How to lower the risk of cardiovascular disease for women within 5 years of giving birth?
This blog outlines evidence recently published in the Journal of Diabetes, and is written by Dr Vivian Lee, Research Fellow, The George Institute for Global Health
Sarah, a full-time working mother, is a proud parent of a lively 2-year-old boy named Ollie. Being slightly overweight and having experienced gestational diabetes during her pregnancy with Ollie, she is aware of the importance of maintaining a healthy diet and regular exercise. However, without the support of extended family and the constant demands of motherhood, she finds herself in an endless race against time.
Given Sarah’s history of gestational diabetes during pregnancy, being overweight and a lack of a healthy lifestyle, she’s at an increased risk of developing type 2 diabetes. Type 2 diabetes is major chronic disease and an added risk factor for heart disease. So, as well as being at risk of type 2 diabetes, Sarah is also at risk of developing heart disease. All by the time Ollie reaches the age of 10.
This narrative is all too common among women who have recently given birth, regardless of work commitment, or family support. These women face unique challenges, and their health takes a back seat. As a result, there’s an urgent need to provide solutions and reduce their risk of type 2 diabetes and heart disease.
Current evidence supports a healthy diet and being physically active as ways to reduce the risk of type 2 diabetes in postpartum women. However, the evidence is drawn from studies that include women who are on average, 12 years after childbirth. In addition, information on other preventive intervention – asides from diet and exercise - is unknown.
We know early intervention provides a better chance of lowering risk. Therefore, we looked to see if any preventive interventions had an effect in reducing long-term type 2 diabetes in recent (within 5 years) postpartum women. Our findings have just been published in the Journal of Diabetes.
Investigation
We did a search of the literature to identify ‘all’ intervention types aimed at reducing type 2 diabetes in women within 5 years postpartum. We also only included studies that had a follow up for at least 12 months to ensure the benefits – if found – are maintained for that that period.
Discoveries
Our search identified two types of intervention aimed at reducing the risk of type 2 diabetes in recent postpartum women: lifestyle interventions (diet and physical activity), and pharmacotherapy trials. The included women were on average 34.5 years old, with a mean body mass of 28.9kg/m2, and from middle to high-income country. Overall, we did not find any evidence to support the benefits of preventive interventions in reducing type 2 diabetes in recent postpartum women.
We identified two key issues.
Lack of adherence in lifestyle interventions
The largest lifestyle intervention trial including 1823 women did not find any benefits in reducing the risk of type 2 diabetes in postpartum women. Notably, only 26.1% and 27.5% of women attended all group or individual sessions respectively. Therefore, while lifestyle changes show promise in other studies, more work is needed to improve adherence to these behaviour changes in recent postpartum women, a period of time when women face unique challenges.
Lack of pharmacotherapy options
Only three pharmacotherapy trials were found, and one study stopped prematurely due to an issue with the drug. However, the two remaining studies found a benefit. Given the low number and strong indication of benefit, we believe more pharmacotherapy studies are needed.
Next steps
- We plan to keep a close eye on new research for the next five years. We’ll repeat our search annually to catch any newly published studies that meet our criteria. If we find such studies, we’ll include them in our review to ensure it remains current and relevant.
- Feasibility Study: We have developed a feasibility trial that focuses on pharmacotherapy and lifestyle interventions for women within the postpartum period of up to 5 years. The primary objective of this trial is not to evaluate the efficacy of these interventions, but rather to ascertain the feasibility of conducting such a trial within this specific cohort of women. The postpartum period presents unique challenges, and it remains uncertain whether interventions addressing the two main points identified through our review can be effectively implemented during this time. Our feasibility study aims to explore this uncertainty.
- The insights gained from this study will not only enhance our understanding of the challenges and opportunities in this field, but also pave the way for future research, particularly larger studies that are focused on efficacy. Further details of these findings can be found in our paper, ‘The efficacy of interventions to prevent type 2 diabetes among women with recent gestational diabetes mellitus—A living systematic review and meta‐analysis - Lee - 2024 - Journal of Diabetes - Wiley Online Library’.
Author:
Dr Vivian Lee, PhD, is a Research Fellow at The George Institute for Global Health and a Conjoint lecturer at the University of New South Wales.
Vivian is interested in the prevention of non-communicable diseases, with a particular emphasis on leveraging physical activity. Currently, she is dedicated to investigating strategies to reduce the long-term risk of disease using a comprehensive approach involving pharmacotherapy and physical activity in postpartum women. Her research interests include cardiovascular health, exercise and physical activity, prevention, public health, CALD population, women's health and miscarriage.
