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The Comparative Effectiveness of Diabetes Prevention Strategies to Reduce Postpartum Weight Retention in Women With Gestational Diabetes Mellitus: The Gestational Diabetes’ Effects on Moms (GEM) Cluster Randomized Controlled Trial
Open accessAbstract
OBJECTIVE: To compare the effectiveness of diabetes prevention strategies addressing postpartum weight retention for women with gestational diabetes mellitus (GDM) delivered at the health system level: mailed recommendations (usual care) versus usual care plus a Diabetes Prevention Program (DPP)–derived lifestyle intervention. RESEARCH DESIGN AND METHODS: This study was a cluster randomized controlled trial of 44 medical facilities (including 2,280 women with GDM) randomized to intervention or usual care. The intervention included mailed gestational weight gain recommendations plus 13 telephone sessions between 6 weeks and 6 months postpartum. Primary outcomes included the following: proportion meeting the postpartum goals of 1) reaching pregravid weight if pregravid BMI <25.0 kg/m2 or 2) losing 5% of pregravid weight if BMI ≥25.0 kg/m2; and pregravid to postpartum weight change. RESULTS: On average, over the 12-month postpartum period, women in the intervention had significantly higher odds of meeting weight goals than women in usual care (odds ratio [OR] 1.28 [95% CI 1.10, 1.47]). The proportion meeting weight goals was significantly higher in the intervention than usual care at 6 weeks (25.5 vs. 22.4%; OR 1.17 [1.01, 1.36]) and 6 months (30.6 vs. 23.9%; OR 1.45 [1.14, 1.83]). Condition differences were reduced at 12 months (33.0 vs. 28.0%; OR 1.25 [0.96, 1.62]). At 6 months, women in the intervention retained significantly less weight than women in usual care (mean 0.39 kg [SD 5.5] vs. 0.95 kg [5.5]; mean condition difference −0.64 kg [95% CI −1.13, −0.14]) and had greater increases in vigorous-intensity physical activity (mean condition difference 15.4 min/week [4.9, 25.8]). CONCLUSIONS: A DPP-derived lifestyle intervention modestly reduced postpartum weight retention and increased vigorous-intensity physical activity.
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“Of the 5 (20%) studies reporting the effects of TM on T2DM development, only 1 (20%) study by Sakane et al [39] indicated that TM is effective. The other 4 (80%) studies [35,40,44,50] did not show any significant differences compared to the control group.”
From Digital Health Interventions to Prevent Type 2 Diabetes Mellitus: Systematic Review (2025) · cites this paper as [50]
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Metadata
- Authors
- Ferrara, A., Hedderson, M. M., Brown, S. D., Albright, C. L., Ehrlich, S. F., Tsai, A.-L., Caan, B. J., Sternfeld, B., Gordon, N. P., Schmittdiel, J. A., Gunderson, E. P., Mevi, A. A., Herman, W. H., Ching, J., Crites, Y., & Quesenberry, C. P.
- Affiliations
- Kaiser Permanente (US)
- University of Hawaiʻi at Mānoa (US)
- University of Michigan (US)
- Corresponding author
- Ferrara, Assiamira
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2015-04-12
- Volume
- 39
- Issue
- 1
- Pages
- 65-74
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC4686847
- OpenAlex
- W2193661811
- Cited by
- 171
- References
- 37
- Citations by year
- 2026: 14 · 2025: 22 · 2024: 29 · 2023: 17 · 2022: 14 · 2021: 17 · 2020: 12 · 2019: 13 · 2018: 20 · 2017: 8 · 2016: 4 · 2015: 1
- FWCI
- 12.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- University of Southern California
- Agency for Healthcare Research and Quality (R01HS019367)
- University of California, San Diego
- National Institute of Diabetes and Digestive and Kidney Diseases (K01DK105106, R18DK067334, K01DK099404, P30DK092926, P30DK092924, P30DK020572)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- postpartum weight retention, diabetes prevention, lifestyle intervention, Diabetes Prevention Program, telephone-delivered intervention, postpartum weight loss, high-intensity exercise, maternal health
- MeSH terms
- Adult, Behavior Therapy, Diabetes Mellitus, Female, Humans, Life Style, Middle Aged, Pregnancy, Weight Loss, Body Mass Index, Cluster Analysis, Diabetes, Gestational, Risk Reduction Behavior, Postpartum Period, Young Adult
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