Full length article| Volume 220, P106-112, January 2018

Designing a lifestyle intervention to reduce risk of type 2 diabetes in postpartum mothers following gestational diabetes: An online survey with mothers and health professionals

  • Amanda P. Moore
    The Diabetes and Nutritional Sciences Division, Faculty of Life Sciences & Medicine, King's College London, UK
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  • Maria I. D’Amico
    Corresponding author at: Women's Health Research Unit, Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK.
    Women’s Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK
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  • Natalie A.M. Cooper
    Women’s Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK
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  • Shakila Thangaratinam
    Women’s Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK

    Multidisciplinary Evidence Synthesis Hub (mEsh), Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK
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Published:November 14, 2017DOI:



      The aim of this study was to identify what components of a postpartum lifestyle intervention would engage postpartum mothers who had a diagnosis of gestational diabetes.

      Study design

      Two online surveys were conducted, one involving postnatal mothers with GDM (n = 83), and a second for health professionals (n = 46).


      Seventy-eight percent of mothers were aware that healthy eating, exercise and weight management were all important to reduce risk of subsequent type 2 diabetes. However, 80% of women in this survey were not ready to engage in a postpartum lifestyle intervention within the first 6 months of giving birth; in contrast 52% of health professionals recommended they should be engaged in the first six weeks. Group sessions were the most commonly chosen format to deliver an intervention (30%). A community setting was preferred to a medical one. Mothers wanted recipe ideas (95%) in preference to general dietary advice (76%) or cooking skills courses (39%). Walking was the main form of exercise for 79% of mothers in this sample. Women highlighted difficulty in focusing on their own health goals because of competing demands of looking after a baby (41% agreed, Median 3, IQR 2), tiredness (65% agreed, Md 4, IQR 1) and the need for childcare (64% agreed, Md 4, IQR 2).


      A walking programme, recipe ideas and weight monitoring may be useful components when designing a postpartum lifestyle intervention. Barriers to engagement are evident and the intervention should allow women to engage at a time that is appropriate for them.


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        • Bellamy L.
        • Casas J.P.
        • Hingorani A.D.
        • Williams D.
        Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis.
        Lancet. 2009; 373: 1773-1779
        • Kim C.
        • Newton K.M.
        • Knopp R.H.
        Gestational diabetes and the incidence of type 2 diabetes: a systematic review.
        Diabetes Care. 2002; 25: 1862-1868
        • Beharier O.
        • Sergienko R.
        • Kessous R.
        • et al.
        Gestational diabetes mellitus is a significant risk factor for long-term ophthalmic morbidity.
        Arch Gynecol Obstet. 2017; 295: 1477-1482
        • Fuchs Oded
        • Sheiner Eyal
        • Meirovitz Mihai
        • Davidson Ehud
        • Sergienko Ruslan
        • Kessous Roy
        The association between a history of gestational diabetes mellitus and future risk for female malignancies.
        Arch Gynecol Obstet. 2017; 295: 731-736
        • Harreiter J.
        • Dovjak G.
        • Kautzky-Willer A.
        Gestational diabetes mellitus and cardiovascular risk after pregnancy.
        Womens Health (Lond Engl). 2014; 10: 91-108
        • Aroda V.R.
        • Christophi C.A.
        • Edelstein S.L.
        • et al.
        The effect of lifestyle intervention and metformin on preventing or delaying diabetes among women with and without gestational diabetes: the diabetes prevention program outcomes study 10-year follow-up.
        J Clin Endocrinol Metab. 2015; 100: 1646-1653
        • Morton S.
        • Kirkwood S.
        • Thangaratinam S.
        Interventions to modify the progression to type 2 diabetes mellitus in women with gestational diabetes: a systematic review of literature.
        Curr Opin Obstet Gynecol. 2014; 26: 476-486
        • Guo J.
        • Chen J.L.
        • Whittemore R.
        • Whitaker E.
        Postpartum lifestyle interventions to prevent type 2 diabetes among women with history of gestational diabetes: a systematic review of randomized clinical trials.
        J Womens Health (Larchmt). 2016; 25: 38-49
        • Montgomery K.S.
        • Bushee T.D.
        • Phillips J.D.
        • et al.
        Women's challenges with postpartum weight loss.
        Matern Child Health J. 2011; 15: 1176-1184
        • Onyango A.W.
        • Nommsen-Rivers L.
        • Siyam A.
        • et al.
        Post-partum weight change patterns in the WHO multicentre growth reference study.
        Matern Child Nutr. 2011; 7: 228-240
        • Walker L.O.
        • Sterling B.S.
        • Latimer L.
        • Kim S.H.
        • Garcia A.A.
        • Fowles E.R.
        Ethnic-specific weight-loss interventions for low-income postpartum women: findings and lessons.
        West J Nurs Res. 2012; 34: 654-676
        • O'Dea A.
        • Tierney M.
        • McGuire B.E.
        • et al.
        Can the onset of type 2 diabetes be delayed by a group-based lifestyle intervention in women with prediabetes following gestational diabetes mellitus (GDM)? Findings from a randomized control mixed methods trial.
        J Diabetes Res. 2015; : 2015
        • Morrison M.K.
        • Lowe J.M.
        • Collins C.E.
        Perceived risk of Type 2 diabetes in Australian women with a recent history of gestational diabetes mellitus.
        Diabet Med. 2010; 27: 882-886
        • Ferrara A.
        • Ehrlich S.F.
        Strategies for diabetes prevention before and after pregnancy in women with GDM.
        Curr Diabetes Rev. 2011; 7: 75-83
        • Sixsmith J.
        • Boneham M.
        • Goldring J.E.
        Accessing the community: gaining insider perspectives from the outside.
        Qual Health Res. 2003; 13: 578-589
        • Johns R.
        Likert Items and Scales Survey Resource Network.
        • Boone H.
        • Boone D.
        Analysing likert data.
        J Ext. 2012; 50
        • Craig P.
        • Dieppe P.
        • Macintyre S.
        • Michie S.
        • Nazareth I.
        • Petticrew M.
        Developing and evaluating complex interventions: the new Medical Research Council guidance.
        Int J Nurs Stud. 2013; 50: 587-592
        • Jones E.J.
        • Roche C.C.
        • Appel S.J.
        A review of the health beliefs and lifestyle behaviors of women with previous gestational diabetes.
        JOGNN – J Obstetric Gynecol Neonatal Nurs. 2009; 38: 516-526
        • Persson M.
        • Winkvist A.
        • Mogren I.
        Lifestyle and health status in a sample of Swedish women four years after pregnancy: a comparison of women with a history of normal pregnancy and women with a history of gestational diabetes mellitus.
        BMC Pregnancy Childbirth. 2015; 15
        • Kieffer E.C.
        • Carman W.J.
        • Gillespie B.W.
        • Nolan G.H.
        • Worley S.E.
        • Guzman J.R.
        Obesity and gestational diabetes among African-American women and Latinas in Detroit: implications for disparities in women's health.
        J Am Med Womens Assoc. 2001; 56 (Fall 196): 181-187
        • Mukerji G.
        • Kainth S.
        • Pendrith C.
        • et al.
        Predictors of low diabetes risk perception in a multi-ethnic cohort of women with gestational diabetes mellitus.
        Diabet Med. 2016; 33: 1437-1444
        • Walker L.O.
        Managing excessive weight gain during pregnancy and the postpartum period.
        J Obstet Gynecol Neonatal Nurs. 2007; 36: 490-500
        • Peters R.K.
        • Kjos S.L.
        • Xiang A.
        • Buchanan T.A.
        Long-term diabetogenic effect of single pregnancy in women with previous gestational diabetes mellitus.
        Lancet. 1996; 347: 227-230
        • Ehrlich S.F.
        • Hedderson M.M.
        • Quesenberry Jr., C.P.
        • et al.
        Post-partum weight loss and glucose metabolism in women with gestational diabetes: the DEBI Study.
        Diabet Med. 2014; 31: 862-867
        • Knight B.A.
        • Wyatt K.
        Barriers encountered when recruiting obese pregnant women to a dietary intervention.
        Nurs Times. 2010; 106: 20-22
        • Heslehurst N.
        • Newham J.
        • Maniatopoulos G.
        • Fleetwood C.
        • Robalino S.
        • Rankin J.
        Implementation of pregnancy weight management and obesity guidelines: a meta-synthesis of healthcare professionals' barriers and facilitators using the Theoretical Domains Framework.
        Obes Rev. 2014; 15: 462-486
        • Amorim A.R.
        • Linne Y.M.
        • Lourenco P.M.
        Diet or exercise, or both, for weight reduction in women after childbirth.
        Cochrane Database Syst Rev. 2007; : CD005627
        • Evenson K.R.
        • Brouwer R.J.N.
        • Østbye T.
        Changes in physical activity among postpartum overweight and obese women: results from the KAN-DO study.
        Women Health. 2013; 53: 317-334
        • Vyas A.
        • Chaudhary N.
        • Ramiah K.
        • Douglass K.
        Risk perceptions, nutrition and physical activity among South Asian women in the US: does history of gestational diabetes mellitus (GDM) matter?.
        Health. 2012; 4: 1263-1270
        • Gatineau M.
        • Mathrani S.
        Ethnicity and obesity in the UK.
        Perspect Public Health. 2011; 131: 159-160
        • Poston L.
        • Bell R.
        • Croker H.
        • et al.
        Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial.
        Lancet Diabetes Endocrinol. 2015; 3: 767-777
        • Nascimento S.L.
        • Pudwell J.
        • Surita F.G.
        • Adamo K.B.
        • Smith G.N.
        The effect of physical exercise strategies on weight loss in postpartum women: a systematic review and meta-analysis.
        Int J Obes. 2014; 38: 626-635
        • Ferrara A.
        • Hedderson M.M.
        • Albright C.L.
        • et al.
        A pregnancy and postpartum lifestyle intervention in women with gestational diabetes mellitus reduces diabetes risk factors: a feasibility randomized control trial.
        Diabetes Care. 2011; 34: 1519-1525
        • Atkinson L.
        • Olander E.
        • French D.
        Why don't many obese pregnant and post-natal women engage with a weight management service?.
        J Reprod Infant Psychol. 2013; 31: 245-256
        • Carter-Edwards L.
        • Ostbye T.
        • Bastian L.A.
        • Yarnall K.S.
        • Krause K.M.
        • Simmons T.J.
        Barriers to adopting a healthy lifestyle: insight from postpartum women.
        BMC Res Notes. 2009; 2: 161
        • Pedersen P.
        • Baker J.L.
        • Henriksen T.B.
        • et al.
        Influence of psychosocial factors on postpartum weight retention.
        Obesity (Silver Spring). 2011; 19: 639-646
        • Troy N.W.
        Is the significance of postpartum fatigue being overlooked in the lives of women?.
        MCN Am J Matern Child Nurs. 2003; 28: 252-257
        • Michie S.
        • Abraham C.
        • Whittington C.
        • McAteer J.
        • Gupta S.
        Effective techniques in healthy eating and physical activity interventions: a meta-regression.
        Health Psychol. 2009; 28: 690-701
        • van der Pligt P.
        • Willcox J.
        • Hesketh K.D.
        • et al.
        Systematic review of lifestyle interventions to limit postpartum weight retention: implications for future opportunities to prevent maternal overweight and obesity following childbirth.
        Obes Rev. 2013; 14: 792-805
        • Paez K.A.
        • Griffey S.J.
        • Thompson J.
        • Gillman M.W.
        Validation of self-reported weights and heights in the avoiding diabetes after pregnancy trial (ADAPT).
        BMC Med Res Methodol. 2014; 14