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Post‐partum weight loss and glucose metabolism in women with gestational diabetes: the DEBI Study
Author(s) -
Ehrlich S. F.,
Hedderson M. M.,
Quesenberry C. P.,
Feng J.,
Brown S. D.,
Crites Y.,
Ferrara A.
Publication year - 2014
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.12425
Subject(s) - medicine , gestational diabetes , insulin resistance , insulin , diabetes mellitus , endocrinology , breastfeeding , gestational age , weight loss , pregnancy , birth weight , randomized controlled trial , obstetrics , gestation , obesity , pediatrics , genetics , biology
Abstract Aims Women with gestational diabetes are at high risk for developing diabetes; post‐partum weight loss may reduce the risk of diabetes. We evaluated the association of post‐partum weight change with changes in glucose, insulin and homeostasis model assessment of insulin resistance in a subsample ( n = 72) of participants from Diet Exercise and Breastfeeding Intervention ( DEBI ), a randomized pilot trial of lifestyle intervention for women with gestational diabetes. Methods Glucose and insulin were measured fasting and 2 h after an oral glucose tolerance test at 6 weeks and 12 months post‐partum. Women were categorized by weight change (lost > 2 kg vs. maintained/gained) between 6 weeks and 12 months post‐partum. Results Compared with women who maintained or gained weight, women who lost > 2 kg experienced significantly lower increases in fasting glucose [age‐adjusted means: 0.1 mmol/l (95% CI –0.03 to 0.3) vs. 0.4 mmol/l (95% CI 0.3–0.6); P < 0.01] and 2‐h insulin [10.0 pmol/l (95% CI –56.9 to 76.9) vs. 181.2 pmol/l (95% CI 108.3–506.9); P < 0.01] and a significant reduction in 2‐h glucose [–0.9 mmol/l (95% CI –1.4 to –0.3) vs. 0.3 mmol/l (95% CI –0.3 to 0.9); P < 0.01]. In multiple linear regression models adjusted for age, Hispanic ethnicity, medication use, meeting the Institute of Medicine's recommendations for gestational weight gain, breastfeeding and randomized group, a 1‐kg increase in weight was significantly associated with increases in fasting and 2‐h glucose ( P < 0.05), but was not associated with insulin or homeostasis model assessment of insulin resistance. Conclusions In women with gestational diabetes, modest post‐partum weight loss may be associated with improvements in glucose metabolism.