American Diabetes Association
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Lifestyle Changes and Long-Term Weight Gain in Women With and Without a History of Gestational Diabetes Mellitus: A Prospective Study of 54,062 Women in the Nurses' Health Study II

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posted on 2021-12-08, 16:24 authored by Jiaxi Yang, Cuilin Zhang, Jorge E. Chavarro, Janet W. Rich-Edwards, Molin Wang, Wafaie W. Fawzi, JoAnn E. Manson, I-Min Lee, Frank B. Hu, Deirdre K. Tobias
Objective We examined lifestyle factors with mid-life weight change according to history of gestational diabetes mellitus (GDM) in a large longitudinal female cohort.

Research Design and Methods In the Nurses’ Health Study II, we categorized change in lifestyle within 4-year periods and estimated their associations with concurrent change in body weight (kg) among parous women after age 40 for the following: diet quality (Alternate Healthy Eating Index [AHEI]), leisure-time physical activity (PA), alcohol, and smoking, by GDM history status (total n=54,062, 5.3% with a history of GDM).

Results Over a median follow-up of 13 years, average 4-year weight gain was 1.10 kg and 1.33 kg for women with and without prior GDM, respectively. Women improving diet quality had favorable 4-year weight change, particularly among women with a history of GDM (AHEI change from low to high: -2.97 kg [CI: -4.34, -1.60] vs. -1.19 kg [CI: -1.41, -0.96] for GDM vs. non-GDM, respectively; p-heterogeneity=0.04). Increasing PA was associated with weight maintenance for GDM women only (PA increase from low to high: 0.26 kg [95% CI: -0.25, 0.77] vs. 0.90 kg [95% CI: 0.80, 1.01] for GDM vs. non-GDM, respectively; p-heterogeneity=0.02). For both GDM and non-GDM women, weight change did not differ significantly with change in alcohol, while women who quit smoking had significant weight gain (4.38 kg for GDM and 3.85 kg for non-GDM).

Conclusions Improvements in diet quality and PA were related to less weight gain in mid-life among parous women, and the benefit of such improvements on weight management was particularly pronounced among women with a history of GDM.


The Nurses' Health Study II is supported by the National Institutes of Health (NIH) grant U01 CA176726. J.Y. was supported by the PhD program in Population Health Sciences at Harvard University. C.Z. is supported by the NIH intramural research program of Eunice Kennedy Shriver National Institute of Child Health and Human Development. J.E.C. received grants from NIH (U01HL145386 and P30 DK046200). J.E.M. received grants from NIH. D.K.T. received grants from the American Diabetes Association. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.


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