Lifestyle interventions for the prevention and management of gestational diabetes mellitus among Latinas Open Access

Memmer, Amy (2015)

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OBJECTIVE: Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy and it is more common among minority groups (e.g., Latina women) compared to non-Hispanic white women. GDM increases the risk of multiple fetal and maternal perinatal outcomes, and increases a woman's subsequent risk of type 2 diabetes by over seven-fold. Studies of lifestyle interventions to prevent GDM and its related perinatal outcomes have conflicting results, and few studies have included Latinas. This review and meta-analysis aimed to identify what is currently known about the effectiveness of lifestyle interventions and exposures for prevention and management of GDM among Latinas.

METHODS: A systematic review of the literature was performed by searching PubMed, CINAHL, Web of Science, EMBASE, CENTRAL, and databases for studies published in English or Spanish using key words relating to three elements: 1) GDM, 2) lifestyle exposures/interventions (primarily diet and exercise), and 3) the population of Latinas living in the Americas. Observational and experimental studies that addressed all three elements and provided data on the outcomes of interest were considered eligible for inclusion. Meta-analysis was carried out using a fixed effects model to provide summary odds ratios and the I2 assessment of heterogeneity.

RESULTS: The search returned 1647 relevant articles, from which 6 original studies were included in this review. There were no statistically significant relationships between Latinas' reported levels of physical activity in pre-, early, or mid-pregnancy and the risk of developing GDM. Due to heterogeneity of study designs and outcomes, meta-analysis was only performed for the relationship between physical activity levels and the risk of GDM.

CONCLUSIONS: This systematic literature review identified a dearth of studies of lifestyle interventions for prevention and management of GDM that include Latina populations. Although this meta-analysis found no significant association between reported levels of physical activity and risk of GDM, it was limited to two observational studies of physical activity amongst pregnant Latinas, and more research is needed on this topic.

Table of Contents

Chapter 1: Introduction

1.1 Background of the Problem. 1

1.2 Statement of the Problem. 3

1.3 Statement of Purpose. 4

1.4 Research Questions. 4

1.5 Statement of Significance. 5

1.6 Definition of Terms. 6

Chapter 2: Comprehensive Review of the Literature

2.1 Introduction. 7

2.2 Prevalence of GDM. 7

2.3 Risk Factors for GDM. 8

2.4 Health Outcomes of GDM. 8

2.5 Prevention & Management of GDM. 11

2.6 Qualitative Research. 15

2.7 Summary. 17

Chapter 3: Methods & Results

3.1 Methods. 19

3.2 Results. 23

3.21 Main Findings. 25

3.22 Methodological Quality. 29

Chapter 4: Discussion, Recommendations, & Conclusion

4.1 Discussion. 30

4.11 Prevention of GDM. 30

4.12 Prevention of Other Perinatal Outcomes. 33

4.13 Strengths and Weaknesses. 35

4.2 Recommendations. 38

4.3 Conclusion. 40

References. 42


Appendix A. 47

Appendix B. 51

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