A lifestyle intervention of weight-gain restriction: diet and exercise in obese women with gestational diabetes mellitus

Abstract

This study assessed whether a weight-gain restriction regimen, with or without exercise, would impact glycemic control, pregnancy outcome, and total pregnancy weight gain in obese subjects with gestational diabetes mellitus (GDM). A total of 96 subjects with GDM met the inclusion criteria and were sequentially recruited, with 39 subjects self-enrolled in the exercise and diet (ED) group, and the remaining 57 subjects self-enrolled in the diet (D) group owing to contraindications or a lack of personal preference to exercise. All patients were provided a eucaloric or hypocaloric consistent carbohydrate meal plan and instructed in the self-monitoring of blood glucose. In addition, all ED subjects were prescribed an exercise routine equivalent to a 60% symptom-limited VO2 max. Subjects were followed at weekly or biweekly office visits. Results showed maternal weight and body mass index (35.2+/-7.2 (ED) vs. 33.5+/-9.2 (D)) at study entry as well as number of weeks into the study (7.7+/-5.7 (ED) vs. 9.4+/-4.7 (D)) were similar in both the ED and D groups. Weight gain per week was significantly lower in the ED group than in the D group (0.1+/-0.4 kg vs. 0.3+/-0.4 kg; p<0.05). Subjects (either ED or D) who gained weight had a higher percentage of macrosomic infants than those subjects who lost weight or had no weight change during pregnancy. Other pregnancy and fetal outcomes such as complications, gestational age at delivery, and rate of cesarean delivery were similar in both groups. Conclusions of this study were that caloric restriction and exercise result in limited weight gain in obese subjects with GDM, less macrosomic neonates, and no adverse pregnancy outcomes. Pregnancy is an ideal time for behaviour modification, and this intervention may also help promote long-term healthy lifestyle changes.

Weight Gain Restriction During Pregnancy Is Safe for Both the Mother and Neonate

“…Other intervention studies among overweight and obese pregnant women have also evaluated birthweight and gestational age at delivery as outcome variables (18,19,21). No differences were found between the intervention-and control groups, which are in line with our findings (12).…”

“…In two earlier intervention studies on pregnant obese women no differences in the cesarean section rate could be detected (18,19). In our study population there were no differences between the groups in the rates of planned as well as acute cesarean sections and instrumental deliveries (12).…”

“…The results vary and are not very promising (18,19,21). It is so far also unclear whether an intervention program for controlling weight gain may have an effect on pregnancy and delivery outcome.…”

Maternal over-nutrition and offspring obesity predisposition: targets for preventative interventions

“…Increasing attention towards interventions that may be used to improve maternal health could, therefore, impact substantially on offspring health both in the short and long term. A number of early reviews, 19,[22][23][24][25] in addition to two recent studies, 26,27 have identified altering maternal carbohydrate intake as well as maternal physical activity levels as potential strategies for positively regulating maternal weight gain and offspring birth weight among other pregnancy outcomes. However, longitudinal studies that describe the potential long-term benefits of these interventions for offspring health are lacking.…”

Optimizing Pregnancy for Intergenerational Health Benefits

“…Given the importance of PA, the American College of Obstetrics and Gynecology, the Society of Obstetrics and Gynecology Canada/ Canadian Society for Exercise Physiology, and the International Olympic Committee have issued specific guidelines that encourage all pregnant women to engage in routine PA in the absence of contraindications [18][19][20]. Regular moderate intensity PA during pregnancy has consistently been shown to reduce the incidence of GDM [21][22][23][24] and pre-eclampsia [23,[25][26][27][28][29], two pregnancy-related complications implicated in poor neonatal outcomes and downstream child health. Systematic reviews and meta-analyses looking exclusively at PA interventions during pregnancy have shown success in restricting GWG (-0.36 kg, 95% CI: -0.64 to -0.09 kg [30]; -0.61 kg, 95% CI: -1.17, -0.06 [31]; -0.91kg , 95% CI: -1.76, -0.06 [32]) but few studies have been designed to examine the effects on longer-term child growth or body composition [33][34][35].…”