Discussion
GDM among overweight, gestational diabetes, polycystic ovary syndrome, GDM, overweight, preterm labor, preeclampsia
OBESE, GESTATIONAL DIABETES, POLYCYSTIC OVARY SYNDROME, GDM, PRETERM LABOR, TYPE 2 DIABETES, PREECLAMPSIA
This quasi–experimental study investigated the effectiveness of an 8-week phone coaching program, which integrated GWG and physical activity, in reducing the incidence of GDM in overweight or obese pregnant women. The program was delivered by a midwife coach through 4 telephone sessions, each lasting 30–45 min. However, the study found that the program did not result in a significant reduction in the incidence of GDM when compared to the control group. However, the intervention group reported high satisfaction with phone health coaching during pregnancy. This intervention focused on promoting a healthy diet during pregnancy, GWG, and moderate regular exercise throughout pregnancy to prevent GDM. Most published studies used the health coaching intervention to control and treat type 2 diabetes and GDM [Our findings are consistent with those of a meta-analysis that included 23 studies with a total of 8,877 overweight or obese women aimed to prevent GDM. According to this meta-analysis, the physical activity and/or diet interventions (alone or in combination) were less effective than placebo in reducing the risk of GDM [There are several potential explanations for the lack of significant effects of our intervention on the prevention of GDM among overweight or obese women. A meta-analysis [In our study, maternal and neonatal outcomes were desirable in both groups, with no adverse outcomes. Only 2 cases of low birth weight and preterm labor were observed in the control group. In both groups, the cesarean delivery rate was almost equal. In the intervention group, there were 2 cases of normal vaginal birth after cesarean section. A Cochrane review of 15 trials found no evidence of a difference between the control and lifestyle intervention groups in maternal outcomes, such as cesarean section and preeclampsia in treating women with GDM [There are some limitations in this study. First, this study used a non-probability sampling method, while future studies that use random sampling can provide stronger evidence on this intervention. Second, this study had a single-center design with a short intervention. Third, risk factors of gestational diabetes are varied so the risk factors can affect the incidence of gestational diabetes in our participants; however we considered the gestational diabetes risk factors in our exclusion criteria and excluded women with a higher risk of gestational diabetes. We suggest future studies consider having polycystic ovary syndrome of participants and dietary pattern of pregnant women. Moreover, further studies with longer interventions that include both the first and second trimesters of pregnancy can provide more relevant results. According to a meta-analysis, the prevention of GDM in overweight or obese pregnant women may require interventions that target both the first and second trimesters of pregnancy. Third, we did not assess compliance with a healthy dietary pattern, which will impact the association of the coaching intervention with GDM; however, our coaching intervention aimed to promote a healthy diet that supports both GWG and the prevention of GDM, as this was a key goal of the coaching sessions. Finally, participants in the control group might have taken information on physical activity and control weight from the participants in the intervention group, which might cause a confirmation bias.