A randomized trial of the effects of dietary counseling on gestational weight gain and glucose metabolism in obese pregnant women

Abstract

Objective: Can gestational weight gain in obese women be restricted by 10-h dietary consultations and does this restriction impact the pregnancy-induced changes in glucose metabolism? Design: A randomized controlled trial with or without restriction of gestational weight gain to 6-7 kg by ten 1-h dietary consultations. Subjects: Fifty nondiabetic nonsmoking Caucasian obese pregnant women were randomized into intervention group (n ¼ 23, 2874 years, prepregnant body mass index (BMI) 3574 kg m À2 ) or control group (n ¼ 27, 3075 years, prepregnant BMI 3573 kg m À2 ). Measurements: The weight development was measured at inclusion (15 weeks), at 27 weeks, and 36 weeks of gestation. The dietary intakes were reported in the respective weeks by three 7-day weighed food records and blood samples for analyses of fasting s-insulin, s-leptin, b-glucose, and 2-h b-glucose after an oral glucose tolerance test were collected. Results: The women in the intervention group successfully limited their energy intake, and restricted the gestational weight gain to 6.6 kg vs a gain of 13.3 kg in the control group (P ¼ 0.002, 95% confidence interval (CI): 2.6-10.8 kg). Both s-insulin and s-leptin were reduced by 20% in the intervention group compared to the control group at week 27, mean difference: À16 pmol l À1 (P ¼ 0.04, 95% CI: À32 to À1) for insulin and À23 ng ml À1 (P ¼ 0.004, 95% CI: À39 to À8) for leptin. At 36 weeks of gestation, the s-insulin was further reduced by 23%, À25 pmol l À1 (À47 to À4, P ¼ 0.022) and the fasting b-glucose were reduced by 8% compared with the control group (À0.3 mmol l À1 , À0.6 to À0.0, P ¼ 0.03). Conclusions: Restriction of gestational weight gain in obese women is achievable and reduces the deterioration in the glucose metabolism.

Exploring Potential Health Disparities in Excessive Gestational Weight Gain

“…[19][20][21][22] Lifestyle interventions have the potential to help women gain the recommended amount of weight, [23][24][25][26][27] through behavioral strategies, dietary intake recommendations and physical activity. The current research aims to identify sociodemographic and health characteristics of those at elevated risk for excessive gestational weight gain according to the updated 2009 IOM guidelines, with a particular focus on potential racial/ethnic disparities.…”

Risk factors for gestational diabetes: is prevention possible?

“…All of these may have contributed to the large heterogeneity in the findings. Interestingly, a few studies found an improvement in glucose tolerance in the intervention group, even if no reduction was seen in the risk of GDM [46][47][48].…”

The role of families and providers in preventing childhood obesity when we take a systems approach to ending the epidemic

“…To date, existing interventions to prevent excessive weight gain are so limited in number and effectiveness, that both the IOM [32] and the Agency for Health care Research and Quality (AHRQ) [33] have identified this as a major research gap. Interventions based on physical activity and dietary counseling, usually combined with supplementary weight monitoring [34,35], have had modest success in reducing the amount of excessive weight gained during pregnancy, but few efforts have been effective enough for women to gain within their IOM target range [36,37]. Thus, we need to design effective interventions that prevent excessive weight gain during pregnancy that are widely effective, practical, cost-effective, and have mechanisms for widespread diffusion.…”