December 15, 2016
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Lifestyle changes reduce gestational weight gain, not gestational diabetes risk

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In pregnant women with obesity, an intervention combining healthy eating with increased physical activity resulted in a substantial reduction in gestational weight gain, but the measures failed to prevent the development of gestational diabetes, according to results from a multicenter European study.

“An improvement in both lifestyles, as in the combined intervention group, resulted in significant [gestational weight gain] limitation, but still with no impact on fasting glucose or insulin resistance,” David Simmons, DMED, MBBS, professor of medicine at Western Sydney University in New South Wales, Australia, and colleagues wrote. “In spite of the significant changes in [gestational weight gain], post-load glucose and insulin concentrations remained unchanged, and this occurred with and without the [physical activity] intervention.”

David Simmons
David Simmons

Simmons and colleagues analyzed data from 436 pregnant women with obesity but without gestational diabetes participating in the Vitamin D and Lifestyle Intervention for gestational diabetes prevention (DALI) study, a randomized controlled trial conducted in the United Kingdom, Ireland, the Netherlands, Austria, Poland, Italy, Spain, Denmark and Belgium between 2012 and 2015 (mean age, 32 years; mean prepregnancy BMI, 33.7 kg/m²; 6% with history of prior gestational diabetes).

Researchers randomly assigned women to one of four interventions: healthy eating alone (n = 113), physical activity alone (n = 110), healthy eating and physical activity (n = 108) or usual care (controls; n = 105). The healthy eating intervention promoted a high-fiber, high-protein, lower-fat diet with lower simple- and complex-carbohydrate intake, including a focus on portion size. The physical activity intervention promoted both aerobic and resistance physical activity; all interventions recommended limiting gestational weight gain to 5 kg. All women received five face-to-face and up to four telephone coaching sessions, based on the principles of motivational interviewing.

Primary outcome was gestational weight gain at 35 to 37 weeks, fasting glucose and insulin sensitivity measured by homeostatic model of insulin resistance (HOMA-IR) at 24 to 28 weeks. All women underwent a 75-g oral glucose tolerance test at baseline (before 20 weeks’ gestation), at between 24 and 28 weeks’ and between 35 and 37 weeks’ gestation, and at 48 hours after delivery; and they completed the pregnancy physical activity questionnaire at three time points.

Researchers found that women assigned to the combined healthy eating and physical activity intervention experienced less gestational weight gain at 24 to 28 weeks and 35 to 37 weeks vs. those assigned to usual care (adjusted differences, –1.19 kg and –2.02 kg, respectively); however, there were no between-group differences in fasting glucose or HOMA-IR at either 24 to 28 weeks (0.03 mmol/L and 0.002, respectively) or 35 to 37 weeks (–0.03 mmol/L and –0.03, respectively). Women assigned to healthy eating or physical activity alone did not experience improvements in gestational weight gain, fasting glucose or insulin resistance vs. those assigned to usual care; in the healthy eating group, mean fasting glucose was higher vs. usual care. – by Regina Schaffer

Disclosure: The researchers report no relevant financial disclosures.