A randomised trial of a four-step multidisciplinary approach to the antenatal care of obese pregnant women

Quinlivan, Julie A.; Lam, Lawrence T.; Fisher, Jane

doi:10.1111/j.1479-828x.2010.01268.x

Cited by 131 publications

(224 citation statements)

References 25 publications

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“…Although not all GDM events can be prevented, lifestyle interventions introduced early in pregnancy or before pregnancy have the potential of preventing GDM development, at least among some women. This is supported by the promising findings from large observational studies on pre-pregnancy diet and lifestyle (Table 1), aforementioned positive findings from studies that started the intervention early in pregnancy [31][32][33][34][35][36][37][38][39][40], and by the successful prevention of type 2 diabetes with diet and lifestyle modification among non-pregnant individuals, for example, in the FDPS [26] and in the US DPP [27]. Finally, findings from animal and human medical studies have demonstrated the biological plausibility of improving insulin sensitivity and secretion through diet and lifestyle modification.…”

supporting

confidence: 68%

“…Across the individual intervention studies, large variations exist in multiple aspects of the study design, including GDM diagnostic criteria, duration and timing of the intervention, as well as characteristics of the study population, including their race/ethnicity and GDM risk profile. For example, some studies were conducted among a high-risk population, such as overweight or obese women [32] or on women with polycystic ovary syndrome [31], whereas other study populations included both obese and non-obese women [46]. The intervention approaches themselves were diverse, ranging from yoga, aerobic exercises or resistance training, to targeting different aspects of the diet.…”

mentioning

confidence: 99%

“…The few studies that did demonstrate a significant beneficial effect of diet and/or physical activity all started the intervention relatively early, in the first trimester, before or near 13 weeks of gestation [31][32][33][34][35][36][37][38][39][40]. For example, among all the published studies to date on physical activity interventions for GDM prevention [41,42], the point estimate for the majority of studies indicate a beneficial effect, yet only those with the intervention starting early in the first trimester had statistically significant findings [33][34][35]38].…”

mentioning

confidence: 99%

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Risk factors for gestational diabetes: is prevention possible?

2016

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Gestational diabetes mellitus (GDM), a common pregnancy complication, continues to be a significant public health and clinical problem. It carries significant short-term and long-term adverse health outcomes for both mother and offspring, which reinforces the significance of understanding risk factors, in particular modifiable factors, for GDM and of preventing the condition. Research in the past decade from observational studies has identified a few diet and lifestyle factors that are associated with GDM risk and demonstrated that time frames both before and during pregnancy may be relevant to the development of GDM. Findings from intervention studies on the effect of diet and lifestyle on the prevention of GDM have been largely controversial and inconsistent. Variations in study population, types of intervention, timing and duration of intervention and diagnostic criteria for GDM may all at least partly account for the large heterogeneity in the findings from these intervention studies. This review provides an overview of emerging diet, lifestyle, and other factors that may help to prevent GDM, and the challenges associated with prevention. It also discusses major methodological concerns about the available epidemiological studies on GDM risk factors. Findings from both observational and intervention studies are discussed.

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confidence: 68%

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confidence: 99%

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confidence: 99%

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Risk factors for gestational diabetes: is prevention possible?

2016

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“…During the last decade the importance of intervention programmes for obesity and weightgain prevention have been in focus and several intervention studies have been conducted (Polley et al, 2002, Olson et al, 2004, Kinnunen et al, 2007, Wolff et al, 2008, Quinlivan et al, 2011, Shirazian et al, 2010, Phelan et al, 2011. Four of these studies encompassed obese pregnant women (Wolff et al, 2008, Guelinckx et al, 2010, Quinlivan et al, 2011, Shirazian et al, 2010.…”

Section: Introductionmentioning

confidence: 99%

“…Four of these studies encompassed obese pregnant women (Wolff et al, 2008, Guelinckx et al, 2010, Quinlivan et al, 2011, Shirazian et al, 2010. The intervention was associated with a reduced gestational weight gain in the studies by Wolff et al, (2008), Quinlivan et al, (2011) and Shirazian et al,(2010), whereas Guelinckx et al, (2010) reported no difference in weight gain. We have shown in a previous study that an intervention programme aiming to minimise the gestational weight gain to less than 7 kg, was effective (Claesson et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Weight six years after childbirth: A follow-up of obese women in a weight-gain restriction programmme

2014

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Objective: to compare weight development in an intervention group and a control group, six years after participation in a gestational weight-gain restriction programme.Design: follow-up of a prospective intervention study.Settings: antenatal care clinics.Participants: a total of 129 women (88.4 %) from the original intervention group and 166 women (88.8 %) from the original control group.Measurements: the women answered a study specific questionnaire, covering sociodemographic data and health-and weight status. Findings:After adjusting for socio-demographic factors, the mean weight was lower (4.1 kg) among the women in the intervention group, compared to the controls (p=0.028).Furthermore, the mean weight change, e.g. the weight at the six year assessment compared with the weight at the start of the intervention at the first antenatal care visit, was greater in the intervention group than in the control group. The women in the intervention group had a larger mean weight change (-5.2 kg), e.g. weighed less than the women in the control group (-1.9 kg) (p=0.046). Mean weight change expressed in 5 kg classes also showed a significant difference between the two groups (p=0.030).Key conclusions: the results indicate that attending a gestational weight-gain-restriction programme can have a positive effect on weight up to six years after the intervention.Implication for practise: a restrictive gestational weight gain can result in a positive weight development during the first years after childbirth. It might provide both short-and long term medical health benefits for the mother as well as the child.

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Implementation of Antenatal Lifestyle Interventions Into Routine Care

et al. 2022

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ImportanceLifestyle interventions in pregnancy optimize gestational weight gain and improve pregnancy outcomes, with implementation recommended by the US Preventive Services Task Force. Yet, implementation research taking these efficacy trials into pragmatic translation remains limited.ObjectiveTo evaluate success factors for implementing pregnancy lifestyle interventions into antenatal care settings in a meta-analysis, using the penetration, implementation, participation, and effectiveness (PIPE) impact metric.Data SourcesData from a previous systematic review that searched across 9 databases, including MEDLINE, Embase, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, and Health Technology Assessment Database, were obtained, in 2 stages, up to May 6, 2020.Study SelectionRandomized clinical trials reporting gestational weight gain in singleton pregnancies.Data Extraction and SynthesisThe association of penetration, implementation, and participation with effectiveness of antenatal lifestyle interventions in optimizing gestational weight gain was estimated using random-effects meta-analyses. The Cochrane risk of bias tool, version 1.0, was used to assess risk of bias.Main Outcomes and MeasuresPenetration (reach), implementation (fidelity), participation, and effectiveness of randomized clinical trials of lifestyle interventions in pregnancy.ResultsNinety-nine studies with 34 546 participants were included. Only 14 studies reported penetration of target populations. Overall, 38 studies (38.4%) had moderate fidelity, 25 (25.2%) had high fidelity, and 36 (36.4%) had unclear fidelity. Participation was reported in 84 studies (84.8%). Lifestyle interventions were associated with reducing gestational weight gain by 1.15 kg (95% CI, –1.40 to –0.91 kg).Conclusions and RelevanceThe findings of this systematic review and meta-analysis suggest that, despite the large body of evidence on efficacy of lifestyle interventions during pregnancy in optimizing gestational weight gain, little guidance is available to inform implementation of this evidence into practice. There is a need to better elucidate implementation outcomes in trial design alongside pragmatic implementation research to improve the health of women who are pregnant and the next generation.

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A randomised trial of a four-step multidisciplinary approach to the antenatal care of obese pregnant women

Abstract: A four-step management plan adopted with obese women reduces the incidence of gestational diabetes.

Cited by 131 publications

References 25 publications

Risk factors for gestational diabetes: is prevention possible?

Risk factors for gestational diabetes: is prevention possible?

Weight six years after childbirth: A follow-up of obese women in a weight-gain restriction programmme

Implementation of Antenatal Lifestyle Interventions Into Routine Care

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