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Personalized Letter Improves Pregnancy Weight for Women with Gestational Diabetes

Simple intervention using data from electronic health record significantly increases proportion of women who meet national gestational weight gain guidelines.

April 18, 2018



Smiling dark-haired pregnant woman sitting on a couch.

OAKLAND, Calif. — Women with gestational diabetes who received a tailored letter with personalized weight-gain recommendations were significantly more likely to meet national weight-gain guidelines, according to a new Kaiser Permanente study published today in Diabetes Care, a journal of the American Diabetes Association.

Gestational diabetes, the most common pregnancy complication, puts women at high risk for developing type 2 diabetes later in life; this risk is heightened for women who gain too much weight during pregnancy.

The study, “A Tailored Letter Based on Electronic Health Record Data Improves Gestational Weight Gain Among Women with Gestational Diabetes: The Gestational Diabetes’ Effects on Moms (GEM) Cluster-Randomized Controlled Trial,” involved more than 2,000 pregnant women receiving care at Kaiser Permanente facilities in Northern California. Researchers aimed to identify health-system-based approaches to helping women with gestational diabetes manage weight during a critical stage of their lives.

“The tailored letter was a simple, scalable intervention,” said co-lead author Susan D. Brown, PhD, research scientist at the Kaiser Permanente Division of Research. “This low-intensity approach — which efficiently leveraged clinical data to send personalized advice directly to patients on behalf of the health care system — could have beneficial effects at the population-level.”

“We now have data that this pregnancy intervention works well in a large, integrated health care system. With the widespread availability of electronic health record systems, the intervention could be replicated in other health care settings,” said co-lead author Monique M. Hedderson, PhD, research scientist at the Division of Research.

In the study, pregnant women with gestational diabetes across 44 Kaiser Permanente medical facilities were randomized at the facility level into usual care or a multi-component lifestyle intervention. The intervention was delivered during pregnancy, with the tailored letter; and after pregnancy, with 13 telephone sessions led by a lifestyle coach.

Example of letter tailored to information from the patient’s electronic health record.

The letters were automatically generated based on information in the patient’s electronic health record and mailed on behalf of Kaiser Permanente’s Perinatal Service Center. Letters were tailored based on the woman’s pre-pregnancy weight and her trajectory of weight gain up until her diagnosis with gestational diabetes. They included personalized pregnancy weight targets based on the national Institute of Medicine guidelines, as well as tips for healthy eating and activity during pregnancy.

Women who received the tailored letter were significantly more likely to meet the national weight-gain guidelines (72.6 percent) than women receiving usual care (67.1 percent). Women who received the letter were also less likely to have a large-for-gestational-age baby (9.7 percent vs. 12.8 percent). In addition, the improvement in gestational weight gain contributed to women being more likely to lose weight in the year after delivery.

“Our study provides strong evidence that managing weight during pregnancy can have lasting benefits for mom’s weight after the baby is born,” said senior author Assiamira Ferrara, MD, PhD, associate director of women’s and children’s health at the Division of Research.

“Most women gain more weight than recommended in pregnancy. Clinicians want counseling tips and actions that can help their patients meet the weight-gain guidelines — especially high-risk patients, such as those with gestational diabetes,” said Tracy Flanagan, MD, director of women’s health for The Permanente Medical Group of Kaiser Permanente Northern California. “Effective communication, with reminders, tips and coaching, supports patients in achieving that goal.”

This study was funded by the Agency for Healthcare Research and Quality and the National Institute of Diabetes and Digestive and Kidney Diseases.

In addition to Hedderson, Brown and Dr. Ferrara, co-authors of the study were Samantha F. Ehrlich, PhD, MPH, Ai-Lin Tsai, MS, Yeyi Zhu, PhD and Charles P. Quesenberry, PhD, of the Kaiser Permanente Northern California Division of Research; and Yvonne Crites, MD, Kaiser Permanente Medical Center, Santa Clara.

About the Kaiser Permanente Division of Research
The Kaiser Permanente Northern California Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 600-plus staff is working on more than 350 epidemiological and health services research projects. For more information, visit divisionofresearch.kaiserpermanente.org or follow us @KPDOR.

About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 12 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/share.