Web-Based Weight Loss for New Moms with Recent Gestational Diabetes

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Researchers at Joslin and Brigham and Women’s Hospital have teamed up to create a breakthrough healthy lifestyle program to help women with recent gestational diabetes lose weight after pregnancy. The best part? It’s all online, giving busy moms a better chance to drop that baby weight.

Gestational diabetes is impaired glucose tolerance with onset or first recognition during the first trimester of pregnancy. Women with gestational diabetes are at increased risk for pregnancy and delivery complications including larger than average birth weight, neonatal hypoglycemia, and cesarean delivery.

A woman is at higher risk for developing the disorder if she has advanced maternal age, a family history of diabetes, is overweight or obese, and if she has had previous pregnancies.

Although in most women, gestational diabetes goes away after delivery that is not the end of the story. Florence Brown, M.D., Director of the  Joslin-Beth Israel Deaconess Diabetes and Pregnancy Program, explains that women who are affected by gestational diabetes have more have a fifty percent risk of developing type 2 diabetes in the 7 to 10 years after their pregnancy. One of the most important risk factors for developing type 2 diabetes after gestational diabetes is increased weight.

“We know from previous studies that healthy diet, regular exercise and modest weight loss can reduce this risk,” says Dr. Brown. “So, women who had gestational diabetes should have access to lifestyle interventions that support these goals.”

Researchers have demonstrated that intensive lifestyle classes can help individuals lose weight and decrease their risk for type 2 diabetes. But it can be extremely hard and often impossible for a new mom to attend on-site sessions with a tiny baby in tow, especially if there are more kids at home or she’s returning to work.

“A big barrier for women in the months after delivery is doing something on a set schedule, especially if it’s outside the home,” says Ellen W. Seely, M.D., an endocrinologist at Brigham and Women’s Hospital and senior author on the new study. “So we thought, what if we can put the intervention inside their home?”

Dr. Ed Horton

Dr. Ed Horton worked with Dr. Seely as part of the DPP, out of which the online post-gestational diabetes program sprung

Over 15 years ago, Dr. Seely worked as a member of the research team led by Edward S. Horton, M.D, in the Joslin-based Diabetes Prevention Program (DPP). The DPP is part of a fifteen year, NIH funded, multi-center trial designed to prevent or delay the development of diabetes in people with impaired glucose tolerance.

For the DPP, Dr. Horton and collaborators designed a series of sixteen on-site, lifestyle intervention classes over the course of six months. “We gave patients a lot of instruction on healthy eating, cutting back calories, increasing physical exercise and keeping them involved and motivated,” says Dr. Horton.

The classes worked much better than standard counseling, with an average 7 percent loss of body weight.

But as Dr. Seely recognized, having a young baby and hectic post-maternity-leave work schedules are not compatible with a perfect class attendance record.

“This has been a notoriously difficult group of people to have come in on a frequent basis for an on-site program,” says Dr. Horton. “So Dr. Seely and her team took the DPP’s 16 sessions, boiled them down to about 12 sessions, and made them accessible as modules on the internet.”

To design the study, funded by the CDC, Dr. Seely and her team spent months getting feedback from new moms about barriers they faced and what they wanted to see in the program. Using the DPP as a jumping off point, they fine tailored the DPP recommendations to include personalized examples for new moms. “For instance, instead of urging them to hit the gym, we encouraged them to go for a brisk walk with their baby in the stroller,” says Dr. Seely.

It was also important to her that moms could access the modules at any time of day or night and pause them with a click of a button. The narrated, PowerPoint-like slideshows were easily stopped and could be watched multiple times.

Dr. Seely also wanted the moms to have more access to the educators than just the face-to-face meetings of the DPP.  She and her research group developed an email and phone system where the lifestyle coaches could respond to questions within two business days

“So if mom is up at 4 am, she could easily write an email to her lifestyle coach and not have to remember it for [a phone call during] the next business day,” says Dr. Seely.

In addition to the educational videos and improved access to the lifestyle coaches, women could talk to one another through the community forums for tips and motivation. Dr. Seely and her team also added a regularly updated toolkit, adding requested items like “more recipes” and “information on exercise bras” throughout the trial.

At the end of the study (a year after delivery), the women in the web-based program lost an average of 6 pounds and were, on average, back to their pre-pregnancy weight. The control group, who followed regular post-pregnancy care with enhanced screening for diabetes, actually gained weight in the year following pregnancy.

Dr. Brown, who is enrolling women in a separate online lifestyle intervention study through Joslin and Beth Israel, thinks highly of Dr. Seely’s work. “In the future, we’d welcome research collaboration with Dr. Seely.”

So, if you’re a new mom who just had gestational diabetes looking to lose weight and attain a healthy lifestyle, should you look for similar web modules? “We actually developed this program because we couldn’t find anything out there like this for this group of women,” says Dr. Seely. “Focus groups said that they had looked and found nothing similar.”

Dr. Seely is currently working on a larger-scale follow-up study to fine-tune the web based program. “If the larger study also shows that the web-based lifestyle program is effective then we’re going to roll it out and make it available to healthcare organizations and public health systems.”

If Dr. Seely’s program was made available, Dr. Brown says that she would definitely use it for her patients. However, she explains that an even larger problem is insurance. Companies rarely cover intensive lifestyle intervention classes, whether in person or online.

“Standard care of women with gestational diabetes usually ends about 6 weeks after delivery,” says Dr. Brown. “Hopefully [these trials] will convince insurance companies that lifestyle interventions are effective, so that they will cover them.”

Dr. Horton, who consulted with Dr. Seely on her study and who had worked with her on the original Diabetes Prevention Program believes Dr. Seely is really onto something. “I think it has been really important to translate the results of the DPP into real life situations,” says Dr. Horton. “And Dr. Seely’s methods have been quite effective.”

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