title: The Comparative Effectiveness of Diabetes Prevention Strategies to Reduce Postpartum Weight Retention in Women With Gestational Diabetes Mellitus: The Gestational Diabetes' Effects on Moms (GEM) Cluster Randomized Controlled Trial.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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]).
  
  
  CONCLUSIONS
  A DPP-derived lifestyle intervention modestly reduced postpartum weight retention and increased vigorous-intensity physical activity.
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA assiamira.ferrara@kp.org.
authors.forename: Assiamira
authors.initials: A
authors.lastname: Ferrara
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: Monique M
authors.initials: MM
authors.lastname: Hedderson
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: Susan D
authors.initials: SD
authors.lastname: Brown
authors.affiliation: School of Nursing and Dental Hygiene, University of Hawaii at Manoa, Honolulu, HI.
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Albright
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: Samantha F
authors.initials: SF
authors.lastname: Ehrlich
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: Ai-Lin
authors.initials: AL
authors.lastname: Tsai
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: Bette J
authors.initials: BJ
authors.lastname: Caan
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Sternfeld
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: Nancy P
authors.initials: NP
authors.lastname: Gordon
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Schmittdiel
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: Erica P
authors.initials: EP
authors.lastname: Gunderson
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: Ashley A
authors.initials: AA
authors.lastname: Mevi
authors.affiliation: Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
authors.forename: William H
authors.initials: WH
authors.lastname: Herman
authors.affiliation: Division of Perinatology, Department of Obstetrics and Gynecology, Kaiser Permanente Medical Center, Santa Clara, CA.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ching
authors.affiliation: Division of Perinatology, Department of Obstetrics and Gynecology, Kaiser Permanente Medical Center, Santa Clara, CA.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Crites
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: Charles P
authors.initials: CP
authors.lastname: Quesenberry
mesh_terms: D000328:Adult; D001521:Behavior Therapy; D015992:Body Mass Index; D016000:Cluster Analysis; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000517:prevention & control*; D016640:Diabetes, Gestational; D005260:Female; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D049590:Postpartum Period; D011247:Pregnancy; D040242:Risk Reduction Behavior; D015431:Weight Loss / Q000502:physiology*; D055815:Young Adult