SUPPORT AFTER PREGNANCY FOR WOMEN WITH RECENT GESTATIONAL DIABETES
Welcome to the ADAPT-M Program Website!
ADAPT-M is based on the latest clinical research and national guidelines aimed at preventing type 2 diabetes. Studies show that programs like this are safe, effective, and well-liked by both patients and health care providers. ADAPT-M is now being offered as part of standard postpartum care in three Ontario health regions.
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Referral Centres and Program Locations
| Area Served | Referral Centre | Program Location |
| East Toronto | Michael Garron Hospital | South Riverdale Community Health Centre |
| Mississauga | Trillium Health Partners | CarePoint Health |
| Cambridge and Waterloo Region | Langs Community Health Centre | Langs Community Health Centre |
ADAPT-M Roadmap
ADAPT-M Research
Women’s College Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2; Email: adapt-m@wchospital.ca
Principal Investigator
Dr. Lorraine Lipscombe MD, MSc, FRCPC
Co-Principal Investigator
Diana Sherifali, Associate Professor, McMaster University
Co-Investigators
Rebecca Fine, Endocrinologist, Michael Garron Hospital
Kelly Smith, Chief Scientific Officer, Michael Garron Hospital
Amish Parikh, Endocrinologist, Trillium Health Partners
Research Team
Megan Racey
Ishraq Rahman
Apisha Sri
Patient Partners
Jennifer Gordon
Seeta Ramdass
Sadia Mian
Tina Charamis
Students/Trainees
Katelyn Sushko
Paige Alliston
Sameen Ali
Aimen Zehra
The ADAPT-M study is funded by the Canadian Institutes of Health Research (CIHR) and Ministry of Ontario Health (MOH).
About Gestational Diabetes
Gestational Diabetes Mellitus (GDM) is a common condition that affects 6 to 10% of pregnancies in Canada. It happens when the body can’t manage blood sugar levels effectively during pregnancy. While GDM usually goes away after delivery, it is a marker of a higher chance of type 2 diabetes later in life. In fact, up to 60% of women with a history of GDM may develop type 2 diabetes with the highest risk in the first 10 years after delivery. The good news? Research shows that structured lifestyle programs in the first one to three years after childbirth can help prevent type 2 diabetes and improve long-term health.
Goal Setting
A goal is something you want to work towards. Goal-setting is a good way to help you stay on track to make changes in your life. Your ADAPT-M Health Coach will support you as you reach your goals by giving you advice and feedback.
In the ADAPT-M Program, you will learn how to…
What are S.M.A.R.T. Goals?
S.M.A.R.T. goals are goals you can reach with success. They are:
S = Specific
Make sure that your goals only address one plan at a time.
M = Measurable
If your goal is measurable, it is easier for you to keep track of how well you are doing.
A = Achievable
You can lose your drive to reach the goal if your goal is set so high that it feels like you are not going to succeed.
R = Relevant
Your goals should reflect your values and your drive. In other words, your goal should be important to you.
T = Timely
Choosing an end date will help you focus on and plan steps towards meeting your goal.
Nutrition
Eating a balanced diet is important to maintain good health and prevent chronic diseases, such as diabetes. Good nutrition provides our bodies with minerals, vitamins, and other nutrients to live and grow. Navigate these nutrition and healthy eating pages with your health coach to learn how you can start keeping a balanced diet.
Please click the hyperlink to find Canada’s food guide in various languages.
Nutrition Basics and Important Terms
The following vocabulary list will help you understand some of the words or phrases you may come across in the ADAPT-M program. If you do not fully understand any terms in this list or any other words in the ADAPT-M program, please discuss them with your ADAPT-M Health Coach. The terms are listed below in alphabetical order.
Health Canada’s guidelines and considerations on healthy eating based on scientific evidence.
A dietary component needed in larger quantities that provide our bodies with energy for the proper growth and development of the human body. Carbohydrates, fats, and proteins are all macronutrients.
Part of the foods we eat that are mostly vitamins and minerals are micronutrients and make up a small part of our diet.
The amount of food you put on your plate and plan on eating in one sitting.
A way to visually portion food onto your plate to support healthy eating. This replaces the idea of “food groups”. It suggests half your plate be filled with non-starchy vegetables and fruit, one quarter be filled with protein foods, and the remaining quarter be filles with whole grains and starchy vegetables.
A reference amount of food as defined by Health Canada; typically used on the nutrition facts table of a food to suggest the amount of food consumed in one eating occasion and the nutritional value of that serving.
Low Glycemic Index
The Glycemic Index (GI) is a scale out of 100 that ranks a carbohydrate-containing food or drink by how much it raises your blood sugar levels after it is consumed. In general, the more highly processed a food is, or the quicker it is digested, the higher the GI.
A low GI diet can help you:
– Decrease your risk of type 2 diabetes and its complications
– Decrease your risk of heart disease and stroke
– Feel full faster and longer
– Manage your weight
Meal Planning Ideas
Here are some meal planning ideas to lower the overall GI of a meal:
1. Cook pasta ‘al dente’ (firm). Since al dente pasta requires more work from the body during digestion, the digestion rate is slower and, therefore, the GI is lower. Check your pasta package instructions for cooking time.
2. Make fruits and milk part of your meal. These foods often have a low GI.
3. Try lower GI grains, such as quinoa, barley and bulgur.
4. Pulses (e.g., dried beans, peas, lentils and chickpeas) are considered part of two categories: starchy foods and protein foods. Swap half of your higher GI starch food serving with beans, lentils or chickpeas.
For example: Instead of having 1 cup of cooked rice, have 1⁄2 cup of cooked rice mixed with 1⁄2 cup of black beans.
5. Cool red or white potatoes after boiling or baking and enjoy them cold, such as in a potato salad. This increases resistant starch which has a lower effect on blood sugar.
S.M.A.R.T. Goals and Your Nutrition
S.M.A.R.T. goals are goals you can reach with success. They are:
S = Specific
M = Measurable
A = Achievable
R = Relevant
T = Timely
Examples of S.M.A.R.T. Goals focusing on Nutrition:
- I want to increase my vegetable intake so I will try 1 new vegetable per week that I also introduce to my baby. I want to be healthy for myself and my family and this will also set an example for my child.
- When I go back to work in 2 months, I won’t have the time to cook myself lunch. When my mother-in-law comes to visit on Sunday mornings, I will cook extra food to freeze for two of my lunches during the work week.
- I want to increase my weekly vegetable intake, therefore I will ask my best friend to join a vegetarian cooking class with me for 2 months at the local supermarket.
Eating For Your Health
Heart Health
There are different kinds of fat in the foods we eat. Fats are important to give your body energy and to support cell growth. Fats also help you absorb some nutrients and produce hormones. Unsaturated fats can improve your heart health. When possible, choose to eat and cook with unsaturated fats more often and limit saturated and trans fats.
Strength and Fueling Your Body
Exercise is very beneficial in the postpartum period. To support your exercise routine, try to hydrate throughout the day and during your workout by drinking water. Eating balanced meals and snacks before and after a workout will support your energy levels and post-workout recovery.
Protein is an essential macro-nutrient to keep your body working well. Proteins are made up of amino acids (building blocks). Amino acids are part of many body cells. Protein is needed to build hormones and enzymes and build and repair muscle, tissue, skin, nails and hair. Foods that are high in protein include meat, poultry, fish, eggs, tofu, and legumes. Nuts, nut butters, milk, cheese, cottage cheese, soy beverages and yogurt are good sources of protein too. Whole grain breads, rice, pasta, quinoa, and barley contain small amounts of protein.
Promoting Gut Health
You may experience changes in your digestive health postpartum. This is normal as your hormone levels adjust after having a baby. Eating meals and snacks regularly that include fiber, drinking lots of water, exercising, and getting enough sleep can support your digestive system. If you notice certain foods upset your stomach, talk to your health coach.
Culturally Tailored Resources
Other Helpful Resources
Physical Activity
Continuing to exercise is important during the postpartum period. It can help strengthen abdominal muscles, promote weight loss, and relieve stress. There has also been evidence to show that exercise can promote better sleep and improve mental health.
Your coach can help you navigate exercises that are safe and fun for you. Exercising after delivery is not an easy task, working out with a friend or family member and incorporating your baby are some ways to make this process manageable and less daunting.
Physical Activity Basics and Important Terms
The following vocabulary list will help you understand some of the words or phrases you may come across in the ADAPT-M program. If you do not fully understand any terms in this list or any other words in the ADAPT-M program, please discuss them with your ADAPT-M Health Coach. The terms are listed below in alphabetical order.
Also known as cardio, is a type of exercise that uses large muscle groups and is of low to high intensity. The body’s metabolic system uses oxygen to produce energy, movements are rhythmic and repetitive in nature. For example: walking or biking.
Also known as strength training, is a type of exercise that occurs in the absence of oxygen. It involves intense muscle contractions. For example: weightlifting and resistance training.
A type of exercise where muscles/tendons are flexed or expanded to improve flexibility, elasticity, and mobility.
F: Frequency – how often/# of times you exercise
I: Intensity – how hard you exercise
T: Time – how long you exercise for
T: Type – what kind of exercise you do
Common condition in pregnancy; abdominal muscles separate due to several factors (pressure of growing baby, stretching of muscles and connective tissue, hormonal changes, weight gain)
Physical Activity Guidelines
Postpartum women are encouraged to start beginning/returning to exercise in the first 12 weeks postpartum to support mental health. It is recommended that they have at least 120 mins/week of moderate-to-vigorous physical activity spread over four or more days of the week with a combination of aerobic and strength-training exercises. Guidelines also recommend that women perform pelvic floor muscle training daily to reduce the risk of urinary incontinence and to help strengthen pelvic muscles that were affected by pregnancy, labour and/or delivery.
See full guidelines here: Postpartum – 24-Hour Movement Guidelines
Types of Exercise
Important Considerations
Please talk to your doctor and/or ADAPT-M health coach if you have any concerns or questions at any point in your postpartum exercise journey. It is recommended that you speak to a healthcare professional to discuss your exercise plan. It is important to start slowly and listen to your body when returning to exercise postpartum. Try the questionnaire at the following link to get an idea if physical activity after childbirth is recommended for you – Get Active Questionnaire for Postpartum.
Aerobic exercises (also known as cardio) use large muscle groups in a repetitive or rhythmic manner increasing your heart rate and oxygen consumption.
Examples:
- Walking
- Cycling
- Swimming
- Hiking
- Dancing
Benefits:
- Improves mood and mental health
- Enhances heart and lung health
- Lowers risk of type 2 diabetes
- Weight management
- Increases energy and overall well-being
- Improves sleep
- Reduces stress
Strength exercises (also known as resistance training) involve building muscle strength using weights or resistance. Gradually increasing weight or resistance challenges your muscles to work harder.
Examples:
- Lunges
- Squats
- Planks
- Deadlifts
- Leg extensions
- Glute bridge
Benefits:
- Restores muscle strength
- Improves energy levels
- Promotes weight management
- Improved mood and mental health
- Enhances cardiovascular fitness
Pelvic floor muscle training (often involving Kegel exercises) helps restore strength and rehabilitates pelvic muscles after pregnancy and delivery.
Examples
- Kegels
- Pelvic tilts
- Belly breathing
- Bridge pose
Benefits
- Improved bladder and bowel control
- Reduced risk of incontinence and prolapse
- Improved overall pelvic health
- Enhanced sexual function
Diastasis recti occurs when your left and right rectus abdominus muscles separate during pregnancy. Please consult your doctor for more information on this condition and to test whether you have diastasis recti. If you are diagnosed with diastasis recti during pregnancy, it is important to perform exercises to improve abdominal separation. Diastasis recti exercises involve strengthening abdominal muscles and helping them return to their normal position after pregnancy.
Examples:
- Pelvic tilts
- Heel slides
- Glute bridges
- Abdominal bracing
- Diaphragmatic breathing
- Supine marches
- Toe taps
- Leg lifts
Benefits:
- Improves abdominal separation
- Reduces pain and discomfort
- Improves posture and reduces back pain
- Enhances overall well-being
S.M.A.R.T Goal Setting and Physical Activity
S.M.A.R.T. goals are goals you can reach with success. They are:
S = Specific
M = Measurable
A = Achievable
R = Relevant
T = Timely
See some examples below:
- I will walk for at least 30 minutes four times a week.
- I will walk for at least 20 minutes 2 times a week and do strength training for at least 30 minutes 2 times per week.
Tips to get and stay active
- Incorporate exercise into your daily routine and involve your baby in activities such as walking
- Choose a variety of exercises you enjoy and try different exercises until you find the right activities for you
- Spread out physical activity sessions throughout the week, this will be less daunting and manageable
- Limit sedentary time to 8 hours or less/day including no more than 3 hours of recreational screen time
- Mentally plan for exercise the night before, such as putting out your workout outfit before bed and putting on your workout clothes first thing in the morning
Resources
American College of Obstetricians and Gynecologists – Exercise after Pregnancy FAQ’s
SIRC Postpartum Exercise Guidebook
Get Active Questionnaire for Postpartum – (Is physical activity after childbirth recommended for you?)
Mental Health
Navigating Low Mood
Low mood and often referred to as “baby blues” is common postpartum. Baby blues are mild, short-lived, and include feelings of sadness, irritability, and frustration. It resolves within a few days/weeks. Prolonged feelings of sadness and persistent low mood may be a sign of Postpartum Depression, it is strongly recommended to seek professional advice and help if you feel like this is the case. Talk to your doctor or ADAPT-M health coach for support and resources to navigate low mood and/or if you feel like you may have Postpartum Depression.
Tips
- Don’t hesitate to ask friends and family for help
- Make time for yourself and self-care
- Give yourself grace
- Sleep when your baby rests and prioritize rest as much as possible
- Join support groups or community groups and connect with other new mothers
- Maintain a healthy lifestyle, such as healthy eating and exercise
- Seek professional help and advice
- If you have thoughts about harming yourself or your baby, please call 9-1-1 and seek immediate assistance
Helpful Links
For more information on postpartum depression please use the links below:
Your guide to POSTPARTUM HEALTH and caring for your baby
General guide for postpartum health and infant childcare, includes information on postpartum depression, nutrition, physical activity, sleep and more.
Return to Work
Resources to help find childcare and managing work inside and outside the home.
Community Resources
Support Groups
Find a support group with women who are also postpartum!
Supports for Baby
Check with your local health unit or care team