPORT AND EXERCISE 2017; 30:73-81. [PMID: 28428728 PMCID: PMC5393351 DOI: 10.1016/j.psychsport.2017.02.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVES Evaluate effects of a theoretically-based, semi-intensive (Face-to-Face; F2F) exercise intervention and minimum-contact (Home) exercise intervention to the standard care (Control) on exercise, its motivational determinants, blood glucose levels, and insulin use of pregnant women with gestational diabetes mellitus (GDM). DESIGN Randomized control trial with two intervention arms and control (standard care). METHOD Participants (N=65) were randomized to a Control (standard prenatal care/GDM dietary counseling), Home (standard care + phone education/support + home exercise), or F2F (standard care + on-site education/support + guided exercise with instructor on 2 days/week) group from ~20 weeks gestation to delivery. Assessments of exercise and motivational determinants were obtained at baseline (20-weeks gestation) and follow-up (32-weeks gestation). Blood glucose levels (fasting/postprandial mg/dL) and insulin use were extrapolated from medical records. RESULTS At the 32-week follow-up, the F2F group had significantly higher exercise min, pedometer steps/day, and motivational determinants (attitude, subjective norm, perceived control, intention) than controls (p's < .05) and significantly higher exercise min and subjective norm than the Home group (p's < .05); these effect sizes were medium-large (η2 = .11-.23). There was a medium effect (η2 = .13) on postprandial blood glucose at 36-weeks gestation with the F2F group having lower values than controls. Although not significant, the F2F group started insulin later (33 weeks gestation) than the Home (27 weeks) and Control (31 weeks) groups. CONCLUSION A theoretically-based, F2F exercise intervention has multiple health benefits and may be the necessary approach for promoting exercise motivation and behavior among GDM women.
Collapse
Affiliation(s)
- Danielle Symons Downs
- Exercise Psychology Laboratory, Department of Kinesiology, The Pennsylvania State University
- Department of Obstetrics and Gynecology, The Pennsylvania State University
| | | | - Leann L Birch
- College of Family and Consumer Sciences, University of Georgia
| | - Ian M Paul
- Department of Pediatrics and Public Health Sciences, The Pennsylvania State University
| | - Jan S Ulbrecht
- Mount Nittany Physician Group, State College, Pennsylvania
- Departments of Biobehavioral Health and Medicine, The Pennsylvania State University
| |
Collapse
|
|
35
|
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: 2.6] [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.
Collapse
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.
| |
Collapse
|
|
36
|
Devlin CA, Huberty J, Downs DS. Influences of prior miscarriage and weight status on perinatal psychological well-being, exercise motivation and behavior. Midwifery 2016; 43:29-36. [PMID: 27838526 PMCID: PMC5314732 DOI: 10.1016/j.midw.2016.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 09/28/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES women who have experienced miscarriage may be at increased risk for elevated depressive and anxiety symptoms in subsequent pregnancies. Exercise may be a useful strategy for coping with these symptoms. Little is known about how miscarriage influences prenatal exercise behavior. The study purpose was to examine the influences of miscarriage history and prepregnancy weight status on pregnant women's psychological health, exercise motivation, and behavior using the Theory of Planned Behavior. PARTICIPANTS/SETTING Pregnant women (N=203; 41 with prior miscarriage; 72 overweight/obese; BMI > 25.0) in the northeast United States. DESIGN Women prospectively reported their depressive/anxiety symptoms and exercise motivation/behavior in the 1st, 2nd, and 3rd trimesters via mailed surveys. Group differences in depressive/anxiety symptoms, exercise behavior, and its motivational determinants were examined using Chi Square analyses and Univariate and Multivariate Analyses of Covariance. MEASUREMENTS AND FINDINGS Women with a history of miscarriage had higher 1st and 2nd trimester depressive/anxiety symptoms and lower 1st trimester attitudes about exercise and 1st and 2nd trimester perceived behavior control than women without a history of miscarriage. Overweight/obese women had higher 1st and 2nd trimester pregnancy depressive/anxiety symptoms, engaged in less prepregnancy exercise, and had lower levels of exercise intention, attitude, and perceived behavior control throughout pregnancy than normal weight women. KEY CONCLUSIONS Women with a history of miscarriage and overweight/obese women have poorer psychological health and lower motivation to exercise during pregnancy than women without a history of miscarriage and normal weight women. IMPLICATIONS FOR PRACTITIONERS Interventions and healthcare provider communications aimed at promoting perinatal exercise behavior and psychological health should take into account pre-pregnancy weight status and pregnancy history to identify strategies to help women, particularly overweight/obese women with a history of miscarriage, to overcome exercise barriers.
Collapse
Affiliation(s)
- Courtenay A Devlin
- Exercise Psychology Laboratory, Department of Kinesiology, Penn State University, University Park, PA, USA.
| | - Jennifer Huberty
- Department of Exercise Science & Health, School of Nutrition Health and Promotion, Arizona State University, Phoenix, AZ, USA
| | - Danielle Symons Downs
- Exercise Psychology Laboratory, Department of Kinesiology, Penn State University, University Park, PA, USA; Department of OBGYN, Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|
|
37
|
Banerjee AT, McTavish S, Ray JG, Gucciardi E, Lowe J, Feig D, Mukerji G, Wu W, Lipscombe LL. Reported Health Behaviour Changes after a Diagnosis of Gestational Diabetes Mellitus among Ethnic Minority Women Living in Canada. J Immigr Minor Health 2016; 18:1334-1342. [PMID: 26289502 DOI: 10.1007/s10903-015-0266-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The aim of this cross-sectional study was to examine differences in health behaviours among ethnic minority and Caucasian women after a diagnosis of gestational diabetes mellitus (GDM). Data were derived from medical charts and a questionnaire among a multi-ethnic cohort of 898 Canadian pregnant women diagnosed with GDM attending prenatal diabetes clinics in Ontario, Canada. Health behaviours were compared between ethnic minority and Caucasian women, adjusting for relevant covariates. The mean age was 33.9 ± 6.1 years; 60.0 % self-reported to be part of an ethnic minority group. After adjustment for socio-demographic, behavioural and clinical characteristics, ethnic minority women were more likely to report reducing their meal portion sizes (odds ratio [OR] 1.98; 95.0 % confidence interval [CI] 1.20-3.26) and increasing their physical activity (OR 1.71; 95.0 % CI 1.12-2.62) in response to a GDM diagnosis compared to Caucasian women. Ethnic minority women were more likely to report changes in health behaviours after a GDM diagnosis. Further research is needed to determine the impact of these findings on maternal health and perinatal outcomes, during and after delivery.
Collapse
Affiliation(s)
- Ananya Tina Banerjee
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Sarah McTavish
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Joel G Ray
- St. Michael's Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Enza Gucciardi
- School of Nutrition, Ryerson University, Toronto, ON, Canada
| | - Julia Lowe
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Denice Feig
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital, Toronto, ON, Canada
| | - Geetha Mukerji
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital, Toronto, ON, Canada
| | - Wei Wu
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Lorraine L Lipscombe
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| |
Collapse
|
|
38
|
Kaiser B, Jeannot E, Razurel C. Determinants of Health Behaviors After Gestational Diabetes Mellitus: A Prospective Cohort Study in Geneva. J Midwifery Womens Health 2016; 61:571-577. [PMID: 27434581 DOI: 10.1111/jmwh.12486] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is one of the most common complications in pregnancy. The objective of this study was to specify the determinants of postpartum physical activity and dietary habits after a pregnancy complicated by GDM in a population of Swiss women. This information will be used to improve health promotion and diabetes prevention interventions for women with a history of GDM. METHODS A prospective cohort study of 173 pregnant women with a diagnosis of GDM was carried out. Quantitative data were collected at the end of pregnancy (T1) and at 6 months postpartum (T3). Bivariate and multivariate logistic regression analysis was conducted to assess associations between the level of healthy lifestyle at 6 months postpartum, clinical and sociodemographic characteristics, motivation to adopt a healthy lifestyle after birth at the end of pregnancy, and postulated psychosocial correlates of health behaviors. RESULTS Multivariate regression analysis showed that only 2 variables were determinants in a low adherence to healthy lifestyle in the postpartum period after GDM: a lower level of social support (odds ratio [OR], 1.5; P < .001) and more perceived barriers to a healthy lifestyle (OR, 1.2; P = .002). DISCUSSION This study shows that, for women who had GDM, the problem of low adherence to a healthy lifestyle to prevent the onset of type 2 diabetes may be secondary to the lack of resources available for the promotion and development of healthy eating habits and regular physical activity. The findings of this study suggest that some women with a history of GDM do not have the means and resources in the postpartum period to apply the advice given during antenatal monitoring.
Collapse
|
|
39
|
Saligheh M, McNamara B, Rooney R. Perceived barriers and enablers of physical activity in postpartum women: a qualitative approach. BMC Pregnancy Childbirth 2016; 16:131. [PMID: 27256279 PMCID: PMC4890285 DOI: 10.1186/s12884-016-0908-x] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 05/13/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Postpartum women's recovery from birth can be assisted through increased physical activity (PA). However, women face substantial barriers to participating in exercise and require support to enable them to benefit from increased PA. METHODS This study sought to explore women's beliefs about and experiences of PA and exercise during the 6 weeks to 12 months postpartum period. A cohort of 14 postpartum women from a survey study of the barriers and enablers to exercise participation agreed to take part in interview sessions to provide an in-depth understanding of the women's perceptions of the postpartum period and their physical activity during this time. RESULTS Findings are presented with reference to the social ecological framework and indicate postpartum women face substantial personal and environmental barriers to PA and exercise participation: fatigue, a lack of motivation and confidence, substantial time constraints, lack of access to affordable and appropriate activities and poor access to public transport. In contrast, enablers such as possessing greater social support, in particular partner support, improved PA and exercise participation. CONCLUSIONS The findings encourage facilitation of exercise through mothers' groups, mothers' exercise clubs or postnatal classes suggesting behavioral and social change is needed. Interaction between individuals, community, organizations and policy makers is required. In addition, the provision of specifically tailored and appropriate exercise programs could potentially enable increased PA in postpartum women, thereby improving their health.
Collapse
Affiliation(s)
- Maryam Saligheh
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Bentley Campus, Curtin University, Perth, WA, Australia.
- Discipline of Exercise and Sport Science, Faculty of Health Sciences, Cumberland Campus, University of Sydney, 75 East St, Lidcombe, NSW, Australia.
| | - Beverley McNamara
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Bentley Campus, Curtin University, Perth, WA, Australia
| | - Rosanna Rooney
- School of Psychology and Speech Pathology, Faculty of Health Sciences, Bentley Campus, Curtin University, Perth, WA, Australia
| |
Collapse
|
|
40
|
Skurnik G, Roche AT, Stuart JJ, Rich-Edwards J, Tsigas E, Levkoff SE, Seely EW. Improving the postpartum care of women with a recent history of preeclampsia: a focus group study. Hypertens Pregnancy 2016; 35:371-81. [PMID: 27043861 DOI: 10.3109/10641955.2016.1154967] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Women with prior preeclampsia are at increased risk of cardiovascular disease (CVD). This study investigated barriers and facilitators toward learning about this link and engaging in lifestyle modifications to reduce this risk. METHODS Four focus groups were held with 14 women within 6 months of a preeclamptic pregnancy. RESULTS Participants were unaware of the link between preeclampsia and CVD, suggested improvements to provider-patient communication, and discussed the benefits of social support and online tracking (weight, blood pressure) in making lifestyle modifications. CONCLUSIONS Solutions offered may improve efforts to modify lifestyle and communication between providers and women about this link.
Collapse
Affiliation(s)
- Geraldine Skurnik
- a Department of Medicine, Division of Endocrinology, Brigham and Women's Hospital, Boston , MA, USA; Harvard Medical School , Boston , MA , USA
| | - Andrea Teresa Roche
- a Department of Medicine, Division of Endocrinology, Brigham and Women's Hospital, Boston , MA, USA; Harvard Medical School , Boston , MA , USA
| | - Jennifer J Stuart
- b Connors Center for Women's Health and Gender Biology , Division of Women's Health, Brigham and Women's Hospital , Boston , MA , USA.,c Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Janet Rich-Edwards
- b Connors Center for Women's Health and Gender Biology , Division of Women's Health, Brigham and Women's Hospital , Boston , MA , USA.,c Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Eleni Tsigas
- d The Preeclampsia Foundation , Melbourne , FL , USA
| | - Sue E Levkoff
- e College of Social Work, University of South Carolina , Columbia , SC , USA
| | - Ellen W Seely
- a Department of Medicine, Division of Endocrinology, Brigham and Women's Hospital, Boston , MA, USA; Harvard Medical School , Boston , MA , USA
| |
Collapse
|
|
41
|
Beliefs, Barriers, and Preferences of European Overweight Women to Adopt a Healthier Lifestyle in Pregnancy to Minimize Risk of Developing Gestational Diabetes Mellitus: An Explorative Study. J Pregnancy 2016; 2016:3435791. [PMID: 26885396 PMCID: PMC4738738 DOI: 10.1155/2016/3435791] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/10/2015] [Accepted: 09/03/2015] [Indexed: 12/16/2022] Open
Abstract
Introduction. We explored beliefs, perceived barriers, and preferences regarding lifestyle changes among overweight European pregnant women to help inform the development of future lifestyle interventions in the prevention of gestational diabetes mellitus. Methods. An explorative mixed methods, two-staged study was conducted to gather information from pregnant European women (BMI ≥ 25 kg/m2). In three European countries 21 interviews were conducted, followed by 71 questionnaires in six other European countries. Content analysis and descriptive and chi-square statistics were applied (p < 0.05). Results. Women preferred to obtain detailed information about their personal risk. The health of their baby was a major motivating factor. Perceived barriers for physical activity included pregnancy-specific issues such as tiredness and experiencing physical complaints. Insufficient time was a barrier more frequently reported by women with children. Abstaining from snacking was identified as a challenge for the majority of women, especially for those without children. Women preferred to obtain support from their partner, as well as health professionals and valued flexible lifestyle programs. Conclusions. Healthcare professionals need to inform overweight pregnant women about their personal risk, discuss lifestyle modification, and assist in weight management. Lifestyle programs should be tailored to the individual, taking into account barriers experienced by overweight first-time mothers and multipara women.
Collapse
|
|
42
|
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]
|
|
43
|
HALSE RHIANNONE, WALLMAN KARENE, DIMMOCK JAMESA, NEWNHAM JOHNP, GUELFI KYMJ. Home-Based Exercise Improves Fitness and Exercise Attitude and Intention in Women with GDM. Med Sci Sports Exerc 2015; 47:1698-704. [DOI: 10.1249/mss.0000000000000587] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
|
44
|
Jindal R, Siddiqui MA, Gupta N, Wangnoo SK. Prevalence of glucose intolerance at 6 weeks postpartum in Indian women with gestational diabetes mellitus. Diabetes Metab Syndr 2015; 9:143-146. [PMID: 25952037 DOI: 10.1016/j.dsx.2015.04.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS Women with a history of gestational diabetes mellitus (GDM) have an increased risk for future glucose intolerance, and should be followed up with subsequent screening for the development of diabetes or pre-diabetes at 6-12 weeks postpartum. We studied the prevalence of glucose intolerance at 6 weeks postpartum in Indian women with GDM diagnosed according to ADA criteria. MATERIALS AND METHODS This longitudinal study, conducted at a tertiary care centre, included 75 Asian-Indian women aged ≥18 years, with a diagnosis of GDM (as per ADA criteria), who were referred to the Endocrine Department at Indraprastha Apollo Hospital, Delhi. A 2-h 75 g oral glucose tolerance test (OGTT) was performed at 6 weeks postpartum. RESULTS Out of the 75 women who had GDM and were recommended an OGTT at 6 weeks postpartum, 17.3% did not return for the test. Out of 62 women, one-third (33.8%) developed an abnormal OGTT at 6 weeks postpartum, while 66.1% had reverted to normal glucose tolerance. Impaired fasting glucose (IFG) was seen in 14.5%, 4.8% had impaired glucose tolerance (IGT), 8% had both IFG and IGT, and 6.4% had overt type 2 diabetes. CONCLUSION Our study emphasizes the need for compulsory follow up OGTT for women with GDM in our part of the world in view of ethnicity and prevailing socio-cultural factors.
Collapse
Affiliation(s)
- Radhika Jindal
- Apollo Centre for Obesity, Diabetes and Endocrinology (ACODE), Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, India.
| | - Mohammad A Siddiqui
- Apollo Centre for Obesity, Diabetes and Endocrinology (ACODE), Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, India
| | - Nitin Gupta
- Apollo Centre for Obesity, Diabetes and Endocrinology (ACODE), Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, India
| | - Subhash K Wangnoo
- Apollo Centre for Obesity, Diabetes and Endocrinology (ACODE), Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, India
| |
Collapse
|
|
45
|
Wasalathanthri S. Attenuating type 2 diabetes with postpartum interventions following gestational diabetes mellitus. World J Diabetes 2015; 6:648-653. [PMID: 25987963 PMCID: PMC4434086 DOI: 10.4239/wjd.v6.i4.648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 02/04/2015] [Accepted: 02/12/2015] [Indexed: 02/05/2023] Open
Abstract
Women with a history of gestational diabetes should be screened during and after the postpartum period because of a high risk for developing type 2 diabetes mellitus. Although differences exist between guidelines practiced throughout various parts of the world, all recommend the use of cutoffs for fasting and/or post-load plasma glucose to diagnose diabetes or pre-diabetes. The use of these glycemic parameters could be optimized when a trend is observed, rather than considering them as isolated values at various time points. As the presence of insulin resistance and beta-cell dysfunction start before glycemic changes are evident, the estimation of insulin sensitivity and beta-cell function by Homeostatic Model Assessment is suggested for women who have additional risk factors for diabetes, such as obesity. Disease-modifying lifestyle intervention should be the first-line strategy to prevent or delay the onset of diabetes in women with a history of gestational diabetes mellitus. Intensive lifestyle interventions are designed to decrease caloric intake and increase physical activity in order to reduce body weight and fat, which will in turn reduce insulin resistance. This article also reviews unique problems of postpartum women, which should be considered when designing and implementing an intervention. Innovative “out of the box” thinking is appreciated, as continued adherence to a program is a challenge to both the women and the health care personnel who deal with them.
Collapse
|
|
46
|
Jones EJ, Peercy M, Woods JC, Parker SP, Jackson T, Mata SA, McCage S, Levkoff SE, Nicklas JM, Seely EW. Identifying postpartum intervention approaches to reduce cardiometabolic risk among American Indian women with prior gestational diabetes, Oklahoma, 2012-2013. Prev Chronic Dis 2015; 12:E45. [PMID: 25837258 PMCID: PMC4383443 DOI: 10.5888/pcd12.140566] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction Innovative approaches are needed to reduce cardiometabolic risk among American Indian women with a history of gestational diabetes. We assessed beliefs of Oklahoma American Indian women about preventing type 2 diabetes and cardiovascular disease after having gestational diabetes. We also assessed barriers and facilitators to healthy lifestyle changes postpartum and intervention approaches that facilitate participation in a postpartum lifestyle program. Methods In partnership with a tribal health system, we conducted a mixed-method study with American Indian women aged 19 to 45 years who had prior gestational diabetes, using questionnaires, focus groups, and individual interviews. Questionnaires were used to identify women’s cardiometabolic risk perceptions and feasibility and acceptability of Internet or mobile phone technology for delivery of a postpartum lifestyle modification program. Focus groups and individual interviews were conducted to identify key perspectives and preferences related to a potential program. Results Participants were 26 women, all of whom completed surveys; 11 women participated in focus group sessions, and 15 participated in individual interviews. Most women believed they would inevitably develop diabetes, cardiovascular disease, or both; however, they were optimistic that they could delay onset with lifestyle change. Most women expressed enthusiasm for a family focused, technology-based intervention that emphasizes the importance of delaying disease onset, provides motivation, and promotes accountability while accommodating women’s competing priorities. Conclusions Our findings suggest that an intervention that uses the Internet, text messaging, or both and that emphasizes the benefits of delaying disease onset should be tested as a novel, culturally relevant approach to reducing rates of diabetes and cardiovascular disease in this high-risk population.
Collapse
Affiliation(s)
- Emily J Jones
- College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA 02125. E-mail:
| | | | - J Cedric Woods
- Institute for New England Native American Studies, University of Massachusetts Boston, Massachusetts
| | - Stephany P Parker
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, Oklahoma
| | | | - Sara A Mata
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, Oklahoma
| | | | - Sue E Levkoff
- College of Social Work, University of South Carolina, Columbia, South Carolina
| | - Jacinda M Nicklas
- Division of General Internal Medicine, University of Colorado School of Medicine, Boulder, Colorado
| | - Ellen W Seely
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
|
47
|
Lindmark A, Smide B, Leksell J. Perception of healthy lifestyle information in women with gestational diabetes. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.150] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
|
48
|
The Power of Believing: Salient Belief Predictors of Exercise Behavior in Normal Weight, Overweight, and Obese Pregnant Women. J Phys Act Health 2014; 12:1168-76. [PMID: 25409425 DOI: 10.1123/jpah.2014-0262] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Nearly 50% of U.S. women enter pregnancy as overweight or obese (OW/OB). There is a critical need to understand how to motivate OW/OB pregnant women for exercise behavior to improve their health and reduce adverse pregnancy outcomes. PURPOSE To examine salient Theory of Planned Behavior belief predictors of normal weight (NW) and OW/OB pregnant women's exercise behavior (EXB) across pregnancy. METHODS Pregnant women (N = 357) self-reported their exercise beliefs and behavior during each pregnancy trimester. Pearson correlations were used to examine exercise beliefs-behavior associations. Stepwise regressions were used to identify trimester (TRI) 1 and TRI 2 belief predictors of TRI 2 and TRI 3 EXB, respectively, for each weight status group. Belief endorsement was examined to identify critical beliefs. RESULTS TRI 1 EXB beliefs explained 58% of the total variance (22% NW, 36% OW/OB) in TRI 2 EXB. TRI 2 EXB beliefs explained 32% of the total variance (17% NW, 15% OW/OB) in TRI 3 EXB. Individual beliefs varied by weight status and trimester. Control beliefs emerged with the lowest endorsement; making them most critical to target for exercise interventions. CONCLUSION Prenatal exercise interventions should be weight status specific and target salient beliefs/barriers unique to the pregnancy trimesters.
Collapse
|
|
49
|
Lipscombe LL, Banerjee AT, McTavish S, Mukerji G, Lowe J, Ray J, Evans M, Feig DS. Readiness for diabetes prevention and barriers to lifestyle change in women with a history of gestational diabetes mellitus: rationale and study design. Diabetes Res Clin Pract 2014; 106:57-66. [PMID: 25154309 DOI: 10.1016/j.diabres.2014.07.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 03/27/2014] [Accepted: 07/20/2014] [Indexed: 01/08/2023]
Abstract
AIMS Women with gestational diabetes mellitus (GDM) have a high risk of future diabetes, which can be prevented with lifestyle modification. Prior diabetes prevention programmes in this population have been limited by lack of adherence. The aim of this study is to evaluate readiness for behaviour change at different time points after GDM diagnosis and identify barriers and facilitators, to inform a lifestyle modification programme specifically designed for this group. The objective of this paper is to present the rationale and methodological design of this study. METHODS The ongoing prospective cohort study has recruited a multi-ethnic cohort of 1353 women with GDM from 7 Ontario, Canada hospitals during their pregnancy. A questionnaire was developed to evaluate stage of readiness for behaviour change, and sociodemographic, psychosocial, and clinical predictors of healthy diet and physical activity. Thus far, 960 women (71%) have completed a baseline survey prior to delivery. Prospective postpartum follow-up is ongoing. We are surveying women at 2 time-points after delivery: 3-12 months postpartum, and 13-24 months postpartum. Survey data will be linked to health care administrative databases for long-term follow-up for diabetes. Qualitative interviews were conducted in a subset of women to gain a deeper understanding of barriers and facilitators to lifestyle change. CONCLUSIONS Our study is a fundamental first step in effectively addressing diabetes prevention in women with GDM. Our findings will aid in the design of a diabetes prevention intervention specifically targeted to women with recent GDM, which can then be evaluated in a clinical trial.
Collapse
Affiliation(s)
- Lorraine L Lipscombe
- Women's College Research Institute, Women's College Hospital, 76 Grenville St., Toronto, ON, Canada M5G 1N8; Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada M5S 1A8; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St. Suite 425, Toronto, ON, Canada M5T 3M6.
| | - Ananya Tina Banerjee
- Women's College Research Institute, Women's College Hospital, 76 Grenville St., Toronto, ON, Canada M5G 1N8
| | - Sarah McTavish
- Women's College Research Institute, Women's College Hospital, 76 Grenville St., Toronto, ON, Canada M5G 1N8
| | - Geetha Mukerji
- Women's College Research Institute, Women's College Hospital, 76 Grenville St., Toronto, ON, Canada M5G 1N8; Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada M5S 1A8
| | - Julia Lowe
- Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada M5S 1A8; Division of Endocrinology and Metabolism, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, Canada M4N 3M5
| | - Joel Ray
- Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada M5S 1A8; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St. Suite 425, Toronto, ON, Canada M5T 3M6; Division of Endocrinology and Metabolism, St. Michael's Hospital, 61 Queen St. East, Toronto, ON, Canada, M5C 2T2; Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada, M5B 1W8
| | - Marilyn Evans
- Faculty of Health Sciences, Western University, Arthur and Sonia Labatt Health Sciences Building, London, ON, Canada N6A 5B9
| | - Denice S Feig
- Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada M5S 1A8; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St. Suite 425, Toronto, ON, Canada M5T 3M6; Division of Endocrinology, Mount Sinai Hospital, 60 Murray Street, Toronto, ON, Canada, M5T 3L9; Department of Obstetrics and Gyencology, University of Toronto, 123 Edward Street, Toronto, ON, Canada, M5G 1E2
| |
Collapse
|
|
50
|
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: 3.1] [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.
Collapse
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
| |
Collapse
|