A randomized lifestyle intervention preventing gestational diabetes: effects on self-rated health from pregnancy to postpartum

Abstract

Introduction: The purpose was to examine the effects of a randomized lifestyle intervention on self-rated health from pregnancy to postpartum in participants at high risk for gestational diabetes mellitus.

Methods: We included 266 women with a history of gestational diabetes and/or prepregnancy BMI ≥30 kg/m². The intervention group (n = 144) received individualized counseling on diet, physical activity, and weight management from trained nurses at six timepoints between the first trimester of pregnancy and 12 months postpartum, and met three times with a dietitian. The control group (n = 122) received standard antenatal care. We assessed self-rated health at the six timepoints by means of a single question with five response options ranging from good (1) to poor (5). Baseline-adjusted mean changes in self-rated health level were assessed with a mixed model for repeated measure methods.

Results: The mean (SD) for self-rated health at baseline was 1.8 (0.8) in the intervention group and 2.1 (0.9) in the control group (p = 0.006). Self-rated health varied over time (time effect p < 0.001) and was the poorest in the third trimester. The sample indicated that self-rated health improved in the intervention group and deteriorated in the control group from the first trimester to 12 months postpartum, but the difference between the groups did not reach statistical significance (group effect p = 0.064).

Discussion: The self-rated health level varied over time from the first trimester of pregnancy to 12 months postpartum in women at risk for gestational diabetes. Improving self-rated health among high-risk pregnant women through lifestyle intervention calls for further research.

Keywords:

• Gestational diabetes
• lifestyle intervention
• pregnancy
• self-rated health
• women

Acknowledgements

The authors would like to thank the research nurses and the participants.

Disclosure statement

The authors report no conflicts of interest.

Current knowledge on the subject

• Self-rated health strongly predicts both morbidity and mortality.

• Gestational diabetes is associated with adverse self-rated health even three to five years after the diagnosis.

• Little is known about methods of improving self-rated health in women with or at risk for gestational diabetes.

What this study adds

• Self-rated health varied between the first trimester of pregnancy and 1 year postpartum in women at high risk for gestational diabetes.

• Self-rated health was poorest in the third trimester of pregnancy.

• Lifestyle intervention did not improve self-rated health when compared to a control group.

Additional information

Funding

The Finnish Gestational Diabetes Prevention Study (RADIEL) was supported by Ahokas Foundation, Finnish Foundation for Cardiovascular Disease, Special state subsidy for health science research of Helsinki University Central Hospital, Samfundet Folkhälsan, The Finnish Diabetes Research Foundation, State Provincial Office of Southern Finland, and The Social Insurance Institution of Finland. The PhD study of the first author (Engberg) was supported by Tekes – The Finnish Funding Agency for Technology and Innovation (40043/07), Urheiluopistosäätiö (Sports Institute Foundation), University of Helsinki Medicine Fund, Juho Vainio Foundation, and Yrjö Jahnsson Foundation.