. 2021 Feb 1;4(3):e00230. doi: 10.1002/edm2.230

Table 1.

Characteristics of included systematic reviews and details and characteristics of interventions

Study details	Systematic review	Participants	Aims	Description of interventions
Author year, context/setting country	Type of studies, number of studies included = n Meta‐analysis (MA), number of studies included in MA = mn Countries of origin of included studies Appraisal of studies, instrument used Reporting of review, checklist used Quality assessment, rating by Joanna Briggs Institute (JBI) checklist (0–11)	Total number = N		Details, characteristics of initiative Mode (of birth) Duration Follow‐up time (FU) Comparator(s) in randomized controlled trials (RCT), for example usual/standard care (UC)
Buelo et al., 2019 (34) Scottish Collaboration for Public Health Research and Policy, School of Health in Social Science, University of Edinburgh, United Kingdom (UK)	Quantitative (aim 1) Qualitative (aim 2) Mixed‐methods synthesis (aim 3) n = 28 RCT 12 Pre‐post studies 6 Interview 10 Australia 7 USA 5 Canada 4 China 1 Spain 1 Cochrane collaborations Risk of Bias Tool (RoB) Critical Appraisal Skills Programme (CASP) Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) checklist JBI 10 1,2,3,4,5,6,7,8,10, 11	Women with previous gestational diabetes (GDM) N = 5,211	Explore Effectiveness of physical activity (PA) interventions to increase PA (reduce risk of diabetes (DM) Factors that women with previous GDM perceive influence their PA How these factors are addressed by the interventions	Lifestyle interventions or PA only (diet, PA, breastfeeding/child nutrition; diet, PA; diet, PA, mental health) Reporting of intervention components and study quality varied greatly Mode Group/individual Telephone, newsletters Websites, postcards, booklet Duration 12 weeks (w)–1 year (y) Follow‐up time (FU) 12 weeks (w)–1 year (y) Comparator(s) UC
Chasan‐Taber (27) Division of Biostatistics & Epidemiology, Dep. of Public Health, School of Public Health & Health Sciences, University of Massachusetts Amherst, MA, USA	Quantitative RCTs n = 9 5 pilot Australia 4 USA 3 China 1 Malaysia 1 No quality assessment JBI 6 1,2,3,8,10,11	Women with previous GDM N = 1,386	Provide researchers and practitioners with a comprehensive overview of RCTs of lifestyle interventions designed to reduce the risk of DM or DM risk factors among women with a history of GDM	Lifestyle interventions (diet, PA, breastfeeding) measured as impact on: T2DM incidence, weight, diet, PA, breastfeeding, and insulin resistance Weight (return to pre‐pregnancy weight if normal). 4/8 studies were conducted among women with current GDM or recent (within 2 m) Diet (healthy eating, low glycaemic index (GI), reduced calories, or <25/30% calories from fat) PA (moderate intensity) 150 min/w, 30 min/day for 3/5 times/w or 10,000 steps/day for 5 days/week Mode Group sessions/Individualized in‐person Telephone; Web‐based, text messaging, emails FU 10–12 months (m) Pilot studies 12 w ‐ 6 m Comparator Control arm or placebo
Dasqupta 2018 (32) Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada	Quantitative Invited core outcome set (COS) review Qualitative synthesis n = 16 Australia 6 USA 6 China 2 Ireland 1 Spain 1 Malaysia 2 Canada 1 No quality assessment JBI 8 1,2,3,4,5,8,10,11	Women with previous GDM N = 5194 7 studies did not specify population	Gain insights on the factors that may enhance penetration and participation in Diabetes After Pregnancy prevention after GDM. Examine recruitment strategies and context	The Health Behaviour Change (HBC) after pregnancy interventions varied: 2 focused on PA only, incorporating pedometers 4 adapted the US Diabetes Prevention Program (DPP) 5 PA, healthy eating and breastfeeding 1 followed the Finnish‐DPS curriculum, emphasis on a low‐fat diet 1 adopted Mediterranean diet type of approach 1 compared low‐fat to a low‐GI diet 1 incorporated group cooking lessons Mode face‐to‐face, group lessons telephone contact Web‐based
Dennison 2019 (40) Primary Care Unit, Department of Public Health and Primary Care, Cambridge, UK	Qualitative studies n = 21 Australia 7 Tonga 1 Canada 3 Sweden 3 USA 5 UK 1 Ireland 1 Denmark 1 CASP all studies 8/10 JBI 10 (all but 9)	Women with previous GDM N = 903	Systematically synthesize the literature that focuses on the views of women with a history of GDM on reducing their risk of developing DM pp through lifestyle and behaviour changes.	Lifestyle and behaviour changes
Feng 2018 (26) Departments of Nutrition and Nursing, Sir Run Shaw Hospital, School of Medicine Zhejiang University, Hangzhou, China	Quantitative +MA n = 13 mn = 13 Prospective 6 Retrospective 7 USA 6, Ireland 1 Korea 2, Germany 1, Belgium 1, Australia 1, Italy1 New Castle‐Ottawa Scale PRISMA checklist JBI 10 1,2,3,4,5,6,7,8,9,11	Women with previous GDM N = 122,877 Sample size from 91–116,671	Investigate the association between lactation and development of type 2 DM in women with prior GDM.	Breastfeeding Duration 4–12 week FU 6 weeks−19 years Comparator No breastfeeding Breastfeeding <2–3 w
Gilinsky 2015 (27) School of Psychological & Health Sciences, UK	Quantitative +MA n = 13 mn = 11 RCTs 10 RCT cross‐over 1 Pre‐post 2 USA 5 Australia 5 China 1 Hong Kong 1 Malaysia 1 RoB 3/13 rated as low bias risk. PRISMA checklist JBI 8 1,2,3,4,5,6,8,9	Women with previous GDM N = 1,960	Review lifestyle interventions for women with prior GDM to report study characteristics, intervention design and study quality and explore changes in Diet, PA, and sedentary behaviour Anthropometric outcomes Glycaemic control and DM risk	Lifestyle PA and/or diet Breastfeeding Mode Face‐to‐face counselling Web‐based pedometer Telephone‐based education Group PA/education Electronic (SMS text/e‐mail) Newsletters Breastfeeding counselling 5‐day meal plan Free child care FU 6w−6y Comparator UC/no treatment Metformin and placebo Information on conventional dietary recommendations Written materials, two face‐to‐face education lessons (baseline, annually via phone/mail) Both groups advised to PA regularly (30 min, 3 times/w) Participants = own comparator
Goveia 2018 (29) Postgraduate Program in Epidemiology, Universidad Federal do Rio Grande do Sul, Porto Alegre, Brazil	Quantitative +MA n = 15 mn = 8 RCTs 15 USA 3, Australia 4, China 4, Spain 1, Malaysia 1, Israel 1, Ireland 1 RoB PRISMA checklist JBI 11	Women with previous GDM N = 2730	Compared lifestyle interventions: diet, PA or breastfeeding pp with UC without pharmacological treatment	Lifestyle interventions focused on changes in diet and PA. 3 only PA, 1 only on diet, 1 only on breastfeeding Mode 9 remote contact (phone, Internet, or postcards) 4 group sessions 11 individual face‐to‐face sessions (2 of these home visits, 9 held in the clinic). Duration Varied FU 3 m−7 years Comparator Standard/brief advice on diet and/or PA
Guo 2016 (30) School of Nursing, Central South University, Changsha, China.	Quantitative n = 12 6 pilot/feasibility RCTs 12 Australia 4 USA 3 China 4 Malaysia 1 The Cochrane RoB Methodological rigour of included studies PRISMA checklist JBI 10 1,2,3,4,5,6,7,8,10, 11	Women with previous GDM N = 2757 8: pp women with impaired glucose tolerance /impaired FBG or insufficient PA 10: pp women (4: 6 w pp 1: 2 y pp 4: 3 y pp 1: 4 y pp 2)	Systematically examine the components and effectiveness of pp lifestyle interventions in preventing T2DM in women with prior GDM Explore components of interventions that demonstrated a moderate effect on related measures of type 2 DM, insulin resistance, and weight.	Lifestyle interventions Mode PA (1 individual counselling +pedometer+ 5 telephone contacts +7 postcards) PA and psychosocial support (13 sessions, education, pedometer messaging, Internet forum) Diet (1 individual low‐GI diet education +2 handouts) (3 m sessions +dietary advice sheet reminders of PA) Diet and PA (8 individual meetings +2 tel. contacts) (6 home visits+3 tel. contacts) (7 individual sessions) Diet, PA, and psychosocial support (4 individual/tel. sessions) (self‐help booklet+10 tel. sessions) Diet, PA, and breastfeeding (6 tel.+ 2 individual+8 optional tel. sessions+3 tel. contacts) Diet, PA, and behaviour modification (16 individual meetings+3 group sessions) Duration 12 weeks−36 months (median 6 months). FU 3–69 months Comparator Basic advice, written lifestyle recommendations, infant safety, and general health Conventional healthy dietary recommendation. Standard dietary advice sheet and reminding of need for PA Health education materials Oral information about awareness of DM
Jones 2017 (18) Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, USA	Quantitative studies RCTs n = 10 2 = protocols, no findings USA 5 Australian 4 Canada 1 The Cochrane Collaboration RoB JBI 8 1,2,3,4,5,6,10,11	Women with previous GDM N = 520 N = 3,140 incl. protocols	Synthesize current knowledge and practices around tailoring multimodal interventions for situational and cultural relevance to reduce type 2 DM risk in women with prior GDM.	Multimodal home‐based lifestyle modification intervention Theoretical framework/underpinning interventions 4/8 Social cognitive theory 2/8 Trans theoretical model 4/8 No specific theory reported; relevant constructs: self‐efficacy, risk perception, perceived benefits and barriers, health beliefs, self‐regulation, behavioural goals, social support, barriers to change Mode 7 Motivational interviewing or patient‐cantered counselling with experts 6 tel., 5 supplementary face‐to‐face sessions 4 mailings, 3 website, 2 supplementary text messages Duration Interventions are divided into 3 distinct phases: Prenatal (3‐trimester; 10‐14w) Early pp (6 weeks−6 months) Late pp (6–12 months) FU 3–12 months Comparator UC
Kaiser 2013 (35) Midwifery. University of Applied Sciences, Geneva, Switzerland	Mixed n = 18 Cross‐sectional surveys = 10 Cross‐sectional, and interviews = 8 Australia 8, Canada 2, USA 7, Sweden 1 No quality assessment JBI 9 1,2,3,4,5,6,7,10,11	Women with GDM N = 19847 Sample sizes 10–17,742	To describe the most significant findings of the studies that examined the prevalence and determinants of pp health behaviours (PA, dietary habits and/or weight loss) in patients with GDM	Identify factors that may impact the adherence to health behaviours specific for GDM patients What are the determinants of adherence or not to adequate pp health behaviours (PA, dietary habits, weight loss) and their potential determinants after GDM. Mode N/A Duration N/A FU 4 weeks−5 years
Middleton 2014 (31) Australian Research Centre for Health of Women and Babies, New Zealand	Cochrane review n = 1 RCT The Cochrane guideline GRADE JBI 10 1,2,3,4,5,6,7,9,10, 11	Women with a diagnosis of GDM in the index pregnancy. N = 256	To assess the effects of reminder systems to increase uptake of testing for T2DM or impaired glucose tolerance in women with a history of GDM.	Reminders of any modality (post, email, phone (direct call or short SMS text) to either women with a history of GDM or their health professional, or both. Mode 3 m pp postal reminders 1) to the woman only, 2) to the physician only, 3) to both. Women and physicians were contacted 3 times during 1 y FU Duration 1 y FU 1 y Comparator No reminder
Morton 2014 (25) Women's Health Research Unit London, UK	Mixed studies n = 11 RCTs 6 Observational 5 RoB JBI 9 1,2,3,4,5,6,7,10,11	Women with GDM. N = 10,968	Assess the effectiveness of various interventions that delay or arrest the progression from GDM to T2DM.	PA and/or dietary recommendation Breastfeeding Pharmacological interventions – Metformin Troglitazone 200 or 400 mg Pioglitazone 45 mg/day for 3 years Mode Advice by telephone, Individual counselling, lessons Recommendation Monitoring Food‐frequency questionnaire on DM by 14 years Questionnaires to calculate weekly energy expended in metabolic equivalent hours Duration FU 12 weeks−16 years Comparator No control/No intervention/ Placebo No breastfeeding (Ziegler)/ Women without GDM (Ratner) Routine advice on diet and PA plus low glycaemic dietary advice (Shyam) Alternate (Mediterranean) diet, approaches to hypertension (DASH) and healthy eating index (Tobias) Intensive advice diet, PA 3 m tel routine advice (Wein)
Nielsen 2014 (36) Department of International Health, Immunology and Microbiology, University of Copenhagen, Denmark	Mixed n = 58 RCTs, cohort, cross‐sectional, and qualitative studies Majority from high‐income countries: USA 28 Canada 8 Australia 10 New Zealand 1 Europe 7 No quality assessment JBI 5 1,2,5,10,11	Women with GDM N = 82,556 (1,053,345) N = 82,283 36 studies focusing on pp FU. (N = 273 15 studies focusing on GDM treatment) (N = 970,789 12 studies focusing on screening)	Investigate determinants and barriers to GDM care from initial screening and diagnosis to prenatal treatment and pp FU.	Screening during pregnancy Treatment of GDM during pregnancy and pp FU Healthy pp lifestyle interventions (diet or exercise)
Peacock 2014 (37) School of Nursing and Midwifery, Faculty of Health Sciences, The University of Queensland, Australia	Mixed quantitative/qualitative studies n = 30 RCTs 8 Observational 5 Cross‐sectional 8 Qualitative: Thematic Descriptive interpretive Modified grounded theory USA 11 Australia 11 Canada 2 Spain 1 Denmark 1 CONSORT (quality assessment of RCTs) JBI 9 1,2,3,4,5,6,8,10,11	Women previously diagnosed with GDM N = 184,502 Sample size: 10–177,420	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	Behavioural and pharmacological interventions intended to reduce maternal risk of T2DM
Pedersen 2017 (20) Public Health, Section for Health Promotion and Health Services, Aarhus University, Denmark	Quantitative +MA n = 10 RCTs = 9 Cluster RCT = 1, (44 medical centres, N = 2280) mn = 4 (951) Narrative synthesis Australia 4 USA 3 Asia 2 Europa 1 No quality assessment tool PRISMA checklist JBI 8 1,2,3,4,6,7,10,11	Women with a GDM diagnosis in the last pregnancy N = 3636	Review the evidence of effective behavioural interventions seeking to prevent T2DM	T2DM preventive health behaviours among women with previous GDM Behavioural interventions implemented within 2 years of the pp period PA +diet 5 trials measured effect on DM incidence FU 1y – approximately 4y
Tanase‐Nakao 2018 (33) Division of Maternal Medicine, Center for Maternal Foetal, Neonatal and Reproductive Medicine, Japan	Quantitative n = 9 Observational: 3 prospective cohort 4 cross‐sectional 2 retrospective cohorts (case control) USA 7 Germany 1 Korea 1 Data synthesis conducted by random‐effect MA Risk of Bias Assessment tool for non‐randomized studies (RoBANS) MOOSE guidelines JBI 9 1,2,3,4,5,6,7,8,9	Women with previous GDM N = 3,699	Review current findings on breastfeeding for type 2 DM prevention	Breastfeeding Duration FU 4 weeks – 5 years
Van den Heuvel 2018 (38) Division of Woman and Baby, University Medical Center Utrecht Netherlands	Mixed Narrative overview of the literature n = 71 No quality assessment JBI 6 1,2,3,7,10,11	Women prenatal, peri‐, and post‐ care	Provide a comprehensive and contemporary overview of the literature on eHealth in perinatal care and assess the applicability, advantages, limitations, and future of this new generation of pregnancy care	Electronic health (eHealth) including Web‐based informative programs, remote monitoring, tele‐consultation, and mobile device–supported care Mode eHealth, telemedicine
Van Ryswyk 2015 (39) Robinson Research Institute, The University of Adelaide, Australia	Mixed n = 42 Survey‐only 15 Interviews 18 Interviews and surveys 4 Interviews and focus groups 3 Focus groups 2 United States 12 Australia 10, Europe/UK 9 Canada 7 Brazil 2 Vietnam 1 Tonga 1 CASP PRISMA checklist JBI 9 1,2,3,4,5,6,7,10,11	Women with previous GDM N = 7,949	Identify factors that influence pp healthcare seeking for women who have experienced GDM through synthesis of results from qualitative and survey studies

Study details

Systematic review

Participants

Aims

Description of interventions

Author year, context/setting country

Type of studies, number of studies included = n

Meta‐analysis (MA), number of studies included in MA = mn

Countries of origin of included studies

Appraisal of studies, instrument used

Reporting of review, checklist used

Quality assessment, rating by Joanna Briggs Institute (JBI) checklist (0–11)

Total number = N

Details, characteristics of initiative

Mode (of birth)

Duration

Follow‐up time (FU)

Comparator(s) in randomized controlled trials (RCT), for example usual/standard care (UC)

Buelo et al., 2019 (34)

Scottish Collaboration for Public Health Research and Policy, School of Health in Social Science, University of Edinburgh, United Kingdom (UK)

Quantitative (aim 1) Qualitative (aim 2) Mixed‐methods synthesis (aim 3)

n = 28

RCT 12

Pre‐post studies 6

Interview 10

Australia 7

USA 5

Canada 4

China 1

Spain 1

Cochrane collaborations Risk of Bias Tool

(RoB)

Critical Appraisal

Skills Programme (CASP)

Preferred Reporting Items for Systematic Reviews and Meta‐Analyses

(PRISMA) checklist

JBI 10

1,2,3,4,5,6,7,8,10, 11

Women with previous gestational diabetes (GDM)

N = 5,211

Explore

Effectiveness of physical activity (PA) interventions to increase PA (reduce risk of diabetes (DM)
Factors that women with previous GDM perceive influence their PA
How these factors are addressed by the interventions

Lifestyle interventions or PA only (diet, PA, breastfeeding/child nutrition; diet, PA; diet, PA, mental health)

Reporting of intervention components and study quality varied greatly

Mode

Group/individual

Telephone, newsletters

Websites, postcards, booklet

Duration

12 weeks (w)–1 year (y)

Follow‐up time (FU)

12 weeks (w)–1 year (y)

Comparator(s)

Chasan‐Taber (27)

Division of Biostatistics & Epidemiology, Dep. of Public Health, School of Public Health & Health Sciences, University of Massachusetts Amherst, MA, USA

Quantitative

RCTs

n = 9

5 pilot

Australia 4

USA 3

China 1

Malaysia 1

No quality assessment

JBI 6

1,2,3,8,10,11

Women with previous GDM

N = 1,386

Provide researchers and practitioners with a comprehensive overview of RCTs of lifestyle interventions designed to reduce the risk of DM or DM risk factors among women with a history of GDM

Lifestyle interventions (diet, PA, breastfeeding) measured as impact on:

T2DM incidence, weight, diet, PA, breastfeeding, and insulin resistance

Weight (return to pre‐pregnancy weight if normal).

4/8 studies were conducted among women with current GDM or recent (within 2 m)

Diet (healthy eating, low glycaemic index (GI), reduced calories, or <25/30% calories from fat)

PA (moderate intensity)

150 min/w, 30 min/day for 3/5 times/w or 10,000 steps/day for 5 days/week

Mode

Group sessions/Individualized in‐person

Telephone; Web‐based, text messaging, emails

10–12 months (m)

Pilot studies 12 w ‐ 6 m

Comparator

Control arm or placebo

Dasqupta 2018 (32)

Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada

Quantitative

Invited core outcome set (COS) review

Qualitative synthesis

n = 16

Australia 6

USA 6

China 2

Ireland 1

Spain 1

Malaysia 2

Canada 1

No quality assessment

JBI 8 1,2,3,4,5,8,10,11

Women with previous GDM

N = 5194

7 studies did not specify population

Gain insights on the factors that may enhance penetration and participation in Diabetes After Pregnancy prevention after GDM.

Examine recruitment strategies and context

The Health Behaviour Change (HBC) after pregnancy interventions varied:

2 focused on PA only, incorporating pedometers

4 adapted the US Diabetes Prevention Program (DPP)

5 PA, healthy eating and breastfeeding

1 followed the Finnish‐DPS curriculum, emphasis on a low‐fat diet

1 adopted Mediterranean diet type of approach

1 compared low‐fat to a low‐GI diet

1 incorporated group cooking lessons

Mode

face‐to‐face, group lessons

telephone contact

Web‐based

Dennison 2019 (40)

Primary Care Unit, Department of Public Health and Primary Care, Cambridge, UK

Qualitative studies

n = 21

Australia 7

Tonga 1

Canada 3

Sweden 3

USA 5

UK 1

Ireland 1

Denmark 1

CASP all studies 8/10

JBI 10

(all but 9)

Women with previous GDM

N = 903

Systematically synthesize the literature that focuses on the views of women with a history of GDM on reducing their risk of developing DM pp through lifestyle and behaviour changes.

Lifestyle and behaviour changes

Feng 2018 (26)

Departments of Nutrition and Nursing, Sir Run

Shaw Hospital, School of Medicine Zhejiang University, Hangzhou, China

Quantitative +MA

n = 13

mn = 13

Prospective 6

Retrospective 7

USA 6, Ireland 1

Korea 2, Germany 1, Belgium 1, Australia 1, Italy1

New Castle‐Ottawa Scale

PRISMA checklist

JBI 10

1,2,3,4,5,6,7,8,9,11

Women with previous GDM

N = 122,877

Sample size from 91–116,671

Investigate the association between lactation and development of type 2 DM in women with prior GDM.

Breastfeeding

Duration

4–12 week

6 weeks−19 years

Comparator

No breastfeeding

Breastfeeding <2–3 w

Gilinsky 2015 (27)

School of Psychological & Health Sciences, UK

Quantitative +MA

n = 13

mn = 11

RCTs 10

RCT cross‐over 1

Pre‐post 2

USA 5

Australia 5

China 1

Hong Kong 1

Malaysia 1

RoB

3/13 rated as low bias risk.

PRISMA checklist

JBI 8

1,2,3,4,5,6,8,9

Women with previous GDM

N = 1,960

Review lifestyle interventions for women with prior GDM to report study characteristics, intervention design and study quality and explore changes in

Diet, PA, and sedentary behaviour
Anthropometric outcomes
Glycaemic control and DM risk

Lifestyle

PA and/or diet

Breastfeeding

Mode

Face‐to‐face counselling

Web‐based pedometer

Telephone‐based education

Group PA/education

Electronic (SMS text/e‐mail)

Newsletters

Breastfeeding counselling

5‐day meal plan

Free child care

6w−6y

Comparator

UC/no treatment

Metformin and placebo

Information on conventional dietary recommendations

Written materials, two face‐to‐face education lessons (baseline, annually via phone/mail)

Both groups advised to PA regularly (30 min, 3 times/w)

Participants = own comparator

Goveia 2018 (29)

Postgraduate Program in Epidemiology, Universidad Federal do Rio Grande do Sul, Porto Alegre, Brazil

Quantitative +MA

n = 15

mn = 8

RCTs 15

USA 3, Australia 4, China 4, Spain 1, Malaysia 1, Israel 1, Ireland 1

RoB PRISMA checklist

JBI 11

Women with previous GDM

N = 2730

Compared lifestyle interventions: diet, PA or breastfeeding pp with UC without pharmacological treatment

Lifestyle interventions focused on changes in diet and PA.

3 only PA, 1 only on diet, 1 only on breastfeeding

Mode

9 remote contact (phone, Internet, or postcards)

4 group sessions

11 individual face‐to‐face sessions

(2 of these home visits, 9 held in the clinic).

Duration

Varied

3 m−7 years

Comparator

Standard/brief advice on diet and/or PA

Guo 2016 (30)

School of Nursing, Central South University, Changsha, China.

Quantitative

n = 12

6 pilot/feasibility

RCTs 12

Australia 4

USA 3

China 4

Malaysia 1

The Cochrane RoB

Methodological rigour of included studies

PRISMA checklist

JBI 10

1,2,3,4,5,6,7,8,10, 11

Women with previous GDM

N = 2757

8: pp women with impaired glucose tolerance /impaired FBG or insufficient

10: pp women

(4: 6 w pp

1: 2 y pp

4: 3 y pp

1: 4 y pp 2)

Systematically examine the components and effectiveness of pp lifestyle interventions in preventing T2DM in women with prior GDM

Explore components of interventions that demonstrated a moderate effect on related measures of type 2 DM, insulin resistance, and weight.

Lifestyle interventions

Mode

PA (1 individual counselling +pedometer+

5 telephone contacts +7 postcards)

PA and psychosocial support (13 sessions, education, pedometer messaging, Internet forum)

Diet (1 individual low‐GI diet education +2 handouts)

(3 m sessions +dietary advice sheet reminders of PA)

Diet and PA (8 individual meetings +2 tel. contacts)

(6 home visits+3 tel. contacts)

(7 individual sessions)

Diet, PA, and psychosocial support (4 individual/tel. sessions)

(self‐help booklet+10 tel. sessions)

Diet, PA, and breastfeeding (6 tel.+ 2 individual+8 optional tel. sessions+3 tel. contacts)

Diet, PA, and behaviour modification (16 individual meetings+3 group sessions)

Duration

12 weeks−36 months (median 6 months).

3–69 months

Comparator

Basic advice, written lifestyle recommendations,

infant safety, and general health

Conventional healthy dietary recommendation.

Standard dietary advice sheet and reminding of need for PA

Health education materials

Oral information about awareness of DM

Jones 2017 (18)

Department of Nursing, College of Nursing and Health

Sciences, University of Massachusetts Boston, USA

Quantitative studies

RCTs

n = 10

2 = protocols, no findings

USA 5

Australian 4

Canada 1

The Cochrane Collaboration RoB

JBI 8

1,2,3,4,5,6,10,11

Women with previous GDM

N = 520

N = 3,140 incl. protocols

Synthesize current knowledge and practices around tailoring multimodal interventions for situational and cultural relevance to reduce type 2 DM risk in women with prior GDM.

Multimodal home‐based lifestyle modification intervention

Theoretical framework/underpinning interventions

4/8 Social cognitive theory

2/8 Trans theoretical model

4/8 No specific theory reported; relevant constructs: self‐efficacy, risk perception, perceived benefits and barriers, health beliefs, self‐regulation, behavioural goals, social support, barriers to change

Mode

7 Motivational interviewing or patient‐cantered counselling with experts

6 tel., 5 supplementary face‐to‐face sessions

4 mailings, 3 website, 2 supplementary text messages

Duration

Interventions are divided into 3 distinct phases:

Prenatal (3‐trimester; 10‐14w)

Early pp (6 weeks−6 months)

Late pp (6–12 months)

3–12 months

Comparator

Kaiser

2013 (35)

Midwifery.

University of Applied Sciences, Geneva, Switzerland

Mixed

n = 18

Cross‐sectional surveys = 10

Cross‐sectional, and interviews = 8

Australia 8, Canada 2, USA 7, Sweden 1

No quality assessment

JBI 9

1,2,3,4,5,6,7,10,11

Women with GDM

N = 19847

Sample sizes

10–17,742

To describe the most significant findings of the studies that examined the prevalence and determinants of pp health behaviours (PA, dietary habits and/or weight loss) in patients with GDM

Identify factors that may impact the adherence to health behaviours specific for GDM patients

What are the determinants of adherence or not to adequate pp health behaviours (PA, dietary habits, weight loss) and their potential determinants after GDM.

Mode

N/A

Duration

N/A

4 weeks−5 years

Middleton 2014 (31)

Australian Research Centre for Health of Women and Babies, New Zealand

Cochrane review

n = 1

RCT

The Cochrane guideline

GRADE

JBI 10

1,2,3,4,5,6,7,9,10, 11

Women with a diagnosis of GDM in the index pregnancy.

N = 256

To assess the effects of reminder systems to increase uptake of testing for T2DM or impaired glucose tolerance in women with a history of GDM.

Reminders of any modality (post, email, phone (direct call or short SMS text) to either women with a history of GDM or their health professional, or both.

Mode

3 m pp postal reminders

1) to the woman only, 2) to the physician only, 3) to both.

Women and physicians were contacted 3 times during 1 y FU

Duration

1 y

Comparator

No reminder

Morton 2014 (25)

Women's Health

Research Unit

London, UK

Mixed studies

n = 11

RCTs 6

Observational 5

RoB

JBI 9

1,2,3,4,5,6,7,10,11

Women with GDM.

N = 10,968

Assess the effectiveness of various interventions that delay or arrest the progression from GDM to T2DM.

PA and/or dietary recommendation

Breastfeeding

Pharmacological interventions – Metformin

Troglitazone 200 or 400 mg

Pioglitazone 45 mg/day for 3 years

Mode

Advice by telephone, Individual counselling, lessons

Recommendation

Monitoring

Food‐frequency questionnaire on DM by 14 years

Questionnaires to calculate weekly energy expended in metabolic equivalent hours

Duration

12 weeks−16 years

Comparator

No control/No intervention/ Placebo

No breastfeeding (Ziegler)/ Women without GDM (Ratner)

Routine advice on diet and PA plus low glycaemic dietary advice (Shyam)

Alternate (Mediterranean) diet, approaches to hypertension (DASH) and healthy eating index (Tobias)

Intensive advice diet, PA 3 m tel routine advice (Wein)

Nielsen 2014 (36)

Department of International Health, Immunology and Microbiology, University of Copenhagen, Denmark

Mixed

n = 58

RCTs, cohort, cross‐sectional, and qualitative studies

Majority from high‐income countries:

USA 28

Canada 8

Australia 10

New Zealand 1

Europe 7

No quality assessment

JBI 5

1,2,5,10,11

Women with GDM

N = 82,556

(1,053,345)

N = 82,283

36 studies focusing on pp FU.

(N = 273

15 studies focusing on GDM treatment)

(N = 970,789

12 studies focusing on screening)

Investigate determinants and barriers to GDM care from initial screening and diagnosis to prenatal treatment and pp FU.

Screening during pregnancy

Treatment of GDM during pregnancy and pp FU

Healthy pp lifestyle interventions (diet or exercise)

Peacock 2014 (37)

School of Nursing and Midwifery, Faculty of Health Sciences, The University of Queensland, Australia

Mixed quantitative/qualitative studies

n = 30

RCTs 8

Observational 5

Cross‐sectional 8

Qualitative:

Thematic

Descriptive interpretive

Modified grounded theory

USA 11

Australia 11

Canada 2

Spain 1

Denmark 1

CONSORT (quality assessment of RCTs)

JBI 9

1,2,3,4,5,6,8,10,11

Women previously diagnosed with GDM

N = 184,502

Sample size:

10–177,420

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

Behavioural and pharmacological interventions intended to reduce maternal risk of T2DM

Pedersen 2017 (20)

Public Health, Section for Health Promotion and Health Services, Aarhus University, Denmark

Quantitative +MA

n = 10

RCTs = 9

Cluster RCT = 1, (44 medical centres, N = 2280)

mn = 4 (951)

Narrative synthesis

Australia 4

USA 3

Asia 2

Europa 1

No quality assessment tool

PRISMA checklist

JBI 8

1,2,3,4,6,7,10,11

Women with a GDM diagnosis in the last pregnancy

N = 3636

Review the evidence of effective behavioural interventions seeking to prevent T2DM

T2DM preventive health behaviours among women with previous GDM

Behavioural interventions implemented within 2 years of the pp period

PA +diet

5 trials measured effect on DM incidence

FU 1y – approximately 4y

Tanase‐Nakao 2018 (33)

Division of Maternal Medicine, Center for Maternal Foetal, Neonatal and Reproductive Medicine, Japan

Quantitative

n = 9

Observational:

3 prospective cohort

4 cross‐sectional

2 retrospective cohorts (case control)

USA 7

Germany 1

Korea 1

Data synthesis conducted by random‐effect MA

Risk of Bias Assessment tool for non‐randomized studies (RoBANS)

MOOSE guidelines

JBI 9

1,2,3,4,5,6,7,8,9

Women with previous GDM

N = 3,699

Review current findings on breastfeeding for type 2 DM prevention

Breastfeeding

Duration

4 weeks – 5 years

Van den Heuvel 2018 (38)

Division of Woman and Baby, University Medical Center Utrecht Netherlands

Mixed

Narrative overview of the literature

n = 71

No quality assessment

JBI 6

1,2,3,7,10,11

Women prenatal, peri‐, and post‐ care

Provide a comprehensive and contemporary overview of the literature on eHealth in perinatal care and assess the applicability, advantages, limitations, and future of this new generation of pregnancy care

Electronic health (eHealth) including Web‐based informative programs, remote monitoring, tele‐consultation, and mobile device–supported care

Mode

eHealth, telemedicine

Van Ryswyk 2015 (39)

Robinson Research Institute, The University of Adelaide, Australia

Mixed

n = 42

Survey‐only 15

Interviews 18

Interviews and surveys 4

Interviews and focus groups 3

Focus groups 2

United States 12

Australia 10,

Europe/UK 9

Canada 7

Brazil 2

Vietnam 1

Tonga 1

CASP

PRISMA checklist

JBI 9

1,2,3,4,5,6,7,10,11

Women with previous GDM

N = 7,949

Identify factors that influence pp healthcare seeking for women who have experienced GDM through synthesis of results from qualitative and survey studies

Abbreviations: BMI, body mass index; CASP, Critical Appraisal Skills Programme; COS, core outcome set; DM, diabetes mellitus; FBG, Fasting Blood Glucose; FU, follow‐up; GDM, gestational diabetes; GI, glycaemic index; m, month; JBI, Joanna Briggs Institute; MA, meta‐analysis; NS, not significant; OGTT, oral glucose tolerance test; PA, physical activity; pp, postpartum; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta‐analyses; RoB, Cochrane collaborations Risk of Bias Tool; RoBANS, Risk of Bias assessment tool for non‐randomized studies; RCT, randomized controlled trial; UC, usual care; w, week; y, year.