title: Post-partum weight loss and glucose metabolism in women with gestational diabetes: the DEBI Study.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
authors.forename: S F
authors.initials: SF
authors.lastname: Ehrlich
authors.forename: M M
authors.initials: MM
authors.lastname: Hedderson
authors.forename: C P
authors.initials: CP
authors.lastname: Quesenberry
authors.forename: J
authors.initials: J
authors.lastname: Feng
authors.forename: S D
authors.initials: SD
authors.lastname: Brown
authors.forename: Y
authors.initials: Y
authors.lastname: Crites
authors.forename: A
authors.initials: A
authors.lastname: Ferrara
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D001942:Breast Feeding / Q000706:statistics & numerical data*; D018592:Cross-Over Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control*; D016640:Diabetes, Gestational / Q000453:epidemiology / Q000208:ethnology / Q000378:metabolism*; D004522:Educational Status; D005215:Fasting; D005260:Female; D005951:Glucose Tolerance Test; D006706:Homeostasis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010353:Patient Education as Topic; D010865:Pilot Projects; D049590:Postpartum Period; D011247:Pregnancy; D040242:Risk Reduction Behavior; D014481:United States / Q000453:epidemiology / Q000208:ethnology; D015430:Weight Gain; D015431:Weight Loss
chemical_list: D001786:Blood Glucose