Abstract
Background:Gestational diabetes mellitus (GDM) is a common condition of pregnancy, affecting around 5% of pregnancies in the UK. Not only does GDM confer the risk of adverse pregnancy outcomes for the mother and baby, but women with GDM are more likely to develop Type 2 diabetes than women with normoglycaemic pregnancies. This increased risk is also evidenced in the offspring of women who experience GDM. Type 2 diabetes can be prevented or delayed in populations deemed at high risk through lifestyle intervention; hence, there is an opportunity to reduce the risk of future diabetes in this group. However, lifestyle support may need to be adapted to accommodate the demands of motherhood and psychological legacy of GDM.
Aim:
The aim of this study was to develop and test the feasibility of a lifestyle intervention to reduce the risk of developing Type 2 diabetes after GDM.
Methods:
Based on the Medical Research Council’s framework for developing and evaluating complex interventions, an intervention was developed and feasibility tested using the following methods: a qualitative meta-synthesis exploring women’s experiences and perceptions of GDM; a systematic review of interventions to reduce diabetes risk for women with GDM; a qualitative study using interviews and focus groups to explore women’s experiences of GDM and GDM care, factors influencing their health behaviours and their views on diabetes prevention interventions; and a feasibility partially randomised controlled trial to test acceptability and feasibility of an intervention to prevent Type 2 diabetes after GDM and gain preliminary estimates of efficacy.
Results:
• The meta-synthesis included 16 qualitative studies. The key themes that emerged from the synthesis were: the emotional impact of GDM, loss of normal pregnancy, excessive focus on the baby, a lack of support and information, loss of control, and diabetes risk beliefs. It was concluded that interventions need to address the emotional impact of GDM, provide clear and timely information about future diabetes risk, and fit within women’s complex lives.
• The systematic review included 10 studies assessing lifestyle interventions to reduce diabetes risk. The review concluded that some interventions did result in weight reduction in women with previous GDM in the short-term. However, the studies did not explicitly detail the mechanisms of actions for these interventions. The features of more effective interventions included: recruiting during pregnancy or in the first year after birth; addressing the demands of motherhood; facilitating strong provider-participant relationships; and flexible models for delivering the intervention components.
• Women (n=50) in the qualitative study corroborated the findings of the meta-synthesis. Emotional trauma had the potential to affect women’s long-term psychological and physical health. Addressing the emotional stress of pregnancy, personalising risk, adopting a family-centred approach, providing patient-centred care, and developing flexible interventions were recommended approaches.
• Based on these findings, an intervention (the GestatiOnal Diabetes future DiabEteS prevention Study, or GODDESS) was developed together with women with previous GDM. The intervention comprised four motivational interviewing sessions (antenatal and postpartum) and peer support. The study (n=50) demonstrated feasibility and acceptability, and showed a favourable recruitment rate, but strategies to improve retention are needed. The findings suggest that GODDESS can support weight loss and may also reduce depressive symptoms.
Conclusion:
GDM presents multiple opportunities to intervene at the individual, health systems and broader societal levels to reduce the risk of Type 2 diabetes for women and future generations. Adopting a flexible and personalised approach to individual risk reduction may be the way forward. The key findings from this study are that GDM can leave an enduring emotional legacy that negatively impacts women’s engagement with their own health, and a motivational interviewing-based intervention is feasible, acceptable and has the potential to support weight loss and impact depressive symptoms. Further optimisation and evaluation of the intervention in a larger-scale trial is required, as well as additional investigation of the relationship between depression and weight loss in this group.
| Date of Award | 1 Aug 2022 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Angus Forbes (Supervisor) & Khalida Ismail (Supervisor) |