Effects of dietary counselling on food habits and dietary intake of Finnish pregnant women at increased risk for gestational diabetes – a secondary analysis of a cluster‐randomized controlled trial

Abstract

The incidence of gestational diabetes mellitus (GDM) is increasing and GDM might be prevented by improving diet. Few interventions have assessed the effects of dietary counselling on dietary intake of pregnant women. This study examined the effects of dietary counselling on food habits and dietary intake of Finnish pregnant women as secondary outcomes of a trial primarily aiming at preventing GDM. A cluster-randomized controlled trial was conducted in 14 municipalities in Finland, including 399 pregnant women at increased risk for developing GDM. The intervention consisted of dietary counselling focusing on dietary fat, fibre and saccharose intake at four routine maternity clinic visits. Usual counselling practices were continued in the usual care municipalities. A validated 181-item food frequency questionnaire was used to assess changes in diet from baseline to 26-28 and 36-37 weeks gestation. The data were analysed using multilevel mixed-effects linear regression models. By 36-37 weeks gestation, the intervention had beneficial effects on total intake of vegetables, fruits and berries (coefficient for between-group difference in change 61.6 g day(-1), 95% confidence interval 25.7-97.6), the proportions of high-fibre bread of all bread (7.2% units, 2.5-11.9), low-fat cheeses of all cheeses (10.7% units, 2.6-18.9) and vegetable fats of all dietary fats (6.1% -units, 2.0-10.3), and the intake of saturated fatty acids (-0.67 energy-%-units, -1.16 to -0.19), polyunsaturated fatty acids (0.38 energy-%-units, 0.18-0.58), linoleic acid (764 mg day(-1), 173-1354) and fibre (2.07 g day(-1) , 0.39-3.75). The intervention improved diet towards the recommendations in pregnant women at increased risk for GDM suggesting the counselling methods could be implemented in maternity care.

Metabolic syndrome in Finnish women 7 years after a gestational diabetes prevention trial

“…[28][29][30][31] However, 7 years are a long time, and several factors have affected women's lifestyle. Mothers with small children may have had lack of time and may have got tired to follow the recommended lifestyle habits which were discussed during the intervention.…”

“…Our cluster randomised controlled trial (RCT) in Finnish pregnant women at increased GDM risk showed that lifestyle counselling was effective in controlling the proportion of large-for-gestational-age new-borns and improving the women's diet, and preventing excessive gestational weight gain and decrease in physical activity. [28][29][30][31] One year after delivery, the prevalence of MeS among women with GDM risk factors was 16-18% depending on the criteria; with no differences between the intervention and usual care group. 24 Our aim is to study MeS and its components 7 years postpartum among Finnish women who in early pregnancy were at increased risk of developing GDM (intervention or usual care), among women with early pregnancy GDM diagnosis and among women without GDM risk factors during pregnancy (healthy control).…”

Prevalence of Metabolic Syndrome One Year after Delivery in Finnish Women at Increased Risk for Gestational Diabetes Mellitus during Pregnancy

“…The NELLI trial showed that the lifestyle counselling was effective in controlling the proportion of large-for-gestational-age newborns and improving the women's diet and had a minor effect on gestational weight gain and decrease in physical activity [21, 31–33]. Since participation in followup measurements at one year postpartum was low (24% of the original cohort) and the total number of participants was modest, the results must be interpreted carefully.…”

The effect of pre‐pregnancy lifestyle counselling on food intakes and association between food intakes and gestational diabetes in high‐risk women: results from a randomised controlled trial

“…Observational evidence suggests that healthy diets before and during pregnancy may reduce the risk of GDM . Randomised controlled trials have shown improvements in diets after dietary and lifestyle counselling for pregnant women at increased risk of GDM . However, counselling initiated already before pregnancy may be more effective in preventing GDM.…”