Table 2.
RCTs of Lifestyle and/or Pharmacological Interventions for Women With GD
| Intervention | Population and timing | Duration of follow-up |
Sample size | Control group | Intervention group | Outcome(s) | Conclusions | Limitations |
|---|---|---|---|---|---|---|---|---|
| DPP48 | GD and prediabetes at approximately 12 y post partum | 2.8 y | 1416 Without prior GD (487 to placebo, 464 to metformin, 465 to ILS); 350 women with prior GD (122 to placebo, 111 to metformin, 117 to ILS) | Placebo plus standard lifestyle recommendations |
Metformin group received metformin plus standard lifestyle recommendations; ILS group received education about diet and exercise with goal to reduce weight by 7% and increase physical activity to 150 min/wk | Prior GD: ILS and metformin reduced T2D incidence by approximately 50% vs placebo group | Metformin and ILS equally effective at delaying and preventing progression to T2D in women with prior GD | Median 12 y between pregnancy and prediabetes onset; prior GD group median age, 43 y vs 52 y in women without prior GD |
| BAB52 | GD at approximately 6 wk post partum | 6 wk to 12 mo Post partum | 36 in Intervention group, 39 in control group | “It’s Never Too Early to Prevent Diabetes” handout distributed at recruitment | DPP-styled intervention with website; 12 weekly modules about diet and exercise; communications with lifestyle coach | Intervention group gained significantly less weight post partum vs prepregnancy weight (mean, −0.7 kg in intervention group vs +4.0 kg in controls) | Intervention led to less weight gain vs prepregnancy weight | Self-reported prepregnancy weight; single-center study; small sample size |
| GEM53 | GD at approximately 6 wk post partum | Intervention of 6 wk to 6 mo; 7-12 mo postpartum maintenance | 44 Medical facilities: 22 with intervention (1087 women), 22 with standard care (1193 women) | Sent information about GD and lifestyle modifications | DPP-styled intervention with workbook about healthy diet and physical activity; telephone calls with dietician | At 12 mo, intervention group had 1.28-fold odds of achieving weight goal vs control group | Intervention moderately reduced postpartum weight retention; feasible in clinical setting | 26% missed 6-mo clinic-measured weight; 33% missed 12-mo clinic-measured weight |
| PAIGE54 | GD plus BMI ≥25 at approximately 4-6 wk post partum | 4-6 wk to 6 mo Post partum | 29 in Intervention group, 31 in control group | Watched a DVD about GD | 3-mo Free membership to Slimming World; telephone and text support with health educator; pedometer access plus standard of care | Intervention group lost a mean of 3.9 kg and control group gained a mean of 3.8 kg; no significant difference in blood glucose levels | Intervention led to significant weight loss at 6 mo post partum compared with controls | Small sample size; challenges with recruitment due to time constraints, lack of child care and not wanting to leave the infant; predominantly White sample; low pedometer use |
Abbreviations: BAB, Balance After Baby; BMI, body mass index (calculated as weight in kilograms divided by height in meters squared); DPP, Diabetes Prevention Program; GD, gestational diabetes; GEM, Gestational Diabetes’ Effects on Moms; ILS, intensive lifestyle modification; PAIGE, Postnatal Lifestyle Intervention Program for Overweight Women with Previous Gestational Diabetes Mellitus; RCT, randomized clinical trial; T2D, type 2 diabetes.