David Simmons1,2, Roland Devlieger3, André van Assche3, Goele Jans3, Sander Galjaard3,4, Rosa Corcoy5, Juan M Adelantado5,6, Fidelma Dunne7, Gernot Desoye8, Jürgen Harreiter9, Alexandra Kautzky-Willer9, Peter Damm10, Elisabeth R Mathiesen10, Dorte M Jensen11,12, Liselotte Andersen11,12, Annunziata Lapolla13, Maria G Dalfrà13, Alessandra Bertolotto14, Ewa Wender-Ozegowska15, Agnieszka Zawiejska15, David Hill16, Frank J Snoek17,18, Judith G M Jelsma19, Mireille N M van Poppel19,20. 1. Western Sydney University, Campbelltown, New South Wales 2560, Australia. 2. Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, CB2 0QQ England. 3. Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium. 4. Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands. 5. Institut de Recerca de l´Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 6. CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Zaragoza, Spain. 7. Galway Diabetes Research Centre and College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland. 8. Department of Obstetrics and Gynecology, Medizinische Universitaet Graz, Graz, Austria. 9. Gender Medicine Unit, Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria. 10. Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. 11. Department of Endocrinology and Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark. 12. Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark. 13. Universita Degli Studi di Padova, Padua, Italy. 14. Azienda Ospedaliero Universitaria-Pisa, Pisa Italy. 15. Medical Faculty I, Poznan University of Medical Sciences, Poznan, Poland. 16. Recherche en Santé Lawson SA, Bronschhofen, Switzerland. 17. Department of Medical Psychology, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands. 18. Department of Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands. 19. Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands; and. 20. Institute of Sport Science, University of Graz, Graz, Austria.
Abstract
CONTEXT: Lifestyle approaches for preventing gestational diabetes mellitus (GDM) have produced mixed results. OBJECTIVE: The aim of the present study was to compare the effectiveness of 3 lifestyle interventions [healthy eating (HE), physical activity (PA), and both HE and PA (HE+PA)] with usual care (UC) in reducing GDM risk. DESIGN: The present study was a multicenter randomized controlled trial conducted from 2012 to 2014 [the DALI (vitamin D and lifestyle intervention for GDM prevention) lifestyle study]. SETTING: The study occurred at antenatal clinics across 11 centers in 9 European countries. PATIENTS: Consecutive pregnant women at <20 weeks of gestation with a body mass index (BMI) of ≥29 kg/m2 and without GDM using the International Association of Diabetes and Pregnancy Study Group criteria (n = 436). For the intervention, women were randomized, stratified by site, to UC, HE, PA, or HE+PA. The women received 5 face-to-face and ≤4 telephone coaching sessions using the principles of motivational interviewing. A gestational weight gain (GWG) <5 kg was targeted. The coaches received standardized training and an intervention toolkit tailored to their culture and language. MAIN OUTCOME MEASURES: The endpoints were the GWG at 35 to 37 weeks and the fasting glucose and insulin sensitivity [homeostasis model assessment insulin resistance (HOMA-IR)] at 24 to 28 weeks. RESULTS: We randomized 108 women to HE+PA, 113 to HE, 110 to PA, and 105 to UC. In the HE+PA group, but not HE or PA alone, women achieved substantially less GWG than did the controls (UC) by 35 to 37 weeks (-2.02; 95% confidence interval, -3.58 to -0.46 kg). Despite this reduction, no improvements were seen in fasting or postload glucose levels, insulin concentrations, or HOMA-IR. The birthweights and large and small for gestational age rates were similar. CONCLUSIONS: The combined HE+PA intervention was able to limit GWG but did not reduce fasting glycemia. Thus, lifestyle changes alone are unlikely to prevent GDM among women with a BMI of ≥29 kg/m2.
CONTEXT: Lifestyle approaches for preventing gestational diabetes mellitus (GDM) have produced mixed results. OBJECTIVE: The aim of the present study was to compare the effectiveness of 3 lifestyle interventions [healthy eating (HE), physical activity (PA), and both HE and PA (HE+PA)] with usual care (UC) in reducing GDM risk. DESIGN: The present study was a multicenter randomized controlled trial conducted from 2012 to 2014 [the DALI (vitamin D and lifestyle intervention for GDM prevention) lifestyle study]. SETTING: The study occurred at antenatal clinics across 11 centers in 9 European countries. PATIENTS: Consecutive pregnant women at <20 weeks of gestation with a body mass index (BMI) of ≥29 kg/m2 and without GDM using the International Association of Diabetes and Pregnancy Study Group criteria (n = 436). For the intervention, women were randomized, stratified by site, to UC, HE, PA, or HE+PA. The women received 5 face-to-face and ≤4 telephone coaching sessions using the principles of motivational interviewing. A gestational weight gain (GWG) <5 kg was targeted. The coaches received standardized training and an intervention toolkit tailored to their culture and language. MAIN OUTCOME MEASURES: The endpoints were the GWG at 35 to 37 weeks and the fasting glucose and insulin sensitivity [homeostasis model assessment insulin resistance (HOMA-IR)] at 24 to 28 weeks. RESULTS: We randomized 108 women to HE+PA, 113 to HE, 110 to PA, and 105 to UC. In the HE+PA group, but not HE or PA alone, women achieved substantially less GWG than did the controls (UC) by 35 to 37 weeks (-2.02; 95% confidence interval, -3.58 to -0.46 kg). Despite this reduction, no improvements were seen in fasting or postload glucose levels, insulin concentrations, or HOMA-IR. The birthweights and large and small for gestational age rates were similar. CONCLUSIONS: The combined HE+PA intervention was able to limit GWG but did not reduce fasting glycemia. Thus, lifestyle changes alone are unlikely to prevent GDM among women with a BMI of ≥29 kg/m2.
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