Women with gestational diabetes mellitus (GDM) have increased weight and higher glucose levels during pregnancy and in the postpartum period compared to women without GDM. It is therefore recommended to prevent excess gestational weight gain (GWG) and also return to pre-pregnancy weight at 1-year postpartum. This is essential as higher postpartum weight retention (PPWR) at 1-year postpartum is a significant risk factor for long-term weight gain and the most important predictor of future diabetes in women with GDM. To tackle weight and subsequent metabolic health problems such as weight and glucose control in these women, there is a need to comprehend their risk and to investigate different lifestyle approaches. This thesis provides a better understanding of the novel concept of intuitive eating during and after pregnancy and its associations with metabolic health. It also investigates the predictors and consequences of PPWR in a cohort of women with GDM.
This thesis utilized data from the Lausanne University Hospital (CHUV) GDM longitudinal cohort. We assessed the cross-sectional and longitudinal associations between intuitive eating and metabolic health outcomes during pregnancy and in the postpartum period in women with GDM. We also investigated the predictors and consequences of weight retention in this cohort.
The cross-sectional analysis showed that intuitive eating during and after pregnancy was significantly associated with metabolic health outcomes, both with weight and with glucose control. The longitudinal analyses revealed that intuitive eating during pregnancy was also related to later metabolic health outcomes, at the end of pregnancy, but also in the early (6-8 weeks) and late (1-year) postpartum period. Regarding the predictors and consequences of PPWR, GWG predicted higher PPWR, both in the early and late postpartum period. Women with PPWR had worsened glucose control at 1 year postpartum that was not observed in the early postpartum period.
These results suggest that intuitive eating could represent a novel approach to weight and glucose management in women with GDM. Our data regarding the consequences of PPWR also suggest that clinical care with a strong focus on lifestyle interventions in order to improve weight and glucose control should be essential up to the late postpartum.