FROM DIABETES CARE
The incidence of gestational diabetes can be reduced in high-risk women with individualized lifestyle intervention focused on diet and physical activity, new research suggests.
A randomized, controlled trial of 269 women with a history of gestational diabetes or a prepregnancy body mass index of at least 30 kg/m2 showed the intervention was associated with a 36% reduction in the incidence of gestational diabetes, compared with usual care (13.9% vs. 21.6%, P = .044).
This was after adjustment for age, prepregnancy BMI, previous gestational diabetes status, and number of weeks’ gestation at the time of the oral glucose tolerance test, according to a paper published online July 29 in Diabetes Care.
From baseline to the second trimester oral glucose tolerance test – when the gestational diabetes diagnosis was made – women in the intervention group gained slightly less weight than did those in the control group (2.5 kg vs. 3.1 kg).
The intervention was associated with a significantly greater reduction in fasting plasma glucose concentration from baseline to third trimester, but there were no impacts on other pregnancy or birth outcomes such as preeclampsia, birth weight, or gestational age at birth.
“This is, to our knowledge, the first randomized controlled lifestyle intervention trial that has succeeded in reducing the overall incidence of GDM [gestational diabetes mellitus] among high-risk pregnant women,” wrote Dr. Saila B. Koivusalo of University of Helsinki and Helsinki University Hospital.
Women in the intervention arm were counseled by study nurses and dietitians three times during their pregnancy. Counseling was tailored to their risk and stage of pregnancy. The women continued their normal antenatal clinic visits ( Diabetes Care 2015, Jul 29 [doi:10.2337/dc15-0511 ]).
Women with a prepregnancy BMI of 30 kg/m2 were advised not to gain any weight during the first two trimesters, and were given dietary counseling to optimize their consumption of healthy foods and reduce their intake of sugar-rich foods.
They also were counseled to aim for a minimum of 150 minutes of moderate-intensity physical activity per week, as part of an active lifestyle.
Participants in the control group received leaflets on diet and physical activity, which were usually provide by the local antenatal clinics.
Women who undertook the intervention showed significantly greater improvements in their dietary index scores than did those in the control arm, and they increased their median weekly physical activity by 15 minutes while the control group showed no increases.
However, there was no significant difference between the two groups in the number of women who met the physical activity goal of 150 minutes/week in their second trimester (26% of intervention group vs. 23% of the control group).
“Despite the fact that only a small proportion of the women in the intervention group reached the physical activity goals, and the difference in weight gain was modest between the groups, it is obvious that the individual changes in lifestyle do not need to be large but together they have a beneficial effect on the reduction of the incidence of GDM,” the authors wrote.
They pointed out that as the women participating in the trial were all known to be at high risk for gestational diabetes, even the women in the control group would have received advice on weight control as part of their antenatal care and were therefore more of a “mini-intervention” group than pure control.
“We believe that in an unselected high-risk population the impact of this kind of lifestyle intervention could be even more pronounced.”
The Ahokas Foundation, Finnish Foundation for Cardiovascular Disease, Special State Subsidy for Health Science Research of Helsinki University Central Hospital, Samfundet Folkhälsan, Finnish Diabetes Research Foundation, State Provincial Office of Southern Finland, and Social Insurance Institution of Finland funded the study. There were no conflicts of interest declared.
