Skip to main content

01-03-2018 | Gestational diabetes | Article

Prenatal counseling on type 2 diabetes risk, exercise, and nutrition affects the likelihood of postpartum diabetes screening after gestational diabetes

Journal: Journal of Perinatology

Authors: Kai E. Jones, Yan Yan, Graham A. Colditz, Cynthia J. Herrick

Publisher: Nature Publishing Group US




Screening rates for type 2 diabetes after a pregnancy with gestational diabetes are inadequate. We aimed to determine how prenatal counseling on exercise, nutrition, and type 2 diabetes risk affects postpartum screening for diabetes.


Using Pregnancy Risk Assessment Monitoring System data from Colorado (2009–2011) and Massachusetts (2012–2013), we performed multivariable logistic regression to examine the relationship between prenatal counseling and postpartum screening.


Among 556 women, prenatal counseling was associated with increased postpartum diabetes screening, after adjusting for age; parity; and receipt of Women, Infants, and Children (WIC) benefits (adjusted odds ratio (AOR) 3.0 [95% CI 1.4–6.5]). This effect was modified by race/ethnicity. Primiparity (AOR 2.2 [95% CI 1.2–4.1]) and advanced maternal age (AOR 2.2 [95% CI 1.2–3.8]) were associated with increased screening, and receiving WIC benefits was associated with decreased screening (AOR 0.5 [95% CI 0.3–0.9]).


In women with gestational diabetes, culturally appropriate counseling on future diabetes risk, nutrition, and exercise may enhance postpartum diabetes screening.
Lavery JA, Friedman AM, Keyes KM, Wright JD, Ananth CV. Gestational diabetes in the United States: temporal changes in prevalence rates between 1979 and 2010. BJOG. 2017;124:804–813. CrossRefPubMed
DeSisto CL, Kim SY, Sharma AJ. Prevalence estimates of gestational diabetes mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007-2010. Prev Chronic Dis. 2014;11:130415. CrossRef
American Diabetes Association. 13. Management of diabetes in pregnancy. Diabetes Care. 2017;40:S114–S119. CrossRef
Yogev Y, Ben-Haroush A, Chen R, Rosenn B, Hod M, Langer O. Undiagnosed asymptomatic hypoglycemia: diet, insulin, and glyburide for gestational diabetic pregnancy. Obstet Gynecol. 2004;104:88–93. CrossRefPubMed
Dabelea D, Hanson RL, Lindsay RS, Pettitt DJ, Imperatore G, Gabir mM, et al. Intrauterine exposure to diabetes conveys risks for type 2 diabetes and obesity: a study of discordant sibships. Diabetes. 2000;49:2208–11. CrossRefPubMed
Dabelea D, Mayer-Davis EJ, Lamichhane AP, D’Agostino RB Jr., Liese AD, Vehik KS, et al. Association of intrauterine exposure to maternal diabetes and obesity with type 2 diabetes in youth: the SEARCH Case-Control Study. Diabetes Care. 2008;31:1422–6. CrossRefPubMedPubMedCentral
Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009;373:1773–9. CrossRefPubMed
Ratner RE. Prevention of type 2 diabetes in women with previous gestational diabetes. Diabetes Care. 2007;30:S242–S245. CrossRefPubMed
Aroda VR, Christophi CA, Edelstein SL, Zhang P, Herman WH, Barrett-Connor E, et al. The effect of lifestyle intervention and metformin on preventing or delaying diabetes among women with and without gestational diabetes: the Diabetes Prevention Program Outcomes Study 10 year Follow-up. J Clin Endocrinol Metab. 2015;100:1646–53. CrossRefPubMedPubMedCentral
Blumer I, Hadar E, Hadden DR, Jovanovič L, Mestman JH, Murad MH, et al. Diabetes and pregnancy: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2013;98:4227–49. CrossRefPubMed
Gabbe SG, Landon MB, Warren-Boulton E, Fradkin J. Promoting health after gestational diabetes: a national diabetes education program call to action. Obstet Gynecol. 2012;119:171–6. CrossRefPubMedPubMedCentral
American College of Obstetricians and Gynecologists. Practice bulletin: gestational diabetes mellitus. Obstet Gynecol. 2013;122:406–16. CrossRef
Hale NL, Probst JC, Liu J, Martin AB, Bennett KJ, Glover S. Postpartum screening for diabetes among Medicaid-eligible South Carolina women with gestational diabetes. Women’s Health Issues. 2012;22:e163–169. CrossRefPubMed
Ferrara A, Peng T, Kim C. Trends in post-partum diabetes screening and subsequent diabetes and impaired fasting glucose among women with histories of gestational diabetes mellitus: a report from the Translating Research into Action for Diabetes (TRIAD) Study. Diabetes Care. 2009;32:269–74. CrossRefPubMedPubMedCentral
Lawrence JM, Black MH, Hsu JW, Chen W, Sacks DA. Prevalence and timing of postpartum glucose testing and sustained glucose dysregulation after gestational diabetes mellitus. Diabetes Care. 2010;33:569–76. CrossRefPubMed
Tovar A, Chasan-Taber L, Eggleston E, Oken E. Postpartum screening for diabetes among women with a history of gestational diabetes mellitus. Prev Chronic Dis. 2011;8:A124. PubMedPubMedCentral
Symons Downs D, Ulbrecht JS. Understanding exercise beliefs and behaviors in women with gestational diabetes mellitus. Diabetes Care. 2006;29:236–40. CrossRefPubMed
Kim C, McEwen LN, Kerr EA, Piette JD, Chames MC, Ferrara A, et al. Preventive counseling among women with histories of gestational diabetes mellitus. Diabetes Care. 2007;30:2489–95. CrossRefPubMed
Huynh T, Ghaffari N, Bastek J, Durnwald C. Prenatal care in a specialized diabetes in pregnancy program improves compliance with postpartum testing in GDM women. J Matern-Fetal Neonatal Med. 2016;30:1–5.
Stasenko M, Liddell J, Cheng YW, Sparks TN, Killion M, Caughey AB. Patient counseling increases postpartum follow-up in women with gestational diabetes mellitus. Am J Obstet Gynecol. 2011;204:522.e521–522.e526. CrossRef
Centers for Disease Control and Prevention. PRAMS Methodology. [cited 20 Jul 2016]. Available from: https://​www.​cdc.​gov/​prams/​methodology.​htm.
Gilbert BC, Shulman HB, Fischer LA, Rogers MM. The Pregnancy Risk Assessment Monitoring System (PRAMS): methods and 1996 response rates from 11 states. Matern Child Health J. 1999;3:199–209. CrossRefPubMed
Shulman HB, Gilbert BC, Msphbrenda CG, Lansky A. The Pregnancy Risk Assessment Monitoring System (PRAMS): current methods and evaluation of 2001 response rates. Public Health Rep. 2006;121:74–83. CrossRefPubMedPubMedCentral
Lavery JA, Friedman AM, Keyes KM, Wright JD, Ananth CV. Gestational diabetes in the United States: temporal changes in prevalence rates between 1979 and 2010. BJOG. 2016;124:804–13. CrossRefPubMedPubMedCentral
USDA Food and Nutrition Service. WIC income eligibility guidelines. [cited 26 Jun 2017]. Available from: https://​www.​fns.​usda.​gov/​wic/​wic-income-eligibility-guidelines.
Eggleston EM, LeCates RF, Zhang F, Wharam JF, Ross-Degnan D, Oken E. Variation in postpartum glycemic screening in women with a history of gestational diabetes mellitus. Obstet Gynecol. 2016;128:159–67. CrossRefPubMedPubMedCentral
Oza-Frank R. Postpartum diabetes testing among women with recent gestational diabetes mellitus: PRAMS 2009-2010. Matern Child Health J. 2014;18:729–36. CrossRefPubMed
Simmons D, Jelsma JG, Galjaard S, Devlieger R, van Assche A, Jans G, et al. Results from a European multicenter randomized trial of physical activity and/or healthy eating to reduce the risk of gestational diabetes mellitus: the DALI lifestyle pilot. Diabetes Care. 2015;38:1650–6. CrossRefPubMed
Asbee SM, Jenkins TR, Butler JR, White J, Elliot M, Rutledge A. Preventing excessive weight gain during pregnancy through dietary and lifestyle counseling: a randomized controlled trial. Obstet Gynecol. 2009;113:305–12. CrossRefPubMed
Koivusalo SB, Rono K, Klemetti MM, Roine RP, Lindstrom J, Erkkola M, et al. Gestational diabetes mellitus can be prevented by lifestyle intervention: the Finnish gestational diabetes prevention study (RADIEL): a randomized controlled trial. Diabetes Care. 2016;39:24–30. CrossRefPubMed
Vinter CA, Jensen DM, Ovesen P, Beck-Nielsen H, Jorgensen JS. The LiP (Lifestyle in Pregnancy) study: a randomized controlled trial of lifestyle intervention in 360 obese pregnant women. Diabetes Care. 2011;34:2502–7. CrossRefPubMedPubMedCentral
Ferrara A, Hedderson MM, Brown SD, Albright CL, Ehrlich SF, Tsai AL, et al. 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. Diabetes Care. 2016;39:65–74. CrossRefPubMed
Nicklas JM, Zera CA, England LJ, Rosner BA, Horton E, Levkoff SE, et al. A web-based lifestyle intervention for women with recent gestational diabetes mellitus: a randomized controlled trial. Obstet Gynecol. 2014;124:563–70. CrossRefPubMedPubMedCentral
Rautio N, Jokelainen J, Korpi-Hyovalti E, Oksa H, Saaristo T, Peltonen M, et al. Lifestyle intervention in prevention of type 2 diabetes in women with a history of gestational diabetes mellitus: one-year results of the FIN-D2D project. J Women’s Health (Larchmt). 2014;23:506–12. CrossRef
Philis-Tsimikas A, Fortmann AL, Dharkar-Surber S, Euyoque JA, Ruiz M, Schultz J, et al. Dulce mothers: an intervention to reduce diabetes and cardiovascular risk in Latinas after gestational diabetes. Transl Behav Med. 2014;4:18–25. CrossRefPubMedPubMedCentral
Xiang AH, Li BH, Black MH, Sacks DA, Buchanan TA, Jacobsen SJ, et al. Racial and ethnic disparities in diabetes risk after gestational diabetes mellitus. Diabetologia. 2011;54:3016–21. CrossRefPubMed
Oliveira V, Frazao E. The WIC program: background, trends, and economic issues, 2015 edition. SSRN Electron J 2015, 134. https://​doi.​org/​10.​2139/​ssrn.​2709086.

New additions to the Adis Journal Club

A selection of topical peer-reviewed articles from the Adis journals, curated by the editors.

ADA 2022 coverage

Access the latest news and expert insight from the ADA 82nd Scientific Sessions