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Women with a history of Gestational diabetes mellitus (GDM) have a high risk of developing Type 2 diabetes mellitus (T2DM) in their future life. Lifestyle interventions are known to reduce this progression. The success of a lifestyle intervention mainly depends on its feasibility. Therefore, this study aimed to evaluate the feasibility of a lifestyle intervention programme aimed to attenuate the development of T2DM in mothers with a history of GDM. This qualitative phenomenological study was carried out in selected Medical offices of Health (MOH) areas in Sri Lanka. Postpartum mothers with a history of GDM who have undergone a comprehensive, supervised lifestyle intervention program for 1 year, their family members, and public health midwives (PHM) were recruited for this study. Focus group discussions (FGD) were carried out with mothers and PHM while In-depth interviews (IDI) were conducted with family members. Framework analysis was used for the analysis of data. A total of 94 participants (45 mothers, 40 healthcare workers, and 9 family members) participated in FGDs and IDIs to provide feedback regarding the lifestyle intervention. Sixteen sub-themes emerged under the following four domains; (1) Feelings and experiences about the lifestyle intervention programme for postpartum mothers with a history of GDM (2) Facilitating factors (3) Barriers to implementation and (4) Suggestions for improvement. Spouse support and continued follow-up were major facilitating factors. The negative influence of healthcare workers was identified as a major barrier to appropriate implementation. All participants suggested introducing continuing education programmes to healthcare workers to update their knowledge. The spouse's support and follow-ups played a pivotal role in terms of the success of the programme. Enhancing awareness of the healthcare workers is also essential to enhance the effectiveness of the programme. It is imperative to introduce a formal intervention programme for the postpartum management of mothers with a history of GDM. It is recommended that the GDM mothers should be followed up in the postpartum period and this should be included in the national postpartum care guidelines. [ABSTRACT FROM AUTHOR]

Background: A woman with a history of GDM has a high risk of developing type two diabetes (T2DM) in her future life. Lifestyle modifications are known to attenuate the progression of GDM to T2DM. Therefore, the aim of this study was to assess the impact of a simple, cost effective, culturally acceptable lifestyle intervention programme on the trajectory towards T2DM in women with a history of GDM. Methods: This cluster randomized trial was conducted in 100 postpartum women in three selected districts of Sri Lanka. The subjects were divided into intervention (n = 50) and control groups (n = 50) by cluster randomization method. A culturally adapted protocol (comprised of dietary and physical activity modifications) was administered to the intervention group. The glycemic profile was assessed using fasting and 2-hour post-OGTT plasma glucose and HbA1c, and insulin resistance by HOMA-IR at baseline and after one year of intervention. Results: The mean age (SD) of the subjects in the intervention and control groups were 33.0 (5.1) and 34.3 (6.5) years respectively. All glycemic and insulin resistance parameters (i.e. Fasting plasma glucose- FPG, 2-hour post-OGTT plasma glucose, HbA1c and HOMA-ir) were comparable (p > 0.05) between the two groups at baseline. FPG, 2 h post OGTT, HbA1c and HOMA-ir values between intervention vs. control (p) at 12 months were 87.3 vs. 123.2 (< 0.01); 106.5 vs. 156.1 (0.01); 5.3 vs. 6.8 (< 0.01) and 0.9 vs. 2.3 (< 0.01) respectively. All glycemic parameters showed a significant reduction in the intervention group at 12 months compared to baseline. In contrast, the control group showed a significant increase in FPG, 2-hour post-OGTT plasma glucose and HbA1c at 12 months compared to baseline. In multiple linear regression model adjusted for age, parity and family history, the control group showed an approximately 33 times risk of developing insulin resistance compared to the intervention group. Conclusion: The culturally acceptable and individualized lifestyle intervention was able to produce remarkable reductions in glycaemic and insulin resistance parameters among postpartum women with a history of GDM. Trial registration: Ethical clearance was obtained from the Ethics Review Committee of the University of Sri Jayewardenepura, Sri Lanka (ERC 52/14), Sri Lanka Clinical trial registration number Sri Lanka Clinical Trials Registry (SLCTR/2015/021 date 25.09.2015). [ABSTRACT FROM AUTHOR]

Background: Regular physical activity (PA) attenuates the development of type 2 diabetes mellitus in postpartum women with prior gestational diabetes mellitus (GDM). PA is assessed by calculating the energy expenditure (EE), thus accurate estimation of EE is crucial. International PA Questionnaire (IPAQ) and activity diary are widely used subjective methods while pedometer provides objective evidence of PA and EE. Aims and Objectives: This study aims to compare subjective and objective methods of assessing EE as a measure of PA in postpartum women with a history of GDM. Materials and Methods: Fifty postpartum women who had a history of GDM were advised to maintain activity diaries and pedometer readings for 1 week each month up to 1 year and IPAQ was administered at the end of 6 and 12 months. EE was calculated by all three methods separately and Bland-Altman plots were used to assess the level of agreement between IPAQ and the other tools at 6 and 12 months. Friedman test was performed to compare estimated EE between the three methods. Results: There was a poor agreement between the subjective and objective methods. According to Bland-Altman plot results, the highest mean difference was observed between IPAQ and pedometer at 12 months (mean difference was 75.9). This observation indicated an underestimation of pedometer values at 12 months. EE assessed by two subjective methods were statistically comparable at both time points whereas, EE assessed by pedometer was significantly lower (P<0.017) compared to self-reported tools. Conclusion: Assessment of EE by subjective methods which are based on personal judgment may cause overestimation of PA. In contrast, pedometer readings are likely to underestimate the PA as it only reports kinetics activities. Therefore, a combination of subjective and objective methods is recommended to ameliorate the reliability and validity. [ABSTRACT FROM AUTHOR]

Background. Gestational diabetes mellitus (GDM) is a global concern. GDM mothers have a 7-fold relative risk of developing type 2 diabetes mellitus (T2DM) in their later life. User-friendly and culturally acceptable dietary interventions can minimize this risk. Therefore, this study aims at exploring the perceptions of GDM mothers and health care workers regarding factors that influence postpartum dietary practices aimed at attenuating the trajectory from GDM to DM. Methods. The study was conducted in selected MOH areas in three districts of Sri Lanka. Six focus group discussions were conducted with thirty mothers with a history of GDM and six in-depth interviews with six health care workers. The phenomenon of interest was to obtain inputs of two stakeholder groups on healthy food habits of GDM mothers during the postpartum period. Framework analysis was used to analyse the data. Data were coded using the analytical framework, abstracted from transcripts, and summarized verbatim in Microsoft Excel in a matrix comprised of one row per participant and one column per code. Finally, the matrix was reviewed intensely and themes were generated. Results. Overall, seven themes emerged from both cases: (1) myths and traditions specific to the postpartum period, (2) lack of motivation, (3) time pressure, (4) financial barriers, (5) negligence of mothers and families, (6) lack of awareness regarding GDM and its postpartum dietary recommendations, and (7) cultural barriers. Conclusions. This study provides an insight into the existing knowledge, common practices, and attitudes regarding food habits among postpartum mothers with a history of GDM. Since the postpartum period is unique, identifying barriers is crucial when introducing dietary modification protocols in order to prevent or attenuate the progression of GDM to T2DM in these mothers. The knowledge gained will be used to introduce feasible, scientifically sound, and culturally acceptable postpartum dietary recommendations for GDM mothers. [ABSTRACT FROM AUTHOR]