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
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.