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Open Access Original investigation

Group-based activities with on-site childcare and online support improve glucose tolerance in women within 5 years of gestational diabetes pregnancy

Anne-Sophie Brazeau, Aaron Leong, Sara J Meltzer, Rani Cruz, Deborah DaCosta, Mary Hendrickson-Nelson, Lawrence Joseph, Kaberi Dasgupta* and MoMM study group

Author Affiliations

Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, 687 Pine Avenue West, H3A 1A1, Montreal, Quebec, Canada

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Cardiovascular Diabetology 2014, 13:104  doi:10.1186/1475-2840-13-104

Published: 30 June 2014

Abstract

Background

Women with gestational diabetes history are at increased risk for type 2 diabetes. They face specific challenges for behavioural changes, including childcare responsibilities. The aim of this study is to test a tailored type 2 diabetes prevention intervention in women within 5 years of a pregnancy with gestational diabetes, in terms of effects on weight and cardiometabolic risk factors.

Methods

The 13-week intervention, designed based on focus group discussions, included four group sessions, two with spousal participation and all with on-site childcare. Web/telephone-based support was provided between sessions. We computed mean percentage change from baseline (95% confidence intervals, CI) for anthropometric measures, glucose tolerance (75 g Oral glucose tolerance test), insulin resistance/sensitivity, blood pressure, physical activity, dietary intake, and other cardiometabolic risk factors.

Results

Among the 36 enrolled, 27 completed final evaluations. Most attended ≥ 3 sessions (74%), used on-site childcare (88%), and logged onto the website (85%). Steps/day (733 steps, 95% CI 85, 1391) and fruit/vegetable intake (1.5 servings/day, 95% CI 0.3, 2.8) increased. Proportions decreased for convenience meal consumption (−30%, 95% CI −50, −9) and eating out (−22%, 95% CI −44, −0) ≥ 3 times/month. Body mass index and body composition were unchanged. Fasting (−4.9%, 95% CI −9.5, −0.3) and 2-hour postchallenge (−8.0%, 95% CI −15.6, −0.5) glucose declined. Insulin sensitivity increased (ISI 0,120 23.7%, 95% CI 9.1, 38.4; Matsuda index 37.5%, 95% CI 3.5, 72.4). Insulin resistance (HOMA-IR −9.4%, 95% CI −18.6, −0.1) and systolic blood pressure (−3.3%, 95% CI −5.8, −0.8) decreased.

Conclusions

A tailored group intervention appears to lead to improvements in health behaviours and cardiometabolic risk factors despite unchanged body mass index and body composition. This approach merits further study.

Clinical trial registration

ClinicalTrials.gov (NCT01814995).

Keywords:
Gestational diabetes; Type 2 diabetes; Prevention; Insulin resistance; Diet; Exercise; Childcare; Spouse participation