II.

OBJECTIVETo study the effects of lifestyle intervention on gestational weight gain (GWG) and obstetric outcomes.RESEARCH DESIGN AND METHODSThe LiP (Lifestyle in Pregnancy) study was a randomized controlled trial in 360 obese women allocated in early pregnancy to lifestyle intervention or control. The intervention program included dietary guidance, free membership in fitness centers, physical training, and personal coaching.RESULTSA total of 360 obese pregnant women were included, and 304 (84%) were followed up until delivery. The intervention group had a significantly lower median (range) GWG compared with the control group of 7.0 (4.7–10.6) vs. 8.6 kg (5.7–11.5; P = 0.01). The Institute of Medicine (IOM) recommendations on GWG were exceeded in 35.4% of women in the intervention group compared with 46.6% in the control group (P = 0.058). Overall, the obstetric outcomes between the two groups were not significantly different.CONCLUSIONSLifestyle intervention in pregnancy resulted in limited GWG in obese pregnant women. Overall obstetric outcomes were similar in the two groups. Lifestyle intervention resulted in a higher adherence to the IOM weight gain recommendations; however, a significant number of women still exceeded the upper threshold.

OBJECTIVE -The aim of this study was to compare pregnancy outcomes in type 1 diabetic pregnancies with the background population.RESEARCH DESIGN AND METHODS -This nationwide prospective multicenter study took place in eight Danish centers treating pregnant women with type 1 diabetes during [1993][1994][1995][1996][1997][1998][1999]. A total of 990 women with 1,218 pregnancies and delivery after 24 weeks (n ϭ 1,215) or early termination due to severe congenital malformations (n ϭ 3) were included. Data were collected prospectively by one to three caregivers in each center and reported to a central registry.RESULTS -The perinatal mortality rate was 3.1% in type 1 diabetic pregnancies compared with 0.75% in the background population (RR 4.1 [95% CI 2.9 -5.6]), and the stillbirth rate was 2.1% compared with 0. 45 (4.7 [3.2-7.0]). The congenital malformation rate was 5.0% in the study population and 2.8% (1.7 [1.3-2.2]) in the background population. Six of the perinatal deaths (16%) were related to congenital malformations. Only 34% of women performed daily home monitoring of blood glucose at conception, and 58% received preconceptional guidance. Pregnancies with serious adverse outcomes (perinatal death and/or congenital malformations) were characterized by higher HbA 1c values before and during pregnancy and a lesser degree of maternal self-care and preconceptional guidance. Women who performed daily self-monitoring of blood glucose at any time during pregnancy had lower HbA 1c values than women who did not measure their daily profile. Likewise, daily self-monitoring was associated with a reduction in serious adverse outcomes. The caesarean section rate was 55.9 and 12.6%, respectively, and the risk of preterm delivery was 41.7 and 6.0%, respectively. CONCLUSIONS -Type 1 diabetic pregnancies are still complicated by considerably higher rates of severe perinatal complications compared with the background population, and women with poor self-care are at the highest risk. Adequate glycemic control using daily glucose monitoring before and during pregnancy is a crucial step toward reaching the goals of the St. Vincent declaration. Diabetes Care 27:2819 -2823, 2004I n 1989, the St. Vincent declaration (1) stated that the outcome of diabetic pregnancy should approximate that of the nondiabetic pregnancy within 5 years. Since then, four regional prospective studies from the U.K. and Finland (2-5) and two nationwide studies from Holland and France (6,7) have reported rates for perinatal mortality and/or congenital malformations, considerably higher than the background population. The number of pregnancies varied from 111 to 691. In Denmark, clinical data have been prospectively collected since 1992, which enables us to analyze data on a cohort of Ͼ1,200 consecutive pregnancies. The objective was to compare pregnancy outcomes in type 1 diabetic pregnancies with the background population. -During 1993-During -1999, all pregnancies in women with pregestational type 1 diabetes were prospectively reported to a central registry...

Gestational diabetes mellitus (GDM) is increasing in prevalence in tandem with the dramatic increase in the prevalence of overweight and obesity in women of childbearing age. Much controversy surrounds the diagnosis and management of gestational diabetes, emphasizing the importance and relevance of clarity and consensus. If newly proposed criteria are adopted universally a significantly growing number of women will be diagnosed as having GDM, implying new therapeutic challenges to avoid foetal and maternal complications related to the hyperglycemia of gestational diabetes. This review provides an overview of clinical issues related to GDM, including the challenges of screening and diagnosis, the pathophysiology behind GDM, the treatment and prevention of GDM and the long and short term consequences of gestational diabetes for both mother and offspring.