title: A Pregnancy and Postpartum Lifestyle Intervention in Women With Gestational Diabetes Mellitus Reduces Diabetes Risk Factors The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials Mothers After Gestational Diabetes in Australia Diabetes Prevention Program (MAGDA-DPP) post-natal intervention: study protocol for a randomized controlled trial A pragmatic cluster randomized clinical trial of diabetes prevention strategies for women with gestational diabetes: design and rationale of the Gestational Diabetes’ Effects on Moms (GEM) study MobileMums: A Randomized Controlled Trial of an SMS-Based Physical Activity Intervention Low glycaemic index diets improve glucose tolerance and body weight in women with previous history of gestational diabetes: a six months randomized trial Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. Pilot Study of an Individualised Early Postpartum Intervention to Increase Physical Activity in Women with Previous Gestational Diabetes A web-based pedometer programme in women with a recent history of gestational diabetes. Physical activity and sedentary behaviors associated with risk of progression from gestational diabetes mellitus to type 2 diabetes mellitus: a prospective cohort study. Mediators of physical activity behavior change among women with young children. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Rationale, design, and methodology for the optimizing outcomes in women with gestational diabetes mellitus and their infants study Tianjin Gestational Diabetes Mellitus Prevention Program: study design, methods, and 1-year interim report on the feasibility of lifestyle intervention program. A Trial of Simple versus Intensified Dietary Modification for Prevention of Progression to Diabetes Mellitus in Women with Impaired Glucose Tolerance A pilot structured behavioural intervention trial to increase physical activity among women with recent gestational diabetes.
abstract: OBJECTIVE To pilot , among women with gestational diabetes mellitus ( GDM ) , the feasibility of a prenatal/postpartum intervention to modify diet and physical activity similar to the Diabetes Prevention Program . The intervention was delivered by telephone , and support for breastfeeding was addressed . RESEARCH DESIGN AND METHODS The goal was to help women return to their prepregnancy weight , if it was normal , or achieve a 5 % reduction from prepregnancy weight if overweight . Eligible participants were identified shortly after a GDM diagnosis ; 83.8 % consented to be r and omly assigned to intervention or usual medical care ( 96 and 101 women , respectively ) . The retention was 85.2 % at 12 months postpartum . RESULTS The proportion of women who reached the postpartum weight goal was higher , although not statistically significant , in the intervention condition than among usual care ( 37.5 vs. 21.4 % , absolute difference 16.1 % , P = 0.07 ) . The intervention was more effective among women who did not exceed the recommended gestational weight gain ( difference in the proportion of women meeting the weight goals : 22.5 % , P = 0.04 ) . The intervention condition decreased dietary fat intake more than the usual care ( condition difference in the mean change in percent of calories from fat : −3.6 % , P = 0.002 ) and increased breastfeeding , although not significantly ( condition difference in proportion : 15.0 % , P = 0.09 ) . No differences in postpartum physical activity were observed between conditions . CONCLUSIONS This study suggests that a lifestyle intervention that starts during pregnancy and continues postpartum is feasible and may prevent pregnancy weight retention and help overweight women lose weight . Strategies to help postpartum women overcome barriers to increasing physical activity are needed To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results Background Gestational diabetes mellitus ( GDM ) is defined as glucose intolerance with its onset or first recognition during pregnancy . Post-GDM women have a life-time risk exceeding 70 % of developing type 2 diabetes mellitus ( T2DM ) . Lifestyle modifications reduce the incidence of T2DM by up to 58 % for high-risk individuals . Methods / Design The Mothers After Gestational Diabetes in Australia Diabetes Prevention Program ( MAGDA-DPP ) is a r and omized controlled trial aim ing to assess the effectiveness of a structured diabetes prevention intervention for post-GDM women . This trial has an intervention group participating in a diabetes prevention program ( DPP ) , and a control group receiving usual care from their general practitioners during the same time period . The 12-month intervention comprises an individual session followed by five group sessions at two-week intervals , and two follow-up telephone calls .  A total of 574 women will be recruited , with 287 in each arm . The women will undergo blood tests , anthropometric measurements , and self-reported health status , diet , physical activity , quality of life , depression , risk perception and healthcare service usage , at baseline and 12 months . At completion , primary outcome ( changes in diabetes risk ) and secondary outcome ( changes in psychosocial and quality of life measurements and in cardiovascular disease risk factors ) will be assessed in both groups . Discussion This study aims to show whether MAGDA-DPP leads to a reduction in diabetes risk for post-GDM women . The characteristics that predict intervention completion and improvement in clinical and behavioral measures will be useful for further development of DPPs for this population .Trial registration Australian New Zeal and Clinical Trials Registry ANZCTRN Background Women with gestational diabetes ( GDM ) are at high risk of developing diabetes later in life . After a GDM diagnosis , women receive prenatal care to control their blood glucose levels via diet , physical activity and medications . Continuing such lifestyle skills into early motherhood may reduce the risk of diabetes in this high risk population . In the Gestational Diabetes ’ Effects on Moms ( GEM ) study , we are evaluating the comparative effectiveness of diabetes prevention strategies for weight management design ed for pregnant/postpartum women with GDM and delivered at the health system level . Methods / Design The GEM study is a pragmatic cluster r and omized clinical trial of 44 medical facilities at Kaiser Permanente Northern California r and omly assigned to either the intervention or usual care conditions , that includes 2,320 women with a GDM diagnosis between March 27 , 2011 and March 30 , 2012 . A Diabetes Prevention Program-derived print/telephone lifestyle intervention of 13 telephonic sessions tailored to pregnant/postpartum women was developed . The effectiveness of this intervention added to usual care is to be compared to usual care practice s alone , which includes two pages of printed lifestyle recommendations sent to postpartum women via mail . Primary outcomes include the proportion of women who reach a postpartum weight goal and total weight change . Secondary outcomes include postpartum glycemia , blood pressure , depression , percent of calories from fat , total caloric intake and physical activity levels . Data were collected through electronic medical records and surveys at baseline ( soon after GDM diagnosis ) , 6 weeks ( range 2 to 11 weeks ) , 6 months ( range 12 to 34 weeks ) and 12 months postpartum ( range 35 to 64 weeks ) . Discussion There is a need for evidence regarding the effectiveness of lifestyle modification for the prevention of diabetes in women with GDM , as well as confirmation that a diabetes prevention program delivered at the health system level is able to successfully reach this population . Given the use of a telephonic case management model , our Diabetes Prevention Program-derived print/telephone intervention has the potential to be adopted in other setting s and to inform policies to promote the prevention of diabetes among women with GDM.Trial registration Clinical Trials.gov number , NCT01344278 Background Postnatal women ( < 12 months postpartum ) are at increased risk of physical inactivity . Purpose To evaluate the efficacy and feasibility of a theory-based physical activity ( PA ) intervention delivered to postnatal women primarily via mobile telephone short message service ( SMS ) . Methods Eighty-eight women were r and omized to the intervention ( n = 45 ) or minimal contact control ( n = 43 ) condition . The 12-week intervention consisted of a face-to-face PA goal - setting consultation , a goal - setting magnet , three to five personally tailored SMS/week and a nominated support person who received two SMS per week . SMS content targeted constructs of social cognitive theory . Frequency ( days/week ) and duration ( min/week ) of PA participation and walking for exercise  were assessed via self-report at baseline , 6 and 13 weeks . Results Intervention participants increased PA frequency by 1.82 days/week ( SE ± 0.18 ) by 13 weeks ( F(2,85 ) = 4.46 , p = 0.038 ) and walking for exercise frequency by 1.08 days/week ( SE ± 0.24 ) by 13 weeks ( F(2,85 ) = 5.38 , p = 0.02 ) . Positive trends were observed for duration ( min/week ) of PA and walking for exercise . Conclusions Intervention exposure result ed in increased frequency of PA and walking for exercise in postnatal women Background Gestational Diabetes Mellitus ( GDM ) increases risks for type 2 diabetes and weight management is recommended to reduce the risk . Conventional dietary recommendations ( energy-restricted , low fat ) have limited success in women with previous GDM . The effect of lowering Glycaemic Index ( GI ) in managing glycaemic variables and body weight in women post-GDM is unknown . Objective To evaluate the effects of conventional dietary recommendations administered with and without additional low-GI education , in the management of glucose tolerance and body weight in Asian women with previous GDM . MethodS eventy seven Asian , non-diabetic women with previous GDM , between 20- 40y were r and omised into Conventional healthy dietary recommendation ( CHDR )  and  low GI  ( LGI ) groups . CHDR received conventional dietary recommendations only ( energy restricted , low in fat and refined sugars , high-fibre ) . LGI group received advice on lowering GI in addition . Fasting and 2-h post-load blood glucose after 75 g oral glucose tolerance test ( 2HPP ) were measured at baseline and 6 months after intervention . Anthropometry and dietary intake were assessed at baseline , three and six months after intervention . The study is registered at the Malaysian National Medical Research Register ( NMRR ) with Research ID : 5183 . Results After 6 months , significant reductions in body weight , BMI and waist-to-hip ratio were observed only in LGI group ( P<0.05 ) . Mean BMI changes were significantly different between groups ( LGI vs. CHDR : -0.6 vs. 0 kg/m2 , P= 0.03 ) . More subjects achieved weight loss ≥5 % in LGI compared to CHDR group ( 33 % vs. 8 % , P=0.01 ) . Changes in 2HPP were significantly different between groups ( LGI vs. CHDR : median ( IQR ) : -0.2(2.8 ) vs. + 0.8 ( 2.0 ) mmol/L , P=0.025 ) . Subjects with baseline fasting insulin≥2 μIU/ml had greater 2HPP reductions in LGI group compared to those in the CHDR group ( −1.9±0.42 vs. + 1.31±1.4 mmol/L , P<0.001 ) . After 6 months , LGI group diets showed significantly lower GI ( 57±5 vs. 64±6 , P<0.001 ) , GL ( 122±33 vs. 142±35 , P=0.04 ) and higher fibre content ( 17±4 vs.13±4 g , P<0.001 ) . Caloric intakes were comparable between groups . Conclusion In women post-GDM , lowering GI of healthy diets result ed in significant improvements in glucose tolerance and body weight reduction as compared to conventional low-fat diets with similar energy prescription CONTEXT A past history of gestational diabetes mellitus ( GDM ) confers a very high risk of postpartum development of diabetes , particularly type 2 diabetes . OBJECTIVE The Diabetes Prevention Program ( DPP ) sought to identify individuals with impaired glucose tolerance ( IGT ) and intervene in an effort to prevent or delay their progression to diabetes . This analysis examined the differences between women enrolled in DPP with and without a reported history of GDM . DESIGN The DPP was a r and omized , controlled clinical trial . SETTING The study was a multicenter , National Institutes of Health-sponsored trial carried out at 27 centers including academic and Indian Health Services sites . PATIENTS A total of 2190 women were r and omized into the DPP and provided information for past history of GDM . This analysis addressed the differences between those 350 women providing a past history of GDM and those 1416 women with a previous live birth but no history of GDM . INTERVENTIONS Subjects were r and omized to either st and ard lifestyle and placebo or metformin therapy or to an intensive lifestyle intervention . MAIN OUTCOMES The primary outcome was the time to development of diabetes ascertained by semiannual fasting plasma glucose and annual oral glucose tolerance testing . Assessment s of insulin secretion and insulin sensitivity were also performed . RESULTS Whereas entering the study with similar glucose levels , women with a history of GDM r and omized to placebo had a crude incidence rate of diabetes 71 % higher than that of women without such a history . Among women reporting a history of GDM , both intensive lifestyle and metformin therapy reduced the incidence of diabetes by approximately 50 % compared with the placebo group , whereas this reduction was 49 and 14 % , respectively in parous women without GDM . These data suggest that metformin may be more effective in women with a GDM history as compared with those without . CONCLUSIONS Progression to diabetes is more common in women with a history of GDM compared with those without GDM history despite equivalent degrees of IGT at baseline . Both intensive lifestyle and metformin are highly effective in delaying or preventing diabetes in women with IGT and a history of GDM Optimal strategies to prevent progression towards overt diabetes in women with recent gestational diabetes remain ill defined . We report a pilot study of a convenient , home based exercise program with telephone support , suited to the early post-partum period . Twenty eight women with recent gestational diabetes were enrolled at six weeks post-partum into a 12 week r and omised controlled trial of Usual Care ( n = 13 ) versus Supported Care ( individualised exercise program with regular telephone support ; n = 15 ) . Baseline characteristics ( Mean ± SD ) were : Age 33 ± 4 years ; Weight 80 ± 20 kg and Body Mass Index ( BMI ) 30.0 ± 9.7 kg/m2 . The primary outcome , planned physical activity { Median ( Range ) } , increased by 60 ( 0–540 ) mins/week in the SC group versus 0 ( 0–580 ) mins/week in the UC group ( P = 0.234 ) . Walking was the predominant physical activity . Body weight , BMI , waist circumference , % body fat , fasting glucose and insulin did not change significantly over time in either group . This intervention design ed to increase physical activity  in post-partum women with previous gestational diabetes proved feasible . However , no measurable improvement in metabolic or biometric parameters was observed over a three month period AIMS Women with remote histories of gestational diabetes mellitus can reduce their diabetes risk through lifestyle changes , but the effectiveness of interventions in women with more recent histories of gestational diabetes has not been reported . Therefore , we conducted a pilot study of a low-intensity web-based pedometer programme targeting glucose intolerance among women with recent gestational diabetes . METHODS Women with a gestational diabetes delivery within the past 3 years were r and omized to a 13-week intervention consisting of a structured web-based pedometer programme which gave personalized steps-per-week goals , pedometers and education regarding lifestyle modification , or to a letter about diabetes risk reduction and screening after delivery for gestational diabetes ( control condition ) . The main outcome measures were change in fasting plasma glucose and 2-h glucose levels on a 75-g oral glucose tolerance test between baseline and 13-week follow-up . Weight was a secondary outcome and behavioural constructs ( self-efficacy , social support , risk perception ) were also assessed . RESULTS Forty-nine women were enrolled . At 13-week follow-up , women r and omized to the intervention did not have significant changes in behavioural constructs , physical activity or anthropometrics compared with women in the control group . Changes in fasting plasma glucose ( -0.046 mmol/l vs. 0.038 mmol/l , P = 0.65 ) , 2-h glucose values ( -0.48 mmol/l vs. -0.42 mmol/l , P = 0.91 ) and weight ( -0.14 kg vs. -1.5 kg , P = 0.13 ) were similar between the control and intervention groups , respectively . CONCLUSIONS Structured web-based education utilizing pedometers is feasible although uptake may be low . Such programmes may need to be supplemented with additional measures in order to be effective for reduction of diabetes risk IMPORTANCE Women with a history of gestational diabetes mellitus ( GDM ) are at substantially increased risk of type 2 diabetes mellitus ( T2DM ) . The identification of important modifiable factors could help prevent T2DM in this high-risk population . OBJECTIVE To examine the role of physical activity and television watching and other sedentary behaviors  , and changes in these behaviors in the progression from GDM to T2DM . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study of 4554 women from the Nurses ' Health Study II who had a history of GDM , as part of the ongoing Diabetes & Women 's Health Study . These women were followed up from 1991 to 2007 . EXPOSURES Physical activity and television watching and other sedentary behaviors  were assessed in 1991 , 1997 , 2001 , and 2005 . MAIN OUTCOMES AND MEASURE Incident T2DM identified through self-report and confirmed by supplemental question naires . RESULTS We documented 635 incident T2DM cases during 59,287 person-years of follow-up . Each 5-metabolic equivalent hours per week ( MET-h/wk ) increment of total physical activity , which is equivalent to 100 minutes per week of moderate-intensity physical activity , was related to a 9 % lower risk of T2DM ( adjusted relative risk [ RR ] , 0.91 ; 95 % CI , 0.88 - 0.94 ) ; this inverse association remained significant after additional adjustment for body mass index ( BMI ) . Moreover , an increase in physical activity was associated with a lower risk of developing T2DM . Compared with women who maintained their total physical activity levels , women who increased their total physical activity levels by 7.5 MET-h/wk or more ( equivalent to 150 minutes per week of moderate-intensity physical activity ) had a 47 % lower risk of T2DM ( RR , 0.53 ; 95 % CI , 0.38 - 0.75 ) ; the association remained significant after additional adjustment for BMI . The multivariable adjusted RRs ( 95 % CIs ) for T2DM associated with television watching of 0 to 5 , 6 to 10 , 11 to 20 , and 20 or more hours per week were 1 ( reference ) , 1.28 ( 1.04 - 1.59 ) , 1.41 ( 1.11 - 1.79 ) , and 1.77 ( 1.28 - 2.45 ) , respectively ( P value for trend < .001 ) ; additional adjustment for BMI attenuated the association . CONCLUSIONS AND RELEVANCE Increasing physical activity may lower the risk of progression from GDM to T2DM . These findings suggest a hopeful message to women with a history of GDM , although they are at exceptionally high risk for T2DM , promoting an active lifestyle may lower the risk BACKGROUND Women with children are less likely to engage in  adequate physical activity ( PA )  than women without children . This study aim ed to evaluate the efficacy of two strategies for promoting increased  PA  among mothers of preschool-aged children , and to explore the mediators of any result ing change in PA behavior . DESIGN Controlled intervention trial incorporating repeated data collection from 554 women , r and omized to one of three experimental conditions . Intervention Group 1 served as a control , while women in Groups 2 and 3 were given print information about overcoming PA barriers . Women in Group 3 were also invited to discuss the development of local strategies for the promotion of PA among mothers of young children . The primary strategies included increasing partner support , social advocacy , and capacity building , and were implemented through collaboration among participants , research ers , and community organizations . MAIN OUTCOME MEASURES Adequate physical activity ( PA ) , self-efficacy ( SE ) and partner support ( PS ) . RESULTS Following the intervention , women in Group 3 were significantly more likely to meet guidelines for PA than controls ( odds ratio [OR]=1.71 , confidence interval [CI]=1.05 - 2.77 ) ] after controlling for age and PA at baseline . After controlling for baseline PA , residualized change in SE ( OR=1.86 , CI=1.17 - 2.94 ) and PS ( OR=2.29 , CI=1.46 - 3.58 ) significantly predicted meeting guidelines . After controlling for residual change in PS and SE , the significant intervention effect was attenuated ( Group 3 OR=1.40 , CI=0.76 - 2.36 ) , indicating that partner support and self-efficacy may be mediators of physical activity behavior change . CONCLUSIONS The findings indicate that community participation approaches that facilitate increased self-efficacy and partner support can be effective in increasing PA  among mothers of young children BACKGROUND In the 2.8 years of the Diabetes Prevention Program ( DPP ) r and omised clinical trial ,  diabetes incidence  in high-risk adults was reduced by 58 % with intensive lifestyle intervention and by 31 % with metformin , compared with placebo . We investigated the persistence of these effects in the long term . METHODS All active DPP participants were eligible for continued follow-up . 2766 of 3150 ( 88 % ) enrolled for a median additional follow-up of 5.7 years ( IQR 5.5 - 5.8 ) . 910 participants were from the lifestyle , 924 from the metformin , and 932 were from the original placebo groups .  On the basis of the benefits from the intensive lifestyle intervention in the DPP , all three groups were offered group-implemented lifestyle intervention . Metformin treatment was continued in the original metformin group ( 850 mg twice daily as tolerated ) , with participants unmasked to assignment , and the original lifestyle intervention group was offered additional lifestyle support . The primary outcome was development of diabetes according to American Diabetes Association criteria . Analysis was by intention-to-treat . This study is registered with Clinical Trials.gov , number NCT00038727 . FINDINGS During the 10.0-year ( IQR 9.0 - 10.5 ) follow-up since r and omisation to DPP , the original lifestyle group lost , then partly regained weight . The modest weight loss with metformin was maintained . Diabetes incidence rates during the DPP were 4.8 cases per 100 person-years ( 95 % CI 4.1 - 5.7 ) in the intensive lifestyle intervention group , 7.8 ( 6.8 - 8.8 ) in the metformin group , and 11.0 ( 9.8 - 12.3 ) in the placebo group . Diabetes incidence rates in this follow-up study were similar between treatment groups : 5.9 per 100 person-years ( 5.1 - 6.8 ) for lifestyle , 4.9 ( 4.2 - 5.7 ) for metformin , and 5.6 ( 4.8 - 6.5 ) for placebo . Diabetes incidence in the 10 years since DPP r and omisation was reduced by 34 % ( 24 - 42 ) in the lifestyle group and 18 % ( 7 - 28 ) in the metformin group compared with placebo . INTERPRETATION During follow-up after DPP , incidences in the former placebo and metformin groups fell to equal those in the former lifestyle group , but the cumulative incidence of diabetes remained lowest in the lifestyle group . Prevention or delay of diabetes with lifestyle intervention or metformin can persist for at least 10 years . FUNDING National Institute of Diabetes and Digestive and Kidney Diseases ( NIDDK ) Background Women who are diagnosed with gestational diabetes mellitus ( GDM ) are at increased risk for developing prediabetes and type 2 diabetes mellitus ( T2DM ) . To date , there have been few interdisciplinary interventions that target predominantly ethnic minority low-income women diagnosed with GDM . This paper describes the rationale , design and methodology of a 2-year , r and omized , controlled study being conducted in North Carolina . Methods / Design Using a two-group , repeated measures , experimental design , we will test a 14- week intensive intervention on the benefits of breastfeeding , underst and ing gestational diabetes and risk of progression to prediabetes and T2DM , nutrition and exercise education , coping skills training , physical activity ( Phase I ) , educational and motivational text messaging and 3 months of continued monthly contact ( Phase II ) . A total of 100 African American , non-Hispanic white , and bilingual Hispanic women between 22–36 weeks of pregnancy who are diagnosed with GDM and their infants will be r and omized to either the experimental group or the wait-listed control group . The first aim of the study is to determine the feasibility of the intervention . The second aim of study is to test the effects of the intervention on maternal outcomes from baseline ( 22–36 weeks pregnant ) to 10 months postpartum . Primary maternal outcomes will include fasting blood glucose and weight ( BMI ) from baseline to 10 months postpartum . Secondary maternal outcomes will include clinical , adiposity , health behaviors and self-efficacy outcomes from baseline to 10 months postpartum . The third aim of the study is to quantify the effects of the intervention on infant feeding and growth . Infant outcomes will include weight status and breastfeeding from birth through 10 months of age . Data analysis will include general linear mixed-effects models . Safety endpoints include adverse event reporting . Discussion Findings from this trial may lead to an effective intervention to assist women diagnosed with GDM to improve maternal glucose homeostasis and weight as well as stabilize infant growth trajectory , reducing the burden of metabolic disease across two generations . Trial registration OBJECTIVE To assess whether lifestyle intervention can reduce type 2  diabetes risk in women with prior GDM in the Tianjin Gestational Diabetes Mellitus ( GDM ) Prevention Program . METHODS 1180 women who were diagnosed with GDM from 2005 to 2009 were r and omly assigned to either a lifestyle intervention ( n=586 ) or a control group ( n=594 ) . Major elements of the intervention include six face-to-face meetings with study dietitians in the first year , and two additional sessions and two telephone calls in second year . RESULTS During the first year , average body weight loss in the first 404 subjects was 1.40 kg ( 2.1 % ) in the intervention group vs 0.21 kg ( 0.3 % ) in the control group ( P=0.001 ) , and the decrease was more significant among baseline overweight women ( body bass index [ BMI ] ≥24 kg/m² ) in the intervention ( 2.91 kg/4.2 % ) compared with that in the control group ( 0.51 kg/0.7 % ) ( P<0.001 ) . In addition , women in the intervention group , compared with those in the control group , have decreased BMI , body fat , waist circumference , and plasma insulin levels , and have improved behaviors including increased leisure time activity and dietary fiber intake and decreased sedentary time and fat consumptions . CONCLUSION The interim results support the efficacy and feasibility of the lifestyle intervention program Summary : Women with impaired glucose tolerance are at high risk of developing noninsulin dependent diabetes mellitus ( NIDDM ) . The Mercy Hospital for Women has a long‐term follow‐up programme for women with gestational diabetes , which identifies many women with impaired glucose tolerance . Two hundred of these women were entered into a r and omized controlled trial of intensive versus routine dietary advice . Seven women were lost to follow‐up . The annual incidence rates of diabetes mellitus for the 2 groups were 6.1 % ( intervention ) and 7.3 % ( control ) , an incident rate ratio of 0.83 , 95 % confidence interval 0.47–1.48 , p = 0.50 . Overall , there was a return to normal glucose tolerance in 44 % of patients . Multivariate analysis showed that body mass index , fasting and 2‐hour plasma glucose levels at trial entry were significantly associated with an increased risk of diabetes mellitus . Impaired glucose tolerance is an important condition that should be treated with advice about lifestyle modification ( diet and /or exercise ) . We consider that future trials in the management of women with previous gestational diabetes who have impaired glucose tolerance should investigate the effect of pharmacological intervention in addition to diet and /or exercise , the latter providing a therapy that it would be unethical to exclude on the evidence presently available Forty-three women were recruited into a 1-year r and omised controlled trial to test the feasibility of a structured behavioural intervention to increase physical activity  after gestational diabetes . Increases in achievement of physical activity targets were not attained . Recruitment and subject retention were identified as major challenges
target: CONCLUSIONS Lack of method ologically robust trials gives limited evidence for the success of lifestyle interventions in women with prior GDM .
background: PURPOSE To systematic ally review lifestyle interventions for women with prior Gestational Diabetes Mellitus ( GDM ) to report study characteristics , intervention design and study quality and explore changes in 1 ) diet , physical activity and sedentary behaviour ; 2 ) anthropometric outcomes and ; 3 ) glycaemic control and diabetes risk .