Ferrara Assiamira, Hedderson Monique M, Brown Susan D, Albright Cheryl L, Ehrlich Samantha F, Tsai Ai-Lin, Caan Bette J, Sternfeld Barbara, Gordon Nancy P, Schmittdiel Julie A, Gunderson Erica P, Mevi Ashley A, Herman William H, Ching Jenny, Crites Yvonne, Quesenberry Charles P
Division of Research, Kaiser Permanente Northern California, Oakland, CA
Division of Research, Kaiser Permanente Northern California, Oakland, CA.
Diabetes Care. 2016 Jan;39(1):65-74. doi: 10.2337/dc15-1254. Epub 2015 Dec 9.
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.
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/m(2) or 2) losing 5% of pregravid weight if BMI ≥25.0 kg/m(2); and pregravid to postpartum weight change.
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]).
A DPP-derived lifestyle intervention modestly reduced postpartum weight retention and increased vigorous-intensity physical activity.
在卫生系统层面比较针对妊娠糖尿病（GDM）女性产后体重滞留的糖尿病预防策略的有效性：邮寄建议（常规护理）与常规护理加糖尿病预防计划（DPP）衍生的生活方式干预。
本研究是一项对44个医疗机构（包括2280名GDM女性）进行的整群随机对照试验，随机分为干预组或常规护理组。干预措施包括邮寄孕期体重增加建议以及产后6周和6个月之间的13次电话咨询。主要结局包括以下方面：达到产后目标的比例，即1）如果孕前BMI<25.0kg/m²则达到孕前体重，或2）如果BMI≥25.0kg/m²则减轻孕前体重的5%；以及孕前到产后的体重变化。
在产后12个月期间，干预组女性达到体重目标的几率显著高于常规护理组女性（优势比[OR]1.28[95%CI1.10,1.47]）。在6周时（25.5%对22.4%；OR1.17[1.01,1.36]）和6个月时（30.6%对23.9%；OR1.45[1.14,1.83]），干预组达到体重目标的比例显著高于常规护理组。在12个月时组间差异减小（33.0%对28.0%；OR1.25[0.96,1.62]）。在6个月时，干预组女性的体重滞留显著少于常规护理组女性（平均0.39kg[标准差5.5]对0.95kg[5.5]；平均组间差异-0.64kg[95%CI-1.13,-0.14]），并且剧烈强度身体活动的增加幅度更大（平均组间差异15.4分钟/周[4.9,25.8]）。
DPP衍生的生活方式干预适度减轻了产后体重滞留，并增加了剧烈强度身体活动。
