Tailored Letter May Improve Gestational Weight Gain in Gestational Diabetes

A pregnant woman
A pregnant woman
A tailored electronic health record letter may improve gestational weight gain and reduce postpartum weight retention.

A letter based on the electronic health care record data of women with gestational diabetes, describing 6 tailored health messages designed to improve gestational weight gain, led to better outcomes in comparison with usual care, but primarily among women with body mass indices (BMIs) <25, according to a study published in Diabetes Care.

The Gestational Diabetes’ Effects on Moms (GEM) trial sought to reduce postpartum weight retention in women with GDM through a controlled, cluster-randomized trial within the Kaiser Permanente Northern California integrated health care delivery system. Women aged ≥ 18 years who were diagnosed with GDM between March 2011 and March 2012 across 44 facilities were included in the study (N=2014) and randomly assigned into a usual care group or a usual care plus lifestyle intervention via a personalized letter, written using electronic health care record data.

The tailored letters, written at below an eighth-grade reading level, had the participants’ names in the salutation, were printed on official letterhead, and listed 6 messages concerning 1) weight history, 2) gestational weight gain recommendations based on pre-pregnancy BMIs, 3) end of pregnancy weight goals, 4) recommendations for weight management, 5) lifestyle tips for meeting weight goals, and 6) information regarding the impact of gestational weight gain on pregnancy complications and postpartum health.

When the data were analyzed overall, the letters did not appear to have a statistically significant effect on meeting weight goals (36% intervention group vs 33% usual care group; relative risk [RR] 1.08; 95% CI, 0.99–1.18). However, the GEM intervention did increase the changes of goal attainment by 28% for women with normal-range pre-pregnancy BMIs (RR 1.28; 95% CI, 1.05–1.57). No increase was found for women with overweight and obese-range pre-pregnancy BMIs (RR 0.99; 95% CI, 0.87–1.13).

Related Articles

Ultimately, the GEM low-intensity intervention approach did increase the number of women with GDM who achieved appropriate gestational weight gain, which has a positive effect on postpartum weight retention.

“Thus, for women with GDM, pregnancy may offer a unique window of opportunity to intervene to reduce postpartum weight retention when women are motivated to change lifestyle behaviors. Given the increased use of [electronic health care records], system-level interventions using the [electronic health care record] to provide tailored advice to large patient populations offers the potential to improve [gestational weight gain] and may be implementable across medical settings.”


Hedderson MM, Brown SD, Ehrlich SF, et al. 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 [published online April 18, 2018]. Diabetes Care. doi: 10.2337/dc17-1133