Gestational weight gain in overweight and obese women enrolled in a healthy lifestyle and eating habits program

Petrella, Elisabetta; Malavolti, Marcella; Bertarini, Valentina; Pignatti, Lucrezia; Neri, Isabella; Battistini, N.; Facchinetti, Fabio

doi:10.3109/14767058.2013.858318

Cited by 90 publications

(195 citation statements)

References 21 publications

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“…Although not all GDM events can be prevented, lifestyle interventions introduced early in pregnancy or before pregnancy have the potential of preventing GDM development, at least among some women. This is supported by the promising findings from large observational studies on pre-pregnancy diet and lifestyle (Table 1), aforementioned positive findings from studies that started the intervention early in pregnancy [31][32][33][34][35][36][37][38][39][40], and by the successful prevention of type 2 diabetes with diet and lifestyle modification among non-pregnant individuals, for example, in the FDPS [26] and in the US DPP [27]. Finally, findings from animal and human medical studies have demonstrated the biological plausibility of improving insulin sensitivity and secretion through diet and lifestyle modification.…”

mentioning

confidence: 62%

“…The few studies that did demonstrate a significant beneficial effect of diet and/or physical activity all started the intervention relatively early, in the first trimester, before or near 13 weeks of gestation [31][32][33][34][35][36][37][38][39][40]. For example, among all the published studies to date on physical activity interventions for GDM prevention [41,42], the point estimate for the majority of studies indicate a beneficial effect, yet only those with the intervention starting early in the first trimester had statistically significant findings [33][34][35]38].…”

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confidence: 99%

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Risk factors for gestational diabetes: is prevention possible?

2016

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Gestational diabetes mellitus (GDM), a common pregnancy complication, continues to be a significant public health and clinical problem. It carries significant short-term and long-term adverse health outcomes for both mother and offspring, which reinforces the significance of understanding risk factors, in particular modifiable factors, for GDM and of preventing the condition. Research in the past decade from observational studies has identified a few diet and lifestyle factors that are associated with GDM risk and demonstrated that time frames both before and during pregnancy may be relevant to the development of GDM. Findings from intervention studies on the effect of diet and lifestyle on the prevention of GDM have been largely controversial and inconsistent. Variations in study population, types of intervention, timing and duration of intervention and diagnostic criteria for GDM may all at least partly account for the large heterogeneity in the findings from these intervention studies. This review provides an overview of emerging diet, lifestyle, and other factors that may help to prevent GDM, and the challenges associated with prevention. It also discusses major methodological concerns about the available epidemiological studies on GDM risk factors. Findings from both observational and intervention studies are discussed.

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confidence: 62%

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confidence: 99%

Risk factors for gestational diabetes: is prevention possible?

2016

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“…Of the large number of early lifestyle RCTs, only two, (one HE and one HE&PA intervention) showed a substantial (60-77%) reduction in the proportion of women developing GDM (23,24). Both RCTs were also associated with significant GWG reductions (3.4 kg (in obese participants) and 6.8 kg respectively) that were greater than the average GWG reduction of 1.4 kg that has been achieved in lifestyle RCTs (25).…”

Section: Discussionmentioning

confidence: 96%

Effect of physical activity and/or healthy eating on GDM risk: The DALI Lifestyle Study

Simmons

Devlieger

Assche

et al. 2016

The Journal of Clinical Endocrinology & Metabolism

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The DALI Lifestyle Study Context: Lifestyle approaches for preventing gestational diabetes mellitus (GDM) have produced mixed results. Objective: The aim of this study was to compare the effectiveness of three lifestyle interventions (Healthy eating (HE), Physical activity (PA) and both HE and PA (HE+PA)) with usual care (UC) in reducing GDM risk. Design: Multicentre Randomised Controlled Trial 2012-2014: The Dali Lifestyle Study Setting: Antenatal clinics across 11 centres in 9 European countries Patients: Consecutive pregnant women <20 weeks gestation with a BMI≥29 kg/m 2 and without GDM by IADPSG criteria (n=436).Intervention: Women were randomized, stratified by site, to Control, HE, PA or HE+PA. Women received 5 face-to-face and up to 4 telephone coaching sessions, based on the principles of motivational interviewing. Gestational weight gain (GWG) <5kg was targeted. Coaches received standardized training and an intervention toolkit tailored to their culture/language. Main outcome measures: GWG at 35-37 weeks, fasting glucose and insulin sensitivity (HOMA-IR) at 24-28 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 controls by 35-37 weeks . Despite this reduction there were no improvements in fasting or post-load glucose or,insulin concentrations or HOMA-IR. Birthweight, large and small for gestational age rates were similar. Copyright 2016 DOI: 10.1210/jc.2016 Conclusions: The combined HE+PA intervention was able to limit GWG but did not reduce fasting glycaemia. Lifestyle change alone is unlikely to prevent GDM among women with a BMI≥29 kg/m 2 .PRECIS: We studied pregnant women in a large European multi-centre RCT of physical activity and/or healthy eating and found no effect on GDM risk in spite of significant gestational weight gain limitation INTRODUCTIONGestational diabetes mellitus (GDM), high pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) are independently associated with an increased risk of adverse perinatal outcomes, including macrosomia, operative delivery and shoulder dystocia (1). In GDM, such complications have a continuous relationship with maternal glucose concentrations during the oral glucose tolerance test (OGTT) (2). With the increasing prevalence of obesity in pregnancy and GDM (3), it has become increasingly important to develop evidence based clinical interventions that prevent the development of GDM and minimise excess GWG. The development of type 2 diabetes through intensive lifestyle interventions can be reduced by 58% over 4 years in non-pregnant women who have previously had GDM (4). However, whether GDM can be prevented through antenatal lifestyle interventions, even with limitation in excess GWG, is disputed (5). RCTs have provided variable evidence that lifestyle interventions 'work' (6); likely because of different intervention protocols and study populations. Furthermore, at the moment, no studies are available that assessed, ...

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“…The dietary intervention, previously used by our research group [10], was introduced to the pregnant women at the first visit in the presence of both a gynecologist and a dietitian and further detailed through a one hour counseling session about the appropriate GWG at term for each BMI category as recommended by IOM [1]. The primary focus of the dietary intervention was decreasing consumption of foods with a high glycemic index and substituting them with healthier alternatives (fresh fruit and vegetables with low glycemic index).…”

Section: Dietary Interventionmentioning

confidence: 99%

“…Indeed, only a few studies have included both diet and PA in their intervention program. In a previous paper, we demonstrated that a multilevel intervention (including caloric restriction, changes in eating behavior, and regular PA from the beginning of pregnancy) in obese women was able to reduce both GWG and related pregnancy complications [10].…”

Section: Introductionmentioning

confidence: 95%

Gestational Weight Gain and Changes in Body Composition in Pregnant Women with BMI ≥25 Kg/m2 Undergoing a Healthy Lifestyle Program Starting Early in Pregnancy

Malavolti¹,

Petrella²

2016

J Obes Weight Loss Ther

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Gestational weight gain in overweight and obese women enrolled in a healthy lifestyle and eating habits program

Abstract: A caloric restriction associated to changes in eating behavior and constant physical activity, is able to reduce gestational weight gain and related pregnancy complications in obese women.

Cited by 90 publications

References 21 publications

Risk factors for gestational diabetes: is prevention possible?

Risk factors for gestational diabetes: is prevention possible?

Effect of physical activity and/or healthy eating on GDM risk: The DALI Lifestyle Study

Gestational Weight Gain and Changes in Body Composition in Pregnant Women with BMI ≥25 Kg/m2 Undergoing a Healthy Lifestyle Program Starting Early in Pregnancy

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