Results From a European Multicenter Randomized Trial of Physical Activity and/or Healthy Eating to Reduce the Risk of Gestational Diabetes Mellitus: The DALI Lifestyle Pilot

Simmons, David; Jelsma, Judith G. M.; Galjaard, Sander; Devlieger, Roland; Assche, Ado Van; Jans, Goele; Corcoy, Rosa; Adelantado, Juan M.; Dunne, Fidelma; Desoyé, Gernot; Harreiter, Jürgen; Kautzky‐Willer, Alexandra; Damm, Peter; Mathiesen, Elisabeth R.; Jensen, Dorte Møller; Andersen, Lise Lotte Torvin; Lapolla, Annunziata; Dalfrà, Maria Grazia; Bertolotto, Alessandra; Wender-Ożegowska, Ewa; Zawiejska, Agnieszka; Hill, David J.; Rebollo, Pablo; Snoek, Frank J.; Poppel, Mireille N. M. van

doi:10.2337/dc15-0360

Cited by 95 publications

(92 citation statements)

References 21 publications

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“…After signed consent, assessments, including a 75 g OGTT (samples taken at 0, 60, 120 minutes), questionnaire and weight were made before 20 weeks (baseline), between 24-28 weeks (visit 2), between 35-37 weeks (visit 3), and 48 hours post birth as previously described (7,8).…”

Section: Methodsmentioning

confidence: 99%

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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Section: Methodsmentioning

confidence: 99%

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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250

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“…All of these may have contributed to the large heterogeneity in the findings. Interestingly, a few studies found an improvement in glucose tolerance in the intervention group, even if no reduction was seen in the risk of GDM [46][47][48].…”

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confidence: 99%

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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“…While this study produced large numbers of subjects and statistically significant results it did suffer from only having eight suitable studies and including varying amount of data completed via self-reporting, thus leaving it open to misclassification. Despite this, the study strongly supported the benefits of exercise in pregnant women [7] There are several studies that investigate the reduction of risk of GDM in pregnant women and provide a variable level of evidence [7,8]. A multi-centre randomised controlled trial reviewed women from nine countries [8] and compared physical activity and healthy eating in regards to the risk of GDM.…”

Section: Discussionmentioning

confidence: 99%

“…Despite this, the study strongly supported the benefits of exercise in pregnant women [7] There are several studies that investigate the reduction of risk of GDM in pregnant women and provide a variable level of evidence [7,8]. A multi-centre randomised controlled trial reviewed women from nine countries [8] and compared physical activity and healthy eating in regards to the risk of GDM. The women were randomised into three groups with those undertaking five face-to-face and four optional telephone sessions for either exercises, healthy eating or both.…”

Section: Discussionmentioning

confidence: 99%

Exercise As Therapy for Gestational Diabetes - What’s the Evidence?

Wilson

Shenouda

2017

Int J Appl Exerc Physiol

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Men and women differ greatly in their physiology; they are able to undertake different types and levels of activity, and also respond differently physiologically to aerobic and anaerobic exercise. Women have an additional capacity for pregnancy and their ability to undergo significant physiological change in a short period of time. They are, however, subject to further conditions that men are not susceptible to, such as gestational diabetes mellitus (GDM). This review will aim to analyse the recent literature regarding exercise and GDM and determine whether exercise can reduce the risk of developing GDM and any potential sequelae. Despite there being a lack of clear consensus on the subject, exercise is a useful adjunct in the treatment of gestational diabetes and may attenuate some of its more harmful sequelae.

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Results From a European Multicenter Randomized Trial of Physical Activity and/or Healthy Eating to Reduce the Risk of Gestational Diabetes Mellitus: The DALI Lifestyle Pilot

Cited by 95 publications

References 21 publications

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

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

Risk factors for gestational diabetes: is prevention possible?

Exercise As Therapy for Gestational Diabetes - What’s the Evidence?

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