Optimizing healthy gestational weight gain in women at high risk of gestational diabetes: A randomized controlled trial

Abstract

Objective: Optimizing gestational weight gain (GWG) in early pregnancy is of clinical and public health importance, especially in higher risk pregnancies. Design and Methods: In a robustly designed, randomized controlled trial, 228 pregnant women at risk of developing gestational diabetes mellitus (GDM) were allocated to either control (written health information only) or intervention (four-session lifestyle program). All women received standard maternal care. Measures were completed at 12-15 and 26-28 weeks gestation. Measures included anthropometrics (weight and height), physical activity (pedometer and International Physical Activity Questionnaire), questionnaires (risk perception), and GDM screening. When stratified according to baseline BMI, overweight women in the control group gained significantly more weight compared to overweight women in the intervention group [7.8 (3.4) vs. 6.0 (2.2) kg, P < 0.05], yet in obese women, GWG was similar in both groups. Physical activity levels declined by 28 weeks gestation overall (P < 0.01); however, the intervention group retained a 20% higher step count compared to controls [5,203 (3,368) vs. 4,140 (2,420) steps/day, P < 0.05]. Overall, GDM prevalence was 22%, with a trend toward less cases in the intervention group (P ¼ 0.1). Conclusions:Results indicate that a low-intensity lifestyle intervention, integrated with antenatal care, optimizes healthy GWG and attenuates physical activity decline in early pregnancy. Efficacy in limiting weight gain was greatest in overweight women and in high-risk ethnically diverse women.Obesity (2013) 21, 904-909.

Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trials

“…We identified 58 trials published up to June 2015, of which 36 studies (62%) provided individual participant data (IPD),1617343536373839404142434445464748495051525354555657585960616263646566 that accounted for data from 80% of the participants (12 526/15 541); 22 studies (3015 women) did not provide IPD (fig 1). 67686970717273747576777879808182838485868788 A further 45 trials (9945 women)8990919293949596979899100101102103104105106107108109110111112113114115116117118119120121122…”

Pregnancy adverse outcomes related to pregravid body mass index and gestational weight gain, according to the presence or not of gestational diabetes mellitus: A retrospective observational study

“…In women without GDM, controlling weight gain during pregnancy might limit the incidence of LGA without inducing fetal restriction in those who are overweight/obese. It was recently shown that a low-intensity lifestyle intervention in women at high risk for GDM optimalized healthy GWG, while limiting weight gain was more effective in overweight women [41].…”

Gestational diabetes mellitus: does an effective prevention strategy exist?

“…In this trial, lifestyle intervention was more effective than metformin (850 mg twice daily) at reducing T2DM (by 58%; 95% CI [48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66]. However, in a sub-analysis of women with previous pregnancies that were complicated by GDM, metformin was as effective at reducing the incidence of T2DM as lifestyle intervention.…”

“…Five other trials have been conducted that have evaluated the benefits of combined lifestyle interventions in pregnant women with obesity and while all have been associated with reduced gestational weight gain, none have improved the risk of developing GDM [46][47][48][49][50] (TABLE 3). However, two of these trials have shown positive effects on materno-fetal outcomes other than improving glycaemia.…”

“…No differences were observed between combined lifestyle measures and the other two interventions. A trial conducted in Australia that randomly assigned women to either standard antenatal care or to lifestyle sessions provided at four time points (14-16, 20, 24 and 28 weeks gestation) during pregnancy, found no improvements in any materno-fetal outcomes 50 . Finally, in a trial conducted in Canada, the investigators compared methods of lifestyle intervention in 116 women according to category of BMI 51 (TABLE 3).…”