Gestational Diabetes Mellitus in Relation to Maternal Dietary Heme Iron and Nonheme Iron Intake A Prospective Study of Prepregnancy Dietary Iron Intake and Risk for Gestational Diabetes Mellitus Health care costs associated with gestational diabetes mellitus among high-risk women – results from a randomised trial Impact of maternal nutrition on pregnancy outcome--does it matter what pregnant women eat? Change in level of physical activity during pregnancy in obese women: findings from the UPBEAT pilot trial A complex intervention to improve pregnancy outcome in obese women; the UPBEAT randomised controlled trial Maternal low glycaemic index diet, fat intake and postprandial glucose influences neonatal adiposity – secondary analysis from the ROLO study Risk of gestational diabetes mellitus in relation to maternal egg and cholesterol intake. Probiotics and dietary counselling contribute to glucose regulation during and after pregnancy: a randomised controlled trial. Low glycaemic index diet in pregnancy to prevent macrosomia (ROLO study): randomised control trial Postpartum Weight Retention is Associated with Elevated Ratio of Oxidized LDL Lipids to HDL-Cholesterol Synbiotic Food Consumption Reduces Levels of Triacylglycerols and VLDL, but not Cholesterol, LDL, or HDL in Plasma from Pregnant Women Glycemic index of foods: a physiological basis for carbohydrate exchange. A prospective study of prepregnancy dietary fat intake and risk of gestational diabetes. Diet and blood lipids in 1-4 year-old children. Randomized Controlled Trial Investigating the Effects of a Low–Glycemic Index Diet on Pregnancy Outcomes in Women at High Risk of Gestational Diabetes Mellitus: The GI Baby 3 Study Developing a complex intervention for diet and activity behaviour change in obese pregnant women (the UPBEAT trial); assessment of behavioural change and process evaluation in a pilot randomised controlled trial Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial Is intensive counseling in maternity care feasible and effective in promoting physical activity among women at risk for gestational diabetes? Secondary analysis of a cluster randomized NELLI study in Finland Pre-pregnancy potato consumption and risk of gestational diabetes mellitus: prospective cohort study Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. [Impact of a dietary counseling program on the gain weight speed of pregnant women attended in a primary care service]. Probiotics and dietary counselling targeting maternal dietary fat intake modifies breast milk fatty acids and cytokines Pre-pregnancy dietary patterns and risk of gestational diabetes mellitus: results from an Australian population-based prospective cohort study Effects of a low-glycemic load diet in overweight and obese pregnant women: a pilot randomized controlled trial. Preventing Excessive Weight Gain During Pregnancy Through Dietary and Lifestyle Counseling: A Randomized Controlled Trial Design of the New Life(style) study: a randomised controlled trial to optimise maternal weight development during pregnancy. [ISRCTN85313483] Effect of dietary myo-inositol supplementation in pregnancy on the incidence of maternal gestational diabetes mellitus and fetal outcomes: a randomized controlled trial Well-being in pregnancy: an examination of the effect of socioeconomic, dietary and lifestyle factors including impact of a low glycaemic index dietary intervention A randomised control trial of low glycaemic index carbohydrate diet versus no dietary intervention in the prevention of recurrence of macrosomia Can a Low–Glycemic Index Diet Reduce the Need for Insulin in Gestational Diabetes Mellitus? Impact of maternal probiotic-supplemented dietary counseling during pregnancy on colostrum adiponectin concentration: a prospective, randomized, placebo-controlled study. Prospective Study of Pre-Gravid Sugar-Sweetened Beverage Consumption and the Risk of Gestational Diabetes Mellitus A prospective study of dietary patterns, meat intake and the risk of gestational diabetes mellitus Perinatal outcomes in nutritionally monitored obese pregnant women: a randomized clinical trial. The influence of a low glycemic index dietary intervention on maternal dietary intake, glycemic index and gestational weight gain during pregnancy: a randomized controlled trial Impact of maternal probiotic-supplemented dietary counselling on pregnancy outcome and prenatal and postnatal growth: a double-blind, placebo-controlled study. Effect of daily consumption of probiotic yoghurt on insulin resistance in pregnant women: a randomized controlled trial Efficacy of a group-based dietary intervention for limiting gestational weight gain among obese women: a randomized trial Effect of intensive counselling on the quality of dietary fats in pregnant women at high risk of gestational diabetes mellitus. Progressing towards standard outcomes in gestational diabetes Cochrane reviews and randomised trials Does behavioral intervention in pregnancy reduce postpartum weight retention? Twelve-month outcomes of the Fit for Delivery randomized trial. Identification of those most likely to benefit from a low-glycaemic index dietary intervention in pregnancy. Pre-pregnancy fried food consumption and the risk of gestational diabetes mellitus: a prospective cohort study Healthy Moms, a randomized trial to promote and evaluate weight maintenance among obese pregnant women: study design and rationale. The Fit for Delivery study: rationale for the recommendations and test-retest reliability of a dietary score measuring adherence to 10 specific recommendations for prevention of excessive weight gain during pregnancy. Weight status and dietary intake determine serum leptin concentrations in pregnant and lactating women and their infants. Dietary counseling to improve fat quality during pregnancy alters maternal fat intake and infant essential fatty acid status. Association between Physical Activity in Obese Pregnant Women and Pregnancy Outcomes: The UPBEAT Pilot Study Association between healthy maternal dietary pattern and risk for gestational diabetes mellitus From Theory to Practice Insulin sensitivity in third trimester pregnancy. A randomized study of dietary effects Pregnancy and Glycemic Index Outcomes study: effects of low glycemic index compared with conventional dietary advice on selected pregnancy outcomes. Impact of dietary counselling on nutrient intake during pregnancy: a prospective cohort study. Dietary micronutrient intake during pregnancy is a function of carbohydrate quality. Effects of dietary counselling on food habits and dietary intake of Finnish pregnant women at increased risk for gestational diabetes - a secondary analysis of a cluster-randomized controlled trial. Prenatal and perinatal influences on long-term psychomotor development in offspring of diabetic mothers. Prepregnancy low-carbohydrate dietary pattern and risk of gestational diabetes mellitus: a prospective cohort study. A controlled trial of a high dietary fibre intake in pregnancy — Effects on plasma glucose and insulin levels Maternal dietary counseling during pregnancy and infant fatty acid profiles Fish-oil supplementation in pregnancy does not reduce the risk of gestational diabetes or preeclampsia. Prevention of Gestational Diabetes: Design of a Cluster-Randomized Controlled Trial and One-Year Follow-Up Impact of maternal diet on neonatal anthropometry: a randomized controlled trial. Indices of dietary fat quality during midpregnancy is associated with gestational diabetes. Primary Prevention of Gestational Diabetes Mellitus and Large-for-Gestational-Age Newborns by Lifestyle Counseling: A Cluster-Randomized Controlled Trial Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the Fit for Delivery Study.
OBJECTIVE Higher heme iron intake is associated with increased  type 2 diabetes risk .  However , no previous study has evaluated gestational diabetes mellitus ( GDM ) risk in relation to heme iron intake during pregnancy . We investigated associations of maternal preconceptional and early pregnancy heme and nonheme iron intake with subsequent GDM risk . RESEARCH DESIGN AND METHODS We conducted a prospect i ve cohort study of 3,158 pregnant women . A food frequency question naire was used to assess maternal diet . Multivariable generalized linear regression models were used to derive estimates of relative risks ( RRs ) and 95 % CIs . RESULTS Approximately 5.0 % of the cohort developed GDM ( n = 158 ) . Heme iron intake was positively and significantly associated with GDM risk ( Ptrend = 0.04 ) . After adjusting for confounders , women reporting the highest heme iron intake levels ( ≥1.52 vs. < 0.48 mg per day ) experienced a 3.31-fold – increased GDM risk ( 95 % CI 1.02–10.72 ) . In fully adjusted models , we noted that a 1-mg per day increase in heme iron was associated with a 51 % increased GDM risk ( RR 1.51 [ 95 % CI 0.99–2.36 ] ) . Nonheme iron was inversely , though not statistically significantly , associated with GDM risk , and the corresponding RRs were 1.00 , 0.83 , 0.62 , and 0.61 across quartiles of nonheme iron intake ( Ptrend = 0.08 ) . CONCLUSIONS High levels of dietary heme iron intake during the preconceptional and early pregnancy period may be associated with increased GDM risk . Associations of GDM risk  with dietary nonheme iron intake are less clear . Confirmation of these findings by future studies is warranted OBJECTIVE It is important to identify modifiable factors that may lower gestational diabetes mellitus ( GDM ) risk .  Dietary iron is of particular interest given that iron is a strong prooxidant , and high body iron levels can damage pancreatic β-cell function and impair glucose metabolism . The current study is to determine if prepregnancy dietary and supplemental iron intakes are associated with the risk of GDM . RESEARCH DESIGN AND METHODS A prospect i ve study was conducted among 13,475 women who reported a singleton pregnancy between 1991 and 2001 in the Nurses ’ Health Study II . A total of 867 incident GDM cases were reported . Pooled logistic regression was used to estimate the relative risk ( RR ) of GDM by quintiles of iron intake controlling for dietary and nondietary risk factors . RESULTS  Dietary heme iron intake was positively and significantly associated with GDM risk . After adjusting for age , BMI , and other risk factors , RRs ( 95 % CIs ) across increasing quintiles of heme iron were 1.0 ( reference ) , 1.11 ( 0.87–1.43 ) , 1.31 ( 1.03–1.68 ) , 1.51 ( 1.17–1.93 ) , and 1.58 ( 1.21–2.08 ) , respectively ( P for linear trend 0.0001 ) . The multivariate adjusted RR for GDM associated with every 0.5-mg per day of increase in intake was 1.22 ( 1.10–1.36 ) . No significant associations were observed between total dietary , nonheme , or supplemental iron intake and GDM risk . CONCLUSIONS These findings suggest that higher prepregnancy intake of dietary heme iron is associated with an increased GDM risk Background The costs of gestational diabetes mellitus ( GDM ) screening have been frequently reported , but total GDM-related health care costs compared to the health care costs of women without GDM have not been reported . The aim of this study was to analyse GDM-related health care costs among women with an elevated risk of GDM . Methods The study was based on a cluster-r and omised GDM prevention trial ( N = 848 ) carried out at maternity clinics , combined with data from the Finnish Medical Birth Register and Care Registers for Social Welfare and Health Care . Costs of outpatient visits to primary and secondary care , cost of inpatient hospital care before and after delivery , the use of insulin , delivery costs and babies ’ stay in the neonatal intensive care unit were analysed . Women who developed GDM were compared to those who were not diagnosed with GDM . Results Total mean health care costs adjusted for age , body mass index and education were 25.1 % higher among women diagnosed with GDM ( € 6,432 vs. € 5,143 , p < 0.001 ) than among women without GDM . The cost of inpatient visits was 44 % higher and neonatal intensive care unit use was 49 % higher in the GDM group than among women without GDM . The delivery costs were the largest single component in both groups . Conclusions A confirmed GDM diagnosis was associated with a significant increase in total health care costs . Effective lifestyle counselling by primary health care providers may offer a means of reducing the high costs of secondary care Pregnancy presents a unique époque in life with considerable potential to influence not only maternal health but also the health of the next generation . Nutritional interventions in pregnancy can influence maternal , foetal and infant health . This chapter describes the findings of a large r and omised controlled trial on the impact of a  low glycaemic index diet on  maternal and foetal health  and discusses areas of future research in this important area Background Maternal obesity is associated with an increased risk of pregnancy complications , including gestational diabetes . Physical activity ( PA ) might improve glucose metabolism and reduce the incidence of gestational diabetes . The purpose of this study was to explore patterns of PA and factors associated with change in PA in obese pregnant women . Methods PA was assessed objective ly by accelerometer at 16 – 18 weeks ’ ( T0 ) , 27 – 28 weeks ’ ( T1 ) and 35 – 36 weeks ’ gestation ( T2 ) in 183 obese pregnant women recruited to a pilot r and omised trial of a combined diet and PA intervention ( the UPBEAT study ) . Results Valid PA data were available for 140 ( 77 % ) , 76 ( 42 % ) and 54 ( 30 % ) women at T0 , T1 and T2 respectively . Moderate and vigorous physical activity as a proportion of accelerometer wear time declined with gestation from a median of 4.8 % at T0 to 3 % at T2 ( p < 0.05 ) . Total activity as a proportion of accelerometer wear time did not change . Being more active in early pregnancy was associated with a higher level of PA later in pregnancy . The intervention had no effect on PA . Conclusions PA in early pregnancy was the factor most strongly associated with PA at later gestations . Women should be encouraged to participate in PA before becoming pregnant and to maintain their activity levels during pregnancy . There is a need for effective interventions , tailored to the needs of individuals and delivered early in pregnancy to support obese women to be sufficiently active during pregnancy . Trial registration Current Controlled Trials IS RCT N89971375 ( Registered 28/11/2008 ) Background Despite the widespread recognition that obesity in pregnant women is associated with adverse outcomes for mother and child , there is no intervention proven to reduce the risk of these complications . The primary aim of this r and omised controlled trial is to assess in obese pregnant women , whether a complex behavioural intervention , based on changing diet ( to foods with a lower glycemic index ) and physical activity , will reduce the risk of gestational diabetes ( GDM ) and delivery of a large for gestational age ( LGA ) infant . A secondary aim is to determine whether the intervention lowers the long term risk of obesity in the offspring . Methods / Design Multicentre r and omised controlled trial comparing a behavioural intervention design ed to improve glycemic control with st and ard antenatal care in obese pregnant women . Inclusion criteria ; women with a BMI ≥30 kg/m2 and a singleton pregnancy between 15 + 0 weeks and 18 + 6 weeks ’ gestation . Exclusion criteria ; pre-defined , pre-existing diseases and multiple pregnancy . R and omisation is on-line by a computer generated programme and is minimised by BMI category , maternal age , ethnicity , parity and centre . Intervention ; this is delivered by a health trainer over 8 sessions . Based on control theory , with elements of social cognitive theory , the intervention is design ed to improve maternal glycemic control . Women r and omised to the control arm receive st and ard antenatal care until delivery according to local guidelines . All women have a 75 g oral glucose tolerance test at 27 + 0- 28 + 6 weeks ’ gestation . Primary outcome ; Maternal : diagnosis of GDM , according to the International Association of Diabetes in Pregnancy Study Group ( IADPSG ) criteria . Neonatal ; infant LGA defined as > 90th customised birth weight centile . Sample size ; 1546 women to provide 80 % power to detect a 25 % reduction in the incidence of GDM and a 30 % reduction in infants large for gestational age . Discussion All aspects of this protocol have been evaluated in a pilot r and omised controlled trial , with subsequent optimisation of the intervention . The findings of this trial will inform whether lifestyle mediated improvement of glycemic control in obese pregnant women can minimise the risk of pregnancy complications . Trial registration Current controlled trials ; IS RCT N89971375 Background The in utero environment is known to affect fetal development however many of the mechanisms by which this occurs remain unknown . The aim of this study was to examine the association between maternal dietary macronutrient intake and lifestyle throughout pregnancy and neonatal weight and adiposity . Methods This was an analysis of 542 mother and infant pairs from the ROLO study ( R and omised cOntrol trial of LOw glycaemic index diet versus no dietary intervention to prevent recurrence of fetal macrosomia ) . Food diaries as well as food frequency and lifestyle and physical activity question naires were completed during pregnancy . Maternal anthropometry was measured throughout pregnancy and neonatal anthropometry was measured at birth . Results Multiple linear regression analysis revealed the main maternal factor associated with increased birth weight was greater gestational weight gain R2adj23.3 % ( F = 11.547 , p < 0.001 ) . The main maternal factor associated with increased birth length was non-smoking status R2adj27.8 % ( F = 6.193 , p < 0.001 ) . Neonatal central adiposity ( determined using waist : length ratio ) was negatively associated with maternal age , and positively associated with the following parameters : smoking status , maternal pre-pregnancy arm circumference , percentage energy from saturated fat in late pregnancy , postpr and ial glucose at 28 weeks gestation and membership of the control group with a positive trend towards association with trimester 2 glycaemic load R2adj 38.1 % ( F = 8.000 , p < 0.001 ) . Conclusions Several maternal diet and lifestyle factors were associated with neonatal anthropometry .  Low glycaemic index dietary intervention in pregnancy was found to have a beneficial effect on neonatal central adiposity . Additionally , central adiposity was positively associated with maternal dietary fat intake and postpr and ial glucose highlighting the important role of healthy diet in pregnancy in promoting normal neonatal adiposity . Trial registration Current Controlled Trials IS RCT N54392969 Higher egg and cholesterol intakes are associated with increased risk of type 2 diabetes mellitus .  However , their association with gestational diabetes mellitus ( GDM ) has not been evaluated . The authors assessed such associations in both a prospect i ve cohort study ( 1996 - 2008 ; 3,158 participants ) and a case-control study ( 1998 - 2002 ; 185 cases , 411 controls ) .  A food frequency question naire was used to assess maternal diet . Multivariable models were used to derive relative risks and 95 % confidence intervals . Compared with no egg consumption , adjusted relative risks for GDM were 0.94 , 1.01 , 1.12 , 1.54 , and 2.52 for consumption of ≤1 , 2 - 3 , 4 - 6 , 7 - 9 , and ≥10 eggs/week , respectively ( P for trend=0.008 ) . Women with high egg consumption ( ≥7/week ) had a 1.77-fold increased risk compared with women with lower consumption ( 95 % confidence interval ( CI ) : 1.19 , 2.63 ) . The relative risk for the highest quartile of cholesterol intake ( ≥294 mg/day ) versus the lowest ( < 151 mg/day ) was 2.35 ( 95 % CI : 1.35 , 4.09 ) . In the case-control study , the adjusted odds ratio for consuming ≥7 eggs/week versus < 7 eggs/week was 2.65 ( 95 % CI : 1.48 , 4.72 ) , and the odds of GDM increased with increasing cholesterol intake ( P for trend=0.021 ) . In conclusion ,  high  egg and cholesterol intakes before and during pregnancy are associated with increased risk of GDM Balanced glucose metabolism ensures optimal fetal growth with long-term health implication s conferred on both mother and child . We examined whether supplementation of probiotics with dietary counselling affects glucose metabolism in normoglycaemic pregnant women . At the first trimester of pregnancy 256 women were r and omised to receive nutrition counselling to modify dietary intake according to current recommendations or as controls ; the dietary intervention group was further r and omised to receive probiotics ( Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb12 ; diet/probiotics ) or placebo ( diet/placebo ) in a double-blind manner , whilst the control group received placebo ( control/placebo ) . Blood glucose concentrations were lowest in the diet/probiotics group during pregnancy ( baseline-adjusted means 4.45 , 4.60 and 4.56 mmol/l in diet/probiotics , diet/placebo and control/placebo , respectively ; P = 0.025 ) and over the 12 months ' postpartum period ( baseline-adjusted means 4.87 , 5.01 and 5.02 mmol/l ; P = 0.025 ) . Better glucose tolerance in the diet/probiotics group was confirmed by a reduced risk of elevated glucose concentration compared with the control/placebo group ( OR 0.31 ( 95 % CI 0.12 , 0.78 ) ; P = 0.013 ) as well as by the lowest insulin concentration ( adjusted means 7.55 , 9.32 and 9.27 mU/l ; P = 0.032 ) and homeostasis model assessment ( adjusted means 1.49 , 1.90 and 1.88 ; P = 0.028 ) and the highest quantitative insulin sensitivity check index ( adjusted means 0.37 , 0.35 and 0.35 ; P = 0.028 ) during the last trimester of pregnancy . The effects observed extended over the 12-month postpartum period . The present study demonstrated that improved blood glucose control can be achieved by dietary counselling with probiotics even in a normoglycaemic population and thus may provide potential novel means for the prophylactic and therapeutic management of glucose disorders Objective To determine if a low glycaemic index diet in pregnancy could reduce the incidence of macrosomia in an at risk group . Design R and omised controlled trial . Setting Maternity hospital in Dublin , Irel and . Participants 800 women without diabetes , all in their second pregnancy between January 2007 to January 2011 , having previously delivered an infant weighing greater than 4 kg . Intervention Women were r and omised to receive no dietary intervention or start on a low glycaemic index diet from early pregnancy . Main outcomes The primary outcome measure was difference in birth weight . The secondary outcome measure was difference in gestational weight gain . Results No significant difference was seen between the two groups in absolute birth weight , birthweight centile , or ponderal index . Significantly less gestational weight gain occurred in women in the intervention arm ( 12.2 v 13.7 kg ; mean difference −1.3 , 95 % confidence interval −2.4 to −0.2 ; P=0.01 ) . The rate of glucose intolerance was also lower in the intervention arm : 21 % ( 67/320 ) compared with 28 % ( 100/352 ) of controls had a fasting glucose of 5.1 mmol/L or greater or a 1 hour glucose challenge test result of greater than 7.8 mmol/L ( P=0.02 ) . Conclusion A low glycaemic index diet in pregnancy did not reduce the incidence of large for gestational age  infants in a group at risk of fetal macrosomia . It did , however , have a significant positive effect on gestational weight gain and maternal glucose intolerance . Trial registration Current Controlled Trials IS RCT N54392969 Oxidized LDL lipids ( ox-LDL ) are associated with lifestyle diseases such as cardiovascular diseases , metabolic syndrome and type 2 diabetes . The present study investigated how postpartum weight retention effects on ox-LDL and serum lipids . The study is a nested comparative research of a cluster-r and omized controlled trial , NELLI ( lifestyle and counselling during pregnancy ) . During early pregnancy ( 8–12 weeks ) and 1 year postpartum , 141 women participated in measurements for determining of plasma lipids : total cholesterol ( T-C ) , LDL-cholesterol ( LDL-C ) , HDL-cholesterol ( HDL-C ) , triacylglycerols ( TAG ) and ox-LDL . Subjects were stratified into tertiles ( weight loss , unaltered weight and weight gain groups ) based on their weight change from baseline to follow-up . Ox-LDL was determined by baseline level of conjugated dienes in LDL lipids . Among the group of weight gainers , concentration of TAG reduced less ( −0.14 vs. −0.33 , p = 0.002 ) , HDL-C reduced more ( −0.31 vs. −0.16 , p = 0.003 ) and ox-LDL/HDL-C ratio increased ( 3.0 vs. −0.2 , p = 0.003 ) when compared to group of weight loss . Both T-C and LDL-C elevated more ( 0.14 vs. −0.21 , p = 0.008 ; 0.31 vs. 0.07 , p = 0.015 ) and TAG and ox-LDL reduced less ( −0.33 vs. 0.20 , p = 0.033 ; −3.33 vs. −0.68 , p = 0.026 ) in unaltered weight group compared to weight loss group . The women who gained weight developed higher TAG and ox-LDL/HDL-C ratio as compared to those who lost weight . Postpartum weight retention of 3.4 kg or more is associated with atherogenic lipid profile To our knowledge , no reports are available indicating the effects of synbiotic food consumption on blood lipid profiles and biomarkers of oxidative stress among pregnant women . This study was conducted to evaluate the effects of daily consumption of a synbiotic food on blood lipid profiles and biomarkers of oxidative stress in pregnant women . This r and omized , double-blind , controlled clinical trial was performed among 52 primigravida pregnant women , aged 18 to 35-year-old at their third trimester . After a 2-week run-in period , subjects were r and omly assigned to consume either a synbiotic ( n = 26 ) or control food ( n = 26 ) for 9 weeks . The synbiotic food consisted of a probiotic viable and heat-resistant Lactobacillus sporogenes ( 1 × 107 CFU ) and 0.04 g inulin (HPX)/g as the prebiotic . Patients were asked to consume the synbiotic and control foods two times a day . Biochemical measurements including blood lipid profiles , plasma total antioxidant capacity ( TAC ) and total glutathione ( GSH ) were conducted before and after 9 weeks of intervention . Consumption of a synbiotic food for 9 weeks result ed in a significant reduction in serum TAG ( P = 0.04 ) , VLDL ( P = 0.04 ) and a significant rise in plasma GSH levels ( P = 0.004 ) compared to the control food . No significant effects of the synbiotic food consumption on serum TC , LDL , HDL and plasma TAC levels ( P > 0.05 ) were observed . Trial registry code : http://www.i rct .ir . I RCT 201212105623N3 The determine the effect of different foods on the blood glucose , 62 commonly eaten foods and sugars were fed individually to groups of 5 to 10 healthy fasting volunteers .  Blood glucose levels were measured over 2 h , and expressed as a percentage of the area under the glucose response curve when the same amount of carbohydrate was taken as glucose . The largest rises were seen with vegetables ( 70 + /- 5 % ) , followed by breakfast cereals ( 65 + /- 5 % ) , cereals and biscuits ( 60 + /- 3 % ) , fruit ( 50 + /- 5 % ) , dairy products ( 35 + /- 1 % ) , and dried legumes ( 31 + /- 3 % ) . A significant negative relationship was seen between fat ( p less than 0.01 ) and protein ( p less than 0.001 ) and postpr and ial glucose rise but not with fiber or sugar content BACKGROUND Fatty acids play a vital role in glucose homeostasis ; however , studies on habitual dietary fat intakes and gestational diabetes mellitus ( GDM ) risk are limited and provide conflicting findings . OBJECTIVE We determined whether the total amount and the type and source of prepregnancy dietary fats are related to risk of GDM . DESIGN A prospect i ve study was conducted in 13,475 women who reported a singleton pregnancy between 1991 and 2001 in the Nurses ' Health Study II . In these women , 860 incident GDM cases were reported . The adjusted RR of GDM was estimated for quintiles of total fat , specific fat , and the source of fat intakes by pooled logistic regression . RESULTS Higher animal fat and cholesterol intakes were significantly associated with increased GDM risk . Across increasing quintiles of animal fat , RRs ( 95 % CIs ) for GDM were 1.00 ( reference ) , 1.55 ( 1.20 , 1.98 ) , 1.43 ( 1.09 , 1.88 ) , 1.40 ( 1.04 , 1.89 ) , and 1.88 ( 1.36 , 2.60 ) ( P-trend = 0.05 ) . Corresponding RRs ( 95 % CIs ) for dietary cholesterol  were 1.00 ( reference ) , 1.08 ( 0.84 , 1.32 ) , 1.02 ( 0.78 , 1.29 ) , 1.20 ( 0.93 , 1.55 ) , and 1.45 ( 1.11 , 1.89 ) ( P-trend = 0.04 ) . The substitution of 5 % of energy from animal fat for an equal percentage of energy from carbohydrates was associated with significantly increased risk of GDM [ RR ( 95 % CI ) : 1.13 ( 1.08 , 1.18 ) ; P < 0.0001 ] . No significant associations were observed between dietary polyunsaturated fat , monounsaturated fat , or trans fat intakes and GDM risk . CONCLUSION Higher prepregnancy intakes of animal fat and cholesterol were associated with elevated GDM risk BACKGROUND AND AIM Early nutrition may programme blood lipid levels and thereby later  cardiovascular health of children . The objective here was to evaluate the effects of maternal dietary counselling during pregnancy and breastfeeding on  dietary intakes and blood lipid values in 1 - 4 year-old children . Further , the nutritional determinants of children 's lipid profiles were assessed . METHODS AND RESULTS Mothers were r and omised into dietary counselling or control groups at the first trimester of pregnancy . Their children were followed up clinical ly at 1 , 2 and 4 years of age , by three-day food records and analyses of total cholesterol , HDL cholesterol and apolipoproteins A-I and B as well as lipoprotein ( a ) . In general , the mean intake of saturated fatty acids as a proportion of total energy intake ( E% ) was higher than the recommended , while the mean intake of polyunsaturated fatty acids was low in children 's diet . Over the first years , girls had higher concentration of non-HDL cholesterol than boys ; 2.64 mmol/l ( 95 % CI 2.54 - 2.74 ) vs. 2.49 ( 2.38 - 2.60 ) ; p = 0.038 . Maternal dietary counselling was not reflected in the children 's lipid values . Children 's monounsaturated fatty acid intake ( E% ) correlated with apoA-I ( p = 0.048 ) and , furthermore , there was a negative correlation between polyunsaturated fatty acid intake ( E% ) and apoB ( p = 0.046 ) . CONCLUSION Children 's dietary fatty acid intake , but not maternal dietary counselling was shown to be related to blood apolipoproteins in children OBJECTIVE Dietary interventions can improve pregnancy outcomes in women with gestational diabetes mellitus ( GDM ) . We compared the effect of a low – glycemic index ( GI ) versus a conventional high-fiber ( HF ) diet on pregnancy outcomes , birth weight z score , and maternal metabolic profile in women at high risk of GDM . RESEARCH DESIGN AND METHODS One hundred thirty-nine women [ mean ( SD ) age 34.7 ( 0.4 ) years and prepregnancy BMI 25.2 ( 0.5 ) kg/m2 ] were r and omly assigned to a low-GI ( LGI ) diet ( n = 72 ; target GI ∼50 ) or a high-fiber , moderate-GI ( HF ) diet ( n = 67 ; target GI ∼60 ) at 14–20 weeks ’ gestation .  Diet was assessed by 3-day food records and infant body composition by air-displacement plethysmography , and pregnancy outcomes were assessed from medical records . RESULTS The LGI group achieved a lower GI than the HF group [ mean ( SD ) 50 ( 5 ) vs. 58 ( 5 ) ; P < 0.001 ] . There were no differences in glycosylated hemoglobin , fructosamine , or lipids at 36 weeks or differences in birth weight [ LGI 3.4 ( 0.4 ) kg vs. HF 3.4 ( 0.5 ) kg ; P = 0.514 ] , birth weight z score [ LGI 0.31 ( 0.90 ) vs. HF 0.24 ( 1.07 ) ; P = 0.697 ] , ponderal index [ LGI 2.71 ( 0.22 ) vs. HF 2.69 ( 0.23 ) kg/m3 ; P = 0.672 ] , birth weight centile [ LGI 46.2 ( 25.4 ) vs. HF 41.8 ( 25.6 ) ; P = 0.330 ] , % fat mass [ LGI 10 ( 4 ) vs. HF 10 ( 4 ) ; P = 0.789 ] , or incidence of GDM . CONCLUSIONS In intensively monitored women at risk for GDM , a low-GI diet and a healthy diet produce similar pregnancy outcomes Background Complex interventions in obese pregnant women should be theoretically based , feasible and shown to demonstrate anticipated behavioural change prior to inception of large r and omised controlled trials ( RCTs ) . The aim was to determine if a ) a complex intervention in obese pregnant women leads to anticipated changes in diet and physical activity behaviours , and b ) to refine the intervention protocol through process evaluation of intervention fidelity . Methods We undertook a pilot RCT of a complex intervention in obese pregnant women , comparing routine antenatal care with an intervention to reduce dietary glycaemic load and saturated fat intake , and increase physical activity . Subjects included 183 obese pregnant women ( mean BMI 36.3 kg/m2).Diet was assessed by repeated triple pass 24-hour dietary recall and physical activity by accelerometry and question naire , at 16 + 0 to 18 + 6 and at 27 + 0 to 28 + 6 weeks ’ gestation in women in control and intervention arms . Attitudes to behaviour change and quality of life were assessed and a process evaluation undertaken . The full RCT protocol was undertaken to assess feasibility . Results Compared to women in the control arm , women in the intervention arm had a significant reduction in dietary glycaemic load ( 33 points , 95 % CI −47 to −20 ) , ( p < 0.001 ) and saturated fat intake ( −1.6 % energy , 95 % CI −2.8 to −0 . 3 ) at 28 weeks ’ gestation . Objective ly measured physical activity did not change . Physical discomfort and sustained barriers to physical activity were common at 28 weeks ’ gestation . Process evaluation identified barriers to recruitment , group attendance and compliance , leading to modification of intervention delivery . Conclusions This pilot trial of a complex intervention in obese pregnant women suggests greater potential for change in dietary intake than for change in physical activity , and through process evaluation illustrates the considerable advantage of performing an exploratory trial of a complex intervention in obese pregnant women before undertaking a large RCT .Trial registration Trial Registration Number : IS RCT Objective To determine the effect of antenatal dietary and lifestyle interventions on health outcomes in overweight and obese pregnant women . Design Multicentre r and omised trial . We utilised a central telephone r and omisation server , with computer generated schedule , balanced variable blocks , and stratification for parity , body mass index ( BMI ) category , and hospital . Setting Three public maternity hospitals across South Australia . Participants 2212 women with a singleton pregnancy , between 10 + 0 and 20 + 0 weeks ’ gestation , and BMI ≥25 . Interventions 1108 women were r and omised to a comprehensive dietary and lifestyle intervention delivered by research staff ; 1104 were r and omised to st and ard care and received pregnancy care according to local guidelines , which did not include such information . Main outcome measures Incidence of infants born large for gestational age ( birth weight ≥90th centile for gestation and sex ) . Prespecified secondary outcomes included birth weight > 4000 g , hypertension , pre-eclampsia , and gestational diabetes . Analyses used intention to treat principles . Results 2152 women and 2142 liveborn infants were included in the analyses . The risk of the infant being large for gestational age was not significantly different in the two groups ( lifestyle advice 203/1075 ( 19 % ) v st and ard care 224/1067 ( 21 % ) ; adjusted relative risk 0.90 , 95 % confidence interval 0.77 to 1.07 ; P=0.24 ) . Infants born to women after lifestyle advice were significantly less likely to have birth weight above 4000 g ( lifestyle advice 164/1075 ( 15 % ) v st and ard care 201/1067 ( 19 % ) ; 0.82 , 0.68 to 0.99 ; number needed to treat ( NNT ) 28 , 15 to 263 ; P=0.04 ) . There were no differences in maternal pregnancy and birth outcomes between the two treatment groups . Conclusions For women who were overweight or obese , the antenatal lifestyle advice used in this study did not reduce the risk delivering a baby weighing above the 90th centile for gestational age and sex or improve maternal pregnancy and birth outcomes . Trial registration Australian and New Zeal and Clinical Trials Registry ( ACTRN12607000161426 ) Abstract Background Women who are physically active during early pregnancy have notably lower odds of developing gestational diabetes than do inactive women . The purpose of the intervention was to examine whether intensified physical activity ( PA ) counseling in Finnish maternity care is feasible and effective in promoting leisure-time PA ( LTPA ) among pregnant women at risk of gestational diabetes . Methods Fourteen municipalities were r and omized to intervention ( INT ) and usual care group ( UC ) . Nurses in INT integrated five PA counseling sessions into routine maternity visits and offered monthly group meetings on PA instructed by physiotherapists . In UC conventional practice s were continued . Feasibility evaluation included safety ( incidence of PA-related adverse events ; question naire ) , realization ( timing and duration of sessions , number of sessions missed , attendance at group meetings ; systematic record-keeping of the nurses and physiotherapists ) and applicability ( nurses ’ views ; telephone interview ) . Effectiveness outcomes were weekly frequency and duration of total and intensity-specific LTPA and meeting PA recommendation for health self-reported at 8 - 12 ( baseline ) , 26 - 28 and 36 - 37 weeks ’ gestation . Multilevel analysis with adjustments was used in testing for between-group differences in PA changes . Results The decrease in the weekly days of total and moderate-to-vigorous-intensity LTPA was smaller in INT ( N = 219 ) than in UC ( N = 180 ) from baseline to the first follow-up ( 0.1 vs. -1.2 , p = 0.040 and −0.2 vs. -1.3 , p = 0.016 ) . A similar trend was seen in meeting the PA recommendation ( −11%-points vs. -28%-points , p = 0.06 ) . INT did not experience more adverse events classified as warning signs to terminate exercise than UC , counseling was implemented as planned and viewed positively by the nurses . Conclusions Intensified counseling had no effects on the duration of total or intensity-specific weekly LTPA . However , it was able to reduce the decrease in the weekly frequency of total and moderate-to-vigorous-intensity LTPA from baseline to the end of second trimester and was feasibly embedded into routine practice s . Trial registration IS RCT N 33885819 ( http://www.is rct n.org Study question What is the association between potato consumption before pregnancy and the risk of gestational diabetes mellitus ( GDM )  ? Methods This prospect i ve cohort study included 15 632 women from the Nurses ’ Health Study II ( 1991 - 2001 ) . They had no previous GDM or chronic diseases before pregnancy .  Consumption of potatoes and other foods was assessed every four years . Incident first time GDM was ascertained from self reports of a physician diagnosis of GDM , which was previously vali date d by medical records . Study answer and limitations Over the 10 year follow-up there were 854 incident cases of GDM among 21 693 singleton pregnancies . After adjustment for age , parity , and dietary and non-dietary factors , women who consumed more potatoes before pregnancy had higher rates of developing GDM . Substitution of two servings a week of total potatoes with other vegetables , legumes , and whole grain foods was significantly associated with a 9 - 12 % lower risk of GDM . Consumption and diabetes were self reported , and severity of diabetes was unknown . More than 90 % of women were white . A causal association can not be assumed . What this paper adds Higher levels of potato consumption before pregnancy are associated with greater risk of GDM , and substitution of potatoes with other vegetables , legumes , or whole grain foods might lower the risk . Funding , competing interests , data sharing Funding was received from the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development , the National Institutes of Health , and the American Diabetes Association ( No 7 - 12-MN-34 ) . The authors have no competing interests or additional data to share BACKGROUND Behavioural interventions might improve clinical outcomes in pregnant women who are obese . We aim ed to investigate whether a complex intervention addressing diet and physical activity could reduce the incidence of gestational diabetes and large-for-gestational-age infants . METHODS The UK Pregnancies Better Eating and Activity Trial ( UPBEAT ) is a r and omised controlled trial done at antenatal clinics in eight hospitals in multi-ethnic , inner-city locations in the UK . We recruited pregnant women ( 15 - 18 weeks plus 6 days of gestation ) older than 16 years who were obese ( BMI ≥30 kg/m(2 ) ) . We r and omly assigned participants to either a behavioural intervention or st and ard antenatal care with an internet-based , computer-generated , r and omisation procedure , minimising by age , ethnic origin , centre , BMI , and parity . The intervention was delivered once a week through eight health trainer-led sessions . Primary outcomes were gestational diabetes ( diagnosed with an oral glucose tolerance test and by criteria from the International Association of Diabetes in Pregnancy Study Groups ) and large-for-gestational-age infants ( ≥90th customised birthweight centile ) . Analysis was by intention to treat . This trial is registered with Current Controlled Trials , ISCRTN89971375 . Recruitment and pregnancy outcomes are complete but childhood follow-up is ongoing . FINDINGS Between March 31 , 2009 , and June 2 , 2014 , we assessed 8820 women for eligibility and recruited 1555 , with a mean BMI of 36·3 kg/m(2 ) ( SD 4·8 ) . 772 were r and omly assigned to st and ard antenatal care and 783 were allocated the behavioural intervention , of which 651 and 629 women , respectively , completed an oral glucose tolerance test . Gestational diabetes was reported in 172 ( 26 % ) women in the st and ard care group compared with 160 ( 25 % ) in the intervention group ( risk ratio 0·96 , 95 % CI 0·79 - 1·16 ; p=0·68 ) . 61 ( 8 % ) of 751 babies in the st and ard care group were large for gestational age compared with 71 ( 9 % ) of 761 in the intervention group ( 1·15 , 0·83 - 1·59 ; p=0·40 ) . Thus , the primary outcomes did not differ between groups , despite improvements in some maternal secondary outcomes in the intervention group , including reduced dietary glycaemic load , gestational weight gain , and maternal sum-of-skinfold thicknesses , and increased physical activity . Adverse events included neonatal death ( two in the st and ard care group and three in the intervention group ) and fetal death in utero ( ten in the st and ard care group and six in the intervention group ) . No maternal deaths were reported . Incidence of miscarriage ( 2 % in the st and ard care group vs 2 % in the intervention group ) , major obstetric haemorrhage ( 1 % vs 3 % ) , and small-for-gestational-age infants ( ≤5th customised birthweight centile ; 6 % vs 5 % ) did not differ between groups . INTERPRETATION A behavioural intervention addressing diet and physical activity in women with obesity during pregnancy is not adequate to prevent gestational diabetes , or to reduce the incidence of large-for-gestational-age infants . FUNDING National Institute for Health Research , Guys and St Thomas ' Charity , Chief Scientist Office Scotl and , Tommy 's Charity PURPOSE to evaluate the impact of dietary counseling on controlling weight gain in pregnant women , who were served in a public health service facility . METHODS the study was conducted at a known health unit located in the metropolitan region of the city of Porto Alegre , in Rio Gr and e do Sul , Brazil . Three hundred and fifteen pregnant women between the 10th and 29th week of gestation were r and omized to Control and Intervention Groups . The Intervention Group received dietary counseling according to nutritional status , and pregnant women in the Control Group were instructed to follow the routine of the health service facility . Weight and height were measured , and the body mass index ( BMI ) was calculated . The pre-gestational nutritional status was determined according to the following BMI criteria : low weight ( < 18.5 kg/m² ) , eutrophy ( 18.5 to 24.9 kg/m² ) , overweight ( 25.0 to 29.9 kg/m² ) , and obesity ( > 30 kg/m² ) . The nutritional status during pregnancy was determined according to the BMI curve for gestational age adopted by the Health Ministry of Brazil . Data were analyzed by the relative risk and respective 95 % confidence interval , and by the Student 's t-test and χ2 test . Statistical significance was set at p<0.05 . RESULTS the assessment of nutritional status before pregnancy showed that 28.0 % of the women were overweight and 4.1 % were underweight . In the first and last interview during pregnancy , the rates of prevalence of excessive weight were 36.2 and 46.0 % , respectively . The intervention proved to be effective in reducing the rate of weekly weight gain of pregnant women with excess weight ( 342.2 versus 420.2 ; p=0.015 ) and the prevalence of clinical complications ( 9.2 versus 24.85 ; p<0.001 ) . CONCLUSIONS dietary counseling was effective in decreasing the weight gain of pregnant women who were overweight and reducing clinical complications , such as gestational diabetes , preeclampsia , infant low weight , and prematurity in the Intervention Group Purpose Breast milk fatty acids possess immunomodulatory properties , and new intervention strategies beyond supplementation of maternal diet with single oils are called for . The objective of the present study was to evaluate the effect of dietary intervention during pregnancy and breastfeeding on breast milk fatty acid and cytokine composition . Methods Pregnant women were r and omised into three study groups : dietary intervention with probiotics ( diet/probiotic ) or with placebo ( diet/placebo ) and a control group ( control/placebo ) . Dietary intervention included dietary counselling and provision of rapeseed oil-based food products . The probiotics used were Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb12 in combination . Dietary intake was evaluated by food records at every trimester of pregnancy and 1 month postpartum . Breast milk sample s were collected after birth ( colostrum ) and 1 month after delivery for fatty acid and cytokine analysis ( n = 125 ) . Results Dietary intervention improved the quality of fat in the diet . In breast milk , the proportion of α-linolenic acid and total n-3 fatty acids was higher in both dietary intervention groups compared with control group ( p < 0.05 ) . In the diet/probiotic group , the γ-linolenic acid content was higher compared with the diet/placebo group ( p < 0.05 ) . The concentrations of TNF-α , IL-10 , IL-4 and IL-2 were higher in both dietary intervention groups compared with controls , and furthermore , long-chain n-3 fatty acids were associated with several cytokines in colostrum sample s. Conclusion The present intervention demonstrated the possibility of modifying breast milk immunomodulatory factors by dietary means Aims /hypothesisWe examined the associations between  pre-pregnancy dietary patterns  and the incidence of gestational diabetes mellitus ( GDM )  in a population -based cohort study of women of reproductive age . Methods The Australian Longitudinal Study on Women ’s Health included 3,853 women without pre-existing diabetes who were followed-up between 2003 and 2012 .  Pre-pregnancy dietary patterns were derived using factor analysis based on 101 food items from a vali date d food frequency question naire . GDM was self-reported and vali date d in a sub sample . Multivariable regression models with generalised estimating equations were used to estimate RR and 95 % CI . Results During 9 years follow-up , 292 GDM cases ( 4.4 % ) were documented in 6,626 pregnancies . No associations were found for the ‘ Fruit and low-fat dairy ’ and ‘ Cooked vegetables ’ patterns . The ‘ Meats , snacks and sweets ’ pattern was associated with higher GDM risk after adjustment for socioeconomic , reproductive and lifestyle factors ( RR [ 95 % CI ] per SD increase in score : 1.38 [ 1.02 , 1.86 ] ) . Further adjustment for BMI attenuated the results ( 1.35 [ 0.98 , 1.81 ] ) . In stratified analysis , the ‘ Meats , snacks and sweets ’ pattern was associated with significantly higher GDM risk in parous and obese women , and in women with lower educational qualifications . The ‘ Mediterranean-style ’ pattern was associated with lower GDM risk in the fully adjusted model ( 0.85 [ 0.76 , 0.98 ] ) . Conclusions /interpretationThese findings support general dietary recommendations for women of reproductive age to consume a diet rich in vegetables , whole grains , nuts and fish , and low in red and processed meats and snacks . Further prospect i ve studies are needed to confirm these findings BACKGROUND The optimal diet for pregnancy that is complicated by excessive weight is unknown . OBJECTIVE We aim ed to examine the effects of a low-glycemic load ( low-GL ) diet in overweight and obese pregnant women . DESIGN We r and omly assigned 46 overweight or obese pregnant women to receive a low-GL or a low-fat diet .  Participants received carbohydrate-rich foods , fats , and snack foods through home delivery or study visits . The primary outcome was birth weight z score . Other endpoints included infant anthropometric measurements , gestational duration , maternal weight gain , and maternal metabolic parameters . RESULTS There were no significant differences in birth weight z score or other measures of infant adiposity between groups . However , in the low-GL compared with the low-fat group , gestational duration was longer ( mean ± SD : 39.3 ± 1.1 compared with 37.9 ± 3.1 wk ; P = 0.05 ) and fewer deliveries occurred at ≤ 38.0 wk ( 13 % compared with 48 % , P = 0.02 ; with exclusion of planned cesarean deliveries : 5 % compared with 53 % ; P = 0.002 ) . Adjusted head circumference was greater in the low-GL group ( 35.0 ± 0.8 compared with 34.2 ± 1.3 cm , P = 0.01 ) . Women in the low-GL group had smaller increases in triglycerides [ median ( interquartile range ) : 49 ( 19 , 70 ) compared with 93 ( 34 , 129 ) mg/dL ; P = 0.03 ] and total cholesterol [ 13 ( 0 , 36 ) compared with 33 ( 22 , 56 ) mg/dL , P = 0.04 ] and a greater decrease in C-reactive protein [ -2.5 ( -5.5 , -0.7 ) compared with -0.4 ( -1.4 , 1.5 ) mg/dL , P = 0.007 ] . CONCLUSIONS A low-GL diet result ed in longer pregnancy duration , greater infant head circumference , and improved maternal cardiovascular risk factors . Large-scale studies are warranted to evaluate whether dietary intervention during pregnancy aim ed at lowering GL may be useful in the prevention of prematurity and other adverse maternal and infant outcomes . This trial is registered at clinical trials.gov as NCT00364403 OBJECTIVE : To estimate whether an organized , consistent program of dietary and lifestyle counseling prevents excessive weight gain  in pregnancy . METHODS : This r and omized controlled trial assigned women to receive either an organized , consistent program of intensive dietary and lifestyle counseling or routine prenatal care . The primary study outcome was the proportion of patients whose gestational weight gain was within the Institute of Medicine ( IOM ) guidelines . Secondary outcomes included mode of delivery , rate of operative vaginal delivery , neonatal weight , and the incidence of preeclampsia , gestational diabetes mellitus ( GDM ) , vaginal/perineal lacerations , and shoulder dystocia . RESULTS : A total of 100 women were r and omized to the study ( lifestyle counseling 57 , routine prenatal care 43 ) . Baseline demographic characteristics were similar between the study groups . The lifestyle counseling group gained significantly less weight than did the routine prenatal care group ( 28.7±12.5 lb compared with 35.6±15.5 lb , P=.01 ) . The routine prenatal care group had significantly more cesarean deliveries due to “ failure to progress ” ( routine prenatal care 58.3 % compared with lifestyle counseling 25.0 % , P=.02 ) . Across groups , patients who were not adherent to the IOM guidelines had significantly heavier neonates ( adherent 3,203.2±427.2 g compared with not adherent 3,517.4±572.4 g , P<.01 ) . Nulliparous women  gained significantly more weight than did parous women ( 36.5±14.5 lb compared with 27.7±12.7 lb , P<.01 ) . The most predictive factor of IOM adherence was having a normal prepregnancy body mass index . No statistically significant differences were noted between the groups in adherence to IOM guidelines , rate of cesarean delivery , preeclampsia , GDM , operative vaginal delivery , or vaginal lacerations . CONCLUSION : An organized , consistent program of dietary and lifestyle counseling did reduce weight gain in pregnancy . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00792480 LEVEL OF EVIDENCE : Background Preventing excessive weight gain during pregnancy is potentially important in the prevention of overweight and obesity among women of childbearing age . However , few intervention studies aim ing at weight management during pregnancy have been performed and most of these interventions were not as successful as expected . In this paper the design of the New Life(style ) study is described as well as the content of the individually tailored intervention program , which focuses on controlling weight development during pregnancy . Methods The effectiveness of the New Life(style ) intervention program versus usual care by midwives is evaluated in a r and omised controlled trial . Women who expect their first child and visit one of the participating midwifery practice s are included . The intervention is st and ardised in a protocol and executed by trained counsellors with the women who are r and omised in the intervention group . During 5 sessions – at 18 , 22 , 30 and 36 weeks of pregnancy and at 8 weeks postpartum – individual weight gain is discussed in relation to weight gain guidelines for pregnant women of the American Institute of Medicine . Counsellors coach the women to maintain or optimise a healthy lifestyle , in a period of drastic physical and mental changes . Data is collected at 15 , 25 , 35 weeks of pregnancy and at 6 , 26 , and 52 weeks after delivery . Primary outcome measures are body weight , BMI , and skinfold thickness . Secondary outcome measures include physical activity , nutrition and blood levels of factors that are associated with energy homeostasis . Discussion Results of the current RCT will improve the knowledge of determinants of weight gain during pregnancy , weight retention after childbirth and of the effectiveness of the intervention program that is described . Caregivers and research ers in the field of health promotion are offered more insight in specific elements of the New Life(style ) intervention program Abstract Objective : To test the hypothesis that dietary myo-inositol may improve insulin resistance and the development of gestational diabetes mellitus ( GDM ) in women at high risk of this disorder . Design : A prospect i ve , r and omized , double-blind , placebo controlled clinical trial , pilot study . Participants : Non-obese singleton pregnant women with an elevated fasting glucose in the first or early second trimester were studied throughout pregnancy . Intervention : Supplementation with myo-inositol or placebo during pregnancy . Main outcome measure : Development of GDM on a 75 g oral glucose tolerance test at 24–28 weeks ’ gestation . Secondary outcome measures were increased in BMI , need for maternal insulin therapy , macrosomia , polyhydramnios , neonatal birthweight and hypoglycemia . Results : Thirty-six women were allocated to receive myo-inositol and 39 placebo .  The incidence of GDM in mid-pregnancy was significantly reduced ( p = 0.001 ) in women r and omized to receive myo-inositol compared to placebo ( relative risk 0.127 ) . Women r and omized to receive myo-inositol also required less insulin therapy , delivered at a later gestational age , had significantly smaller babies with fewer episodes of neonatal hypoglycemia . Conclusions : Myo-inositol supplementation in pregnancy reduced the incidence of GDM in women at high risk of this disorder . The reduction in incidence of GDM in the treatment arm was accompanied by improved outcomes Background / Objective : Well-being has been linked to the quality of diet and lifestyle in adults ; however , there is a paucity of data in pregnancy . The aim of this study was to examine the relationship between well-being and socioeconomic status , diet and lifestyle during pregnancy and to consider the effect of intervention with low glycaemic index ( GI ) diet on well-being . Subjects/ Methods : This was a cohort analysis of 619 participants of the ROLO study ( R and omised cOntrol trial of LOw GI diet versus no dietary intervention to prevent recurrence of fetal macrosomia ) . The following data were collected : educational attainment , dietary intakes ( food frequency question naire ) , physical activity ( self-reported ) and well-being ( WHO-5-Item Wellbeing Index — expressed as a percentage ) . Results : Well-being was positively associated with education and physical activity . Third-level education was associated with a 3.07-point higher well-being percentage score , and each day that an individual achieved > 30 min walking per week was associated with a 1.10-point increase in percentage well-being score , Radj2 2.4 % ( F=7.260 , P=0.001 ) . The intervention low GI group had a significantly lower percentage well-being score than the usual diet group ( 56.3 % vs 59.9 % , P=0.015 ) . No correlation was noted between well-being and GI status calculated from food diaries ( P=0.469 ) . Well-being was not associated with micronutrient intake . Conclusions : Well-being in pregnancy was independently and positively associated with education and physical activity and negatively associated with low GI dietary intervention . These findings have significance not only for women at risk of low mood but also for healthcare professionals when counselling women about the importance of healthy lifestyle in pregnancy Background Maternal weight and maternal weight gain during pregnancy exert a significant influence on infant birth weight and the incidence of macrosomia . Fetal macrosomia is associated with an increase in both adverse obstetric and neonatal outcome , and also confers a future risk of childhood obesity . Studies have shown that a low glycaemic diet is associated with lower birth weights , however these studies have been small and not r and omised [ 1 , 2 ] . Fetal macrosomia recurs in a second pregnancy in one third of women , and maternal weight influences this recurrence risk [ 3 ] . Methods / Design We propose a r and omised control trial of low glycaemic index carbohydrate diet vs. no dietary intervention in the prevention of recurrence of fetal macrosomia .  Secundigravid women whose first baby was macrosomic , defined as a birth weight greater than 4000 g will be recruited at their first antenatal visit . Patients will be r and omised into two arms , a control arm which will receive no dietary intervention and a diet arm which will be commenced on a low glycaemic index diet . The primary outcome measure will be the mean birth weight centiles and ponderal indices in each group . Discussion Altering the source of maternal dietary carbohydrate may prove to be valuable in the management of pregnancies where there has been a history of fetal macrosomia . Fetal macrosomia recurs in a second pregnancy in one third of women . This r and omised control trial will investigate whether or not a low glycaemic index diet can affect this recurrence risk . Current Controlled Trials Registration NumberIS RCT OBJECTIVE A low – glycemic index diet is effective as a treatment for individuals with diabetes and has been shown to improve pregnancy outcomes when used from the first trimester . A low – glycemic index diet is commonly advised as treatment for women with gestational diabetes mellitus ( GDM ) . However , the efficacy of this advice and associated pregnancy outcomes have not been systematic ally examined . The purpose of this study was to determine whether prescribing a low – glycemic index diet for women with GDM could reduce the number of women requiring insulin without compromise of pregnancy outcomes . RESEARCH DESIGN AND METHODS All women with GDM seen over a 12-month period were considered for inclusion in the study . Women ( n = 63 ) were r and omly assigned to receive either a low – glycemic index diet or a conventional high-fiber ( and higher glycemic index ) diet . RESULTS Of the 31 women r and omly assigned to a low – glycemic index diet , 9 ( 29 % ) required insulin . Of the women r and omly assigned to a higher – glycemic index diet , a significantly higher proportion , 19 of 32 ( 59 % ) , met the criteria to commence insulin treatment ( P = 0.023 ) . However , 9 of these 19 women were able to avoid insulin use by changing to a low – glycemic index diet . Key obstetric and fetal outcomes were not significantly different . CONCLUSIONS Using a low – glycemic index diet for women with GDM effectively halved the number needing to use insulin , with no compromise of obstetric or fetal outcomes BACKGROUND The breast milk bioactive substances such as adiponectin , have a presumably long-term impact upon the health and well-being of a child . AIM To determine the impact of probiotic-supplemented dietary counseling during pregnancy on colostrum adiponectin concentration . STUDY DESIGN AND SUBJECTS Altogether 256 pregnant women were r and omized into three study groups : dietary intervention with probiotics ( diet/probiotics ) or with placebo ( diet/placebo ) and a control group ( control/placebo ) . The intervention group received dietary counseling provided by a nutritionist , the main focus being the amount and the type of dietary fat . The probiotics used were Lactobacillus rhamnosus GG and Bifidobacterium lactis in combination . Dietary intake was evaluated by food records at every trimester of pregnancy . Breast milk sample s were collected after birth ( colostrum ) for adiponectin concentration analysis ( n=181 ) . RESULTS The dietary intervention increased the colostrum adiponectin concentration ( ng/mL , geometric mean [ 95 % CI ] ) , the difference being significant when comparing to the control group ; 12.7 [ 10.6 - 29.7 ] vs. 10.2 [ 9.9 - 13.2 ] , P=0.024 . Maternal weight gain during pregnancy ( kg ) correlated inversely with colostrum adiponectin concentration ; β (SE)=-1.7 ( 0.1 ) , P=0.020 , and gestational diabetes mellitus was associated with the likelihood of adiponectin concentration falling into the lowest quartile ; OR 2.36 , 95 % CI 1.1 - 3.2 , P=0.028 . CONCLUSIONS In showing that the colostrum adiponectin concentration is markedly dependent on maternal diet and nutritional status during pregnancy , and considering that colostrum adiponectin has potential effects on metabolism , nutrition , and immune function in the neonates , the results of this study underscore the importance of the metabolic homeostasis of the mother for the child 's initial nutritional environment OBJECTIVE Consumption of sugar-sweetened beverages ( SSBs ) was related to an elevated risk of type 2 diabetes and insulin resistance in several recent studies among middle- or older-aged population s. Studies on SSB consumption and glucose intolerance among pregnant women , however , are lacking . We therefore examined the association between regular SSB consumption before pregnancy and the risk of gestational diabetes mellitus ( GDM ) . RESEARCH DESIGN AND METHODS This was a prospect i ve study among 13,475 U.S. women who reported at least one singleton pregnancy between 1992 and 2001 in the Nurses ' Health Study II . GDM was self-reported and vali date d by medical record review in a sub sample . Cox proportional hazards models with multivariate adjustments were applied to examine the association of SSB consumption with GDM risk . RESULTS During 10 years of follow-up , 860 incident GDM case subjects were identified . After adjustment for age , parity , race , physical activity , smoking , alcohol intake , prepregnancy BMI , and Western dietary pattern , intake of sugar-sweetened cola was positively associated with the risk of GDM , whereas no significant association was found for other SSBs and diet beverages . Compared with women who consumed < 1 serving/month , those who consumed ≥5 servings/week of sugar-sweetened cola had a 22 % greater GDM risk ( relative risk 1.22 [ 95 % CI 1.01–1.47 ] ) . CONCLUSIONS Findings from this study suggest that prepregnancy higher consumption of sugar-sweetened cola ( ≥5 servings/week ) is associated with an elevated GDM risk , whereas no significant association with GDM risk was observed for other SSBs and diet beverages Aims /hypothesisThe aim of this study was to prospect ively examine whether dietary patterns are related to risk of gestational diabetes mellitus ( GDM ) .  Methods This prospect i ve cohort study included 13,110 women who were free of cardiovascular disease , cancer , type 2 diabetes and history of GDM . Subjects completed a vali date d semi-quantitative food frequency question naire in 1991 , and reported at least one singleton pregnancy between 1992 and 1998 in the Nurses ’ Health Study II . Two major dietary patterns ( i.e. ‘ prudent ’ and ‘ Western ’ ) were identified through factor analysis . The prudent pattern was characterised by a high intake of fruit , green leafy vegetables , poultry and fish , whereas the Western pattern was characterised by high intake of red meat , processed meat , refined grain products , sweets , French fries and pizza . Results We documented 758 incident cases of GDM . After adjustment for age , parity , pre-pregnancy BMI and other covariates , the relative risk ( RR ) of GDM , comparing the highest with the lowest quintile of the Western pattern scores , was 1.63 ( 95 % CI 1.20–2.21 ; ptrend=0.001 ) , whereas the RR comparing the lowest with the highest quintile of the prudent pattern scores was 1.39 ( 95 % CI 1.08–1.80 ; ptrend=0.018 ) . The RR for each increment of one serving/day was 1.61 ( 95 % CI 1.25–2.07 ) for red meat and 1.64 ( 95 % CI 1.13–2.38 ) for processed meat . Conclusions /interpretationThese findings suggest that pre-pregnancy dietary patterns may affect women ’s risk of developing GDM . A diet high in red and processed meat was associated with a significantly elevated risk BACKGROUND Although obesity in pregnancy continues to be associated with ongoing health problems , many clinicians have been reluctant to place nondiabetic , obese , pregnant women on a monitored , calorie-appropriate nutritional regimen for fear of fetal growth restriction , low birth weight , or starvation ketosis . METHODS A total of 257 patients were enrolled in the r and omized study , with a loss-to-follow-up rate of 9.73 % . Patients were assigned r and omly to either the control ( unmonitored ) group ( n=116 ) , consisting of conventional prenatal dietary management , or to the study ( monitored ) group ( n=116 ) , which was prescribed a balanced nutritional regimen and were asked to record in a diary all of the foods eaten during each day .  Women were eligible for the study if they were pregnant with a single fetus between 12 and 28 weeks of gestation and had a prepregnancy body mass index of more than 30 kg/m2 . The primary outcome was to compare perinatal outcomes in the control vs the study groups . The secondary measure was to compare outcomes in adherent and nonadherent patients in the study group . RESULTS Omnibus MANOVA showed statistically significant differences between the study and control groups regarding 3 variables : ( 1 ) gestational hypertension , p < .46 ; ( 2 ) mother 's last weight before delivery , p < .001 ; and ( 3 ) mother 's 6-week postpartum weight , p < .001 . Patients gaining 15 pounds or more during their pregnancy showed statistically significant differences between the groups for 8 variables . CONCLUSION Obese pregnant women may be placed on a healthy , well-balanced , monitored nutritional program during their antepartum course without adverse perinatal outcomes Background Maternal diet is known to impact pregnancy outcome . Following a low glycemic index ( GI ) diet during pregnancy has been shown to improve maternal glycemia and reduce infant birthweight and may be associated with a higher fibre intake . We assessed the impact of a low GI dietary intervention on maternal GI , nutritional intake and gestational weight gain ( GWG ) during pregnancy . Compliance and acceptability of the low GI diet was also examined . Method Eight hundred women were r and omised in early pregnancy to receive low GI and healthy eating dietary advice or to receive st and ard maternity care .  The intervention group received dietary advice at a group education session before 22 weeks gestation . All women completed a 3 day food diary during each trimester of pregnancy . Two hundred and thirty five women from the intervention arm and 285 women from the control arm returned complete 3x3d FDs and were included in the present analysis . Results Maternal GI was significantly reduced in the intervention group at trimester 2 and 3 . The numbers of women within the lowest quartile of GI increased from 37 % in trimester 1 to 52 % in trimester 3 ( P < 0.001 ) among the intervention group . The intervention group had significantly lower energy intake ( P < 0.05 ) , higher protein ( % TE ) ( P < 0.01 ) and higher dietary fibre intake ( P < 0.01 ) post intervention . Consumption of food groups with known high GI values were significantly reduced among the intervention group . Women in the intervention low GI group were less likely to exceed the Institute of Medicine ’s GWG goals . Conclusion A dietary intervention in early pregnancy had a positive influence on maternal GI , food and nutrient intakes and GWG . Following a low GI diet may be particularly beneficial for women at risk of exceeding the GWG goals for pregnancy . Trial registration Current Controlled Trials Registration Number : IS RCT N54392969 The perinatal nutritional environment impacts upon the health and well-being of mother and child also in the long term . The aim of the present study was to determine the safety and efficacy of perinatal probiotic-supplemented dietary counselling by evaluating pregnancy outcome and fetal and infant growth during the 24 months ' follow-up . Altogether , 256 women were r and omised at their first trimester of pregnancy into a control and a dietary intervention group . The intervention group received intensive dietary counselling provided by a nutritionist and were further r and omised , double-blind to receive probiotics ( Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb12 ; diet/probiotics ) or placebo ( diet/placebo ) . Firstly , probiotic intervention reduced the frequency of gestational diabetes mellitus ( GDM ) ; 13 % ( diet/probiotics ) v. 36 % ( diet/placebo ) and 34 % ( control ) ; P = 0.003 . Secondly , the safety of this approach was attested by normal duration of pregnancies with no adverse events in mothers or children . No significant differences in prenatal or postnatal growth rates among the study groups were detected . Thirdly , distinctive effects of the two interventions were detected ; probiotic intervention reduced the risk of GDM and dietary intervention diminished the risk of larger birth size in affected cases ; P = 0.035 for birth weight and P = 0.028 for birth length . The results of the present study show that probiotic-supplemented perinatal dietary counselling could be a safe and cost-effective tool in addressing the metabolic epidemic . In view of the fact that birth size is a risk marker for later obesity , the present results are of significance for public health in demonstrating that this risk is modifiable Background / objectives : Owing to excess body weight and increased secretion of inflammatory cytokines primarily during the third trimester , pregnancy is associated with elevated insulin resistance . To our knowledge , no report is available indicating the effects of probiotic yoghurt consumption on serum insulin levels in pregnant women . This study was design ed to determine the effects of daily consumption of probiotic yoghurt on insulin resistance and serum insulin levels of Iranian pregnant women . Subjects/ methods : In this r and omized controlled clinical trial , 70 primigravida pregnant women with singleton pregnancy at their third trimester were participated . We r and omly assigned participants to consume 200 g per day of conventional ( n=33 ) or the probiotic group ( n=37 ) for 9 weeks . The probiotic yoghurt was a commercially available product prepared with the starter cultures of Streptococcus thermophilus and Lactobacillus bulgaricus , enriched with probiotic culture of two strains of lactobacilli ( Lactobacillus acidophilus LA5 ) and bifidobacteria ( Bifidobacterium animalis BB12 ) with a total of min 1 × 107 colony-forming units . Fasting blood sample s were taken at baseline and after 9-week intervention to measure fasting plasma glucose and serum insulin levels . Homeostatic model assessment of insulin resistance ( HOMA-IR ) was used to calculate insulin resistance score . Results : Although consumption of probiotic yogurt for 9 weeks did not affect serum insulin levels and HOMA-IR score , significant differences were found comparing changes in these variables between probiotic and conventional yogurts ( changes from baseline in serum insulin levels : + 1.2±1.2 vs + 5.0±1.1 μIU/ml , respectively , P=0.02 ; and in HOMA-IR score : −0.2±0.3 vs 0.7±0.2 , respectively , P=0.01 ) . Conclusions : It is concluded that in contrast to conventional yogurt , daily consumption of probiotic yogurt for 9 weeks maintains serum insulin levels and might help pregnant women prevent developing insulin resistance Objective Observational studies suggest that minimal gestational weight gain ( GWG ) may optimize pregnancy outcomes for obese women . This trial tested the efficacy of a group-based weight management intervention for limiting GWG among obese women . Methods We r and omized 114 obese women ( BMI [ mean±SD ] 36.7±4.9 kg/m2 ) between 7–21 weeks ’ ( 14.9±2.6 ) gestation to intervention  ( n=56 ) or usual care control conditions  ( n=58 ) . The intervention included individualized calorie goals , advice to maintain weight within 3 % of r and omization and follow the Dietary Approaches to Stop Hypertension dietary pattern without sodium restriction , and attendance at weekly group meetings until delivery . Control participants received one-time dietary advice . Our three main outcomes were maternal weight change from r and omization to 2 weeks postpartum and from r and omization to 34 weeks gestation , and newborn large-for-gestational age ( birth weight > 90th percentile , LGA ) . Results Intervention participants gained less weight from r and omization to 34 weeks gestation ( 5.0 vs 8.4 kg , mean difference=−3.4 kg , 95 % CI [ −5.1 , −1.8 ] ) , and from r and omization to 2 weeks postpartum ( −2.6 vs + 1.2 kg , mean difference=−3.8 kg , 95 % CI [ −5.9 , −1.7 ] ) . They also had a lower proportion of LGA babies ( 9 % vs. 26 % , odds ratio=0.28 , 95 % CI [ 0.09 , 0.84 ] ) . Conclusions The intervention result ed in lower GWG and lower prevalence of LGA newborns As part of a feasibility study to prevent gestational diabetes mellitus ( GDM ) , we evaluated the effect of an intensive dietary therapy on quality of diet , weight gain and birth weight in women at high risk of GDM . Women with risk factors for GDM ( n 54 ) were r and omly assigned from April 2005 to May 2006 to a  lifestyle intervention group ( n 27 ) including dietary advice six times during pregnancy or to a close follow-up group ( n 27 ) in a community-based setting in Finl and . Dietary intake was recorded three times during pregnancy using 4 d food records . The main outcome was the incidence of GDM . The secondary outcomes were the changes in nutrient intake , weight gain and birth weight . Overall , seventeen ( 65 % ) women in the intervention group and eighteen ( 69 % ) women in the close follow-up group returned all three food records . PUFA intake increased ( P = 0·008 ) during pregnancy in the intervention as compared to the close follow-up group . There were no clear differences in the changes of saturated fat or fibre intake between the groups . Intensive dietary education result ed in a somewhat lower weight gain during pregnancy ( P = 0·062 ) and higher birth weights of the infants ( P = 0·047 ) without an effect on macrosomia as compared to the close follow-up group . Individualised counselling by a clinical nutritionist as part of a lifestyle intervention improved the quality of dietary fat intake in pregnant women at high risk of GDM Outcomes in gestational diabetes Cochrane protocol s and review s before and after development of ‘ st and ard outcomes ’ by WOMBAT ( WOMen and Babies health and well‐being : Action through Trials ) were surveyed . An increase in ‘ common ’ outcomes ( those prespecified by ≥50 % of the protocol s and review s ) over time was observed ( 2001–2009 : 27 vs 2010–2014 : 46 ) . There were discrepancies in outcomes prespecified in review s and reported by r and omised trials . Efforts are needed to develop a core outcome set , to reduce research waste and improve health outcomes BACKGROUND Excessive weight gain during pregnancy is a risk factor for postpartum weight retention and future weight gain and obesity . Whether a behavioral intervention in pregnancy can reduce long-term weight retention is unknown . OBJECTIVE This r and omized trial tested whether a low-intensity behavioral intervention to prevent excessive gestational weight gain could increase the proportion of women who returned to prepregnancy weight by 12 mo postpartum . DESIGN Women ( n = 401 , 13.5 wk of gestation , 50 % normal weight , 50 % overweight/obese ) were r and omly assigned into an intervention or  control  group ; 79 % completed the 12-mo assessment . The telephone-based intervention targeted gestational weight gain , healthy eating , and exercise and was discontinued at delivery . RESULTS In modified intent-to-treat analyses that excluded women with miscarriages ( n = 6 ) , gestational diabetes ( n = 32 ) , or subsequent pregnancies ( n = 32 ) , the intervention had no significant effect on the odds of achieving prepregnancy weight at 12 mo postpartum ( n = 331 ; 35.4 % compared with 28.1 % ; P = 0.18 ) . Completer analyses suggested that the intervention tended to increase the percentages of women who reached prepregnancy weight ( n = 261 ; 45.3 % compared with 35.3 % ; P = 0.09 ) and significantly reduced the magnitude of mean ± SD postpartum weight retained ( 1.4 ± 6.3 compared with 3.0 ± 5.7 kg ; P = 0.046 ) at 12 mo . Women in the intervention group reported higher dietary restraint through 6 mo postpartum ( P = 0.023 ) and more frequent self-monitoring of body weight ( P < 0.02 for all ) throughout the study . CONCLUSIONS A low-intensity behavioral intervention in pregnancy can reduce 12-mo postpartum weight retention and improve dietary restraint and self-weighing in study completers . Future research is needed to test the long-term effects of more intensive behavioral interventions in pregnancy . This trial was registered at clinical trials.gov as NCT01117961 The present study is a secondary analysis of the ROLO study , a r and omised control trial of a low-glycaemic index ( GI ) diet in pregnancy to prevent the recurrence of fetal macrosomia . The objectives of the present study were to identify which women are most likely to respond to a low-GI dietary intervention in pregnancy with respect to three outcome measures : birth weight ; maternal glucose intolerance ; gestational weight gain ( GWG ) . In early pregnancy , 372 women had their mid-upper arm circumference recorded and BMI calculated . Concentrations of glucose , insulin and leptin were measured in early pregnancy and at 28 weeks . At delivery , infant birth weight was recorded and fetal glucose , C-peptide and leptin concentrations were measured in the cord blood . Women who benefited in terms of infant birth weight were shorter , with a lower education level . Those who maintained weight gain within the GWG guidelines were less overweight in both their first and second pregnancies , with no difference being observed in maternal height . Women who at 28 weeks of gestation developed glucose intolerance , despite the low-GI diet , had a higher BMI and higher glucose concentrations in early pregnancy with more insulin resistance . They also had significantly higher-interval pregnancy weight gain . For each analysis , women who responded to the intervention had lower leptin concentrations in early pregnancy than those who did not . These findings suggest that the maternal metabolic environment in early pregnancy is important in determining later risks of excessive weight gain and metabolic disturbance , whereas birth weight is mediated more by genetic factors . It highlights key areas , which warrant further interrogation before future pregnancy intervention studies , in particular , maternal education level and inter-pregnancy weight gain Aims /hypothesisFried foods are frequently consumed in Western countries . However , the health effects of frequent fried food consumption in humans are not well understood . We aim ed to prospect ively examine the association between pre-pregnancy  fried food consumption and risk of incident gestational diabetes mellitus ( GDM ) . Methods We included 21,079 singleton pregnancies from 15,027 women in the Nurses ' Health Study II cohort . Since 1991 and every 4 years thereafter , we collected diet information , including consumption of fried foods at home and away from home , using a vali date d food frequency question naire . We used generalised estimating equations with log-binomial models to estimate the RRs and 95 % CIs . Results We documented 847 incident GDM pregnancies during 10 years of follow-up . After adjustment for age , parity , dietary and non-dietary factors , the RRs ( 95 % CIs ) of GDM among women who consumed total fried foods 1–3 , 4–6 and ≥7 times/week , compared with those who consumed it less than once/week , were 1.13 ( 0.97 , 1.32 ) , 1.31 ( 1.08 , 1.59 ) and 2.18 ( 1.53 , 3.09 ) , respectively ( p for trend < 0.001 ) . The association persisted after further adjustment for BMI ( p for trend = 0.01 ) . When analysed separately , we found a significant association of GDM  with fried food consumption away from home , but not with fried food consumption at home . Conclusions /interpretationFrequent fried food consumption , particularly away from home , was significantly associated with a greater risk of incident GDM . Our study indicates potential benefits of limiting fried food consumption in the prevention of GDM in women of reproductive age BACKGROUND Obesity and excessive weight gain during pregnancy are associated with adverse pregnancy outcomes . Observational studies suggest that minimal or no gestational weight gain ( GWG ) may minimize the risk of adverse pregnancy outcomes for obese women . OBJECTIVE This report describes the design of Healthy Moms , a r and omized trial testing a weekly , group-based , weight management intervention design ed to help limit GWG to 3 % of weight ( measured at the time of r and omization ) among obese pregnant women ( BMI ≥30 kg/m(2 ) ) . Participants are r and omized at 10 - 20 weeks gestation to either the intervention or a single dietary advice control condition . PRIMARY OUTCOMES The study is powered for the primary outcome of total GWG , yielding a target sample size of 160 women . Additional secondary outcomes include weight change between r and omization and one-year postpartum and proportion of infants with birth weight>90th percentile for gestational age . Statistical analyses will be based on intention-to-treat . METHODS Following r and omization , all participants receive a 45-minute dietary consultation . They are encouraged to follow the Dietary Approaches to Stop Hypertension diet without sodium restriction . Intervention group participants receive an individualized calorie intake goal , a second individual counseling session and attend weekly group meetings until they give birth . Research staff assesses all participants at 34-weeks gestation and at 2-weeks and one-year postpartum with their infants . SUMMARY The Healthy Moms study is testing weight management techniques that have been used with non-pregnant adults . We aim to help obese women limit GWG to improve their long-term health and the health of their offspring Aim ing at preventing excessive weight gain during pregnancy , 10 specific dietary recommendations are given to pregnant women in the intervention arm of the Norwegian Fit for Delivery ( FFD ) study . This paper presents the rationale and test-retest reliability of the  food frequency question naire ( FFQ ) and a  dietary score  measuring adherence to the recommendations . The study is part of the ongoing FFD study , a r and omised , controlled , intervention study in nulliparous pregnant women . A 43-item FFQ was developed for the FFD study . A dietary score was constructed from 10 subscales corresponding to the 10 dietary recommendations . Adding the subscales yielded a score from 0 to 10 with increasing score indicating healthier dietary behaviour . The score was divided into tertiles , grouping participants into low , medium and high adherence to the dietary recommendations . Pregnant women attending ultrasound screening at about week 19 of pregnancy were asked to complete the FFQ twice , 2 weeks apart . Of 154 pregnant women completing the first question naire , 106 ( 69 % ) completed the form on both occasions and was included in the study . The test-retest correlations of the score and subscales were r = 0.68 and r = 0.56 - 0.84 , respectively ( both P ≤ 0.001 ) . There was 68 % test-retest correct classification of the score and 70 - 87 % of the subscales . In conclusion , acceptable test-retest reliability of the FFQ and the dietary score was found . The score will be used in the FFD study to measure adherence to the dietary recommendations throughout pregnancy and in the following year post-partum Leptin regulates energy homeostasis and immune and metabolic functions . Highly elevated leptin concentrations during pregnancy may be associated with aberrations in maternal metabolism and long-term health consequences both in women and children . The objective of the present study was to evaluate whether dietary counselling , probiotic supplementation , maternal characteristics or dietary intake during pregnancy has an impact on serum leptin concentrations in women , cord blood or in children . A total of 256 pregnant women were r and omised to a control group ( n 85 ) or to receive dietary counselling with probiotics ( n 85 ) or placebo ( n 86 ) . Dietary counselling aim ed at affecting the type of fat used and to increase the amount of fibre in the women 's diet . Women 's dietary intake and serum leptin concentrations were analysed at the first and third trimesters of pregnancy and at 1 month postpartum . Furthermore , leptin concentrations were measured from the cord blood and from children 's serum at 1 and 6 months of age . Weight status and dietary composition were the key determinants of leptin concentrations . Specifically , high dietary fibre and low SFA intakes were related to low serum leptin concentrations in women . Female sex and birth weight were associated with higher infant leptin , whereas cord blood leptin was additionally affected by maternal leptin concentration and protein intake . Probiotics or dietary counselling did not affect leptin concentrations . Weight control to recommended levels and modification of diet towards higher fibre and lower SFA intakes during pregnancy may through leptin concentrations provide health benefits to both women and children To explore the effect of maternal dietary intervention on infant essential fatty acid ( FA ) status , we conducted a prospect i ve , single-blind , r and omized nutrition intervention study . At the first trimester of pregnancy , 90 women from families with a history of allergy were r and omized either to receive intensive dietary counseling to modify dietary intake according to current recommendations or as controls . Infants ' cord and 1-mo isolated serum phospholipid FA were identified and quantified by GC . Detectable levels of eicosatrienoic acid [ ETA , 20:3(n-9 ) ] were taken as a biochemical marker for essential FA deficiency , and the DHA sufficiency index [ 22:6(n-3):22:5(n-6 ) ] and the DHA deficiency index [ 22:5(n-6):22:4(n-6 ) ] were taken as markers for DHA [ 22:6(n-3 ) ] status . The concentration of ETA was lower in cord blood in the intervention ( I ) group [ median 0.64 ( IQR 0.40 - 0.78 ) mg/L ; 2.09 ( 1.31 - 2.54 ) μmol/L ] than in the control ( C ) group [ 0.92 ( 0.54 - 1.20 ) mg/L ; 3.00 ( 1.76 - 3.92 ) μmol/L ] ( P = 0.048 ) . The proportion of ETA in total FA in the I group [ 0.73 % ( 0.48 - 0.85 % ) ] was lower than in the C group [ 0.93 % ( 0.78 - 1.22 % ) ] ( P = 0.003 ) . A higher DHA sufficiency index and lower DHA deficiency index were detected in cord blood in the I group than in the C group , although the groups did not differ in the DHA concentration or proportion of the total FA . There were no differences among groups at 1 mo for any of the variables measured . Our findings suggest a better supply of essential FA , particularly important during the period of rapid development , in infants whose mothers received dietary counseling . The results thus highlight the importance of maternal diet for child health , calling for dietary counseling for pregnant women in primary health care Background : Obesity in pregnancy is associated with fetal macrosomia , a raised neonatal fat mass and an increased risk of obesity and poor metabolic health in childhood which persists into adulthood . The offspring of obese women are more likely to be obese than the offspring of lean women when they become pregnant themselves , perpetuating a cycle of obesity and its associated negative metabolic consequences . Increasing physical activity during pregnancy could improve insulin sensitivity and reduce the risk of maternal and offspring adverse outcomes . The UK Pregnancy Better Eating and Activity Trial ( UPBEAT ) is a trial of a complex intervention design ed to improve pregnancy outcomes through dietary changes and physical activity .  Data from the pilot trial of 183 women were available for analysis . The relationship between the time spent at different physical activity levels and maternal and infant pregnancy outcomes was examined . Key Messages : Strong evidence exists that physical activity improves insulin sensitivity in non-pregnant population s , and lifestyle interventions of proven effectiveness in non-pregnant population s have been developed . Women who are active in pregnancy demonstrate better glucose control and favourable pregnancy outcomes . There is a lack of effective interventions to support obese pregnant women to be physically active . Conclusions : No difference was detected in objective ly measured physical activity between women r and omised to the intervention and control arms of the UPBEAT pilot trial . Light-intensity physical activity was lower in early pregnancy in women who delivered macrosomic infants . Maternal sedentary time at 35 - 36 weeks ' gestation was positively associated and moderate-intensity physical activity was inversely associated with neonatal abdominal circumference . Maternal physical activity is associated with infant birth weight and abdominal circumference and is an appropriate target for intervention to improve infant outcomes . The challenge remains to develop an effective intervention to support obese pregnant women to be physically active Background / Objectives : Gestational diabetes mellitus ( GDM ) is associated with negative health effects for mother and child . The aim was to investigate the association between maternal dietary patterns and GDM.Subjects/ Methods : Prospect i ve observational study including 168 pregnant women aged 18–40 years , recruited at routine 20-week ultrasound . All participants kept a 4-day weighed food record following recruitment ( commencement : gestational weeks 19–24 ) . Principal component analysis was used to extract dietary patterns from 29 food groups . A Healthy Eating Index ( HEI ) was constructed . All women underwent an oral glucose tolerance test in weeks 23–28 . Results : One clear dietary pattern ( Eigenvalue 2.4 ) was extracted with positive factor loadings for seafood ; eggs ; vegetables ; fruits and berries ; vegetable oils ; nuts and seeds ; pasta ; breakfast cereals ; and coffee , tea and cocoa powder , and negative factor loadings for soft drinks and French fries . This pattern was labeled a prudent dietary pattern . Explained variance was 8.2 % . The prevalence of GDM was 2.3 % among women of normal weight before pregnancy ( n=86 ) and 18.3 % among overweight/obese women ( n=82 ) . The prudent dietary pattern was associated with lower risk of GDM ( OR : 0.54 ; 95 % CI : 0.30 , 0.98 ) . When adjusting for age , parity , prepregnancy weight , energy intake , weekly weight gain and total metabolic equivalent of task the association remained ( OR : 0.36 ; 95 % CI : 0.14 , 0.94 ) . Similar results were found when only including overweight or obese women ( OR : 0.31 ; 95 % CI : 0.13 , 0.75 ) . Conclusions : Adhering to a prudent dietary pattern in pregnancy was clearly associated with lower risk of GDM , especially among women already at higher risk because of overweight/obesity before pregnancy Background .  Intervention fidelity  is an increasingly important method ological concept in process evaluations . In this article , the authors investigated the intervention fidelity in a r and omized controlled trial on excessive weight gain prevention in pregnancy . Method . A sample of 109 audiotaped counseling sessions , linked to 65 women in the intervention group of the New Life(style ) trial , was drawn . The following criteria were quantitatively evaluated using a fidelity checklist : ( a ) reach , ( b ) dose , ( c ) adherence to study objectives , ( d ) adherence to underlying problem-solving treatment ( PST ) theory , and ( e ) counselor competence . Results . A total of 60.4 % received all counseling sessions . The dose of intervention components was generally moderate ( 50.9 % to 60.4 % ) , and the dose of PST components was low ( 17.3 % ) . Adherence to study objectives was moderate ( 64.2 % ) and adherence to PST theory was low ( 43.2 % ) . The counselors sufficiently stimulated the participant to optimize lifestyle ( 54.2 % of the sessions ) , provided positive feedback ( 50.5 % ) , and left the initiative regarding problem solving to the participant ( 71 % ) . One of the two counselors performed significantly better on all measured criteria ( p < .001 ) . Conclusions . Intervention fidelity in the New Life(style ) trial was generally low to moderate . In future interventions , it is recommended to put more emphasis on counselor recruitment , training , and intervention protocol contents . Fellow research ers are encouraged to embed a process evaluation into all study stages , taking into account all essential process elements , and to link process outcomes to more distal , health outcomes Summary . The metabolic effects of three diets were investigated in a r and omized study in 15 non‐pregnant women and 14 pregnant women in the third trimester ; all the women were of normal weight . After 2‐week periods of habituation to each diet , metabolic profiles were performed on st and ardized intakes . Diet 1 contained 40 % of energy as carbohydrate and 10 g dietary fibre representing typical Western intakes . Diet 2 contained 40 % energy as carbohydrate and 52 g dietary fibre and diet 3 contained 60 % of energy as carbohydrate and 84 g dietary fibre , representing typical developing world intakes . No deterioration in glucose homeostasis in pregnancy was seen on any of the three diets in contrast to previous work . On diet 1 there was a loss of insulin sensitivity in pregnancy , but not on diets 2 and 3 . The loss of insulin sensitivity which is typical of Western women in the third trimester of pregnancy and is considered to be physiological , may be a diet‐induced artefact BACKGROUND Eating carbohydrate foods with a high glycemic index ( GI ) has been postulated to result in fetoplacental overgrowth and higher infant body fat . A diet with a low glycemic index ( LGI ) has been shown to reduce birth percentiles and the ponderal index ( PI ) . OBJECTIVES We investigated whether offering LGI dietary advice at the first antenatal visit would result in a lower fetal birth weight , birth percentile , and PI than providing healthy eating ( HE ) advice . This advice had to be presented within the re sources of routine antenatal care . DESIGN The Pregnancy and Glycemic Index Outcomes study was a 2-arm , parallel- design , r and omized , controlled trial that compared the effects of LGI dietary advice with HE advice on pregnancy outcomes . Eligible volunteers who attended for routine antenatal care at < 20 wk of gestation were r and omly assigned to either group . RESULTS A total of 691 women were enrolled , and 576 women had final data considered . In the LGI group , the GI was reduced from a mean ( ± SEM ) of 56 ± 0.3 at enrollment to 52 ± 0.3 ( P < 0.001 ) at the final assessment . There were no significant differences in primary outcomes of fetal birth weight , birth percentile , or PI . In a multivariate regression analysis , the glycemic load was the only significant dietary predictor ( P = 0.046 ) of primary outcomes but explained < 1 % of all variation . CONCLUSION A low-intensity dietary intervention with an LGI diet compared with an HE diet in pregnancy did not result in any significant differences in birth weight , fetal percentile , or PI The aim of this study was to assess the impact of dietary counselling combined with the provision of food products on food and nutrient intake in pregnant women . We carried out a prospect i ve cohort study of healthy and atopic pregnant women ( n 209 ) , who were r and omized into dietary intervention and control groups . The intervention group received dietary counselling and food products to modify the fat composition of their diet to meet current recommendations . Three-day food records were collected during each trimester of pregnancy . Women in the intervention group consumed more vegetables , fruits , soft margarines and vegetable oils and less butter than those in the control group during the course of pregnancy ( P<0.05 ) . The main distinction between the groups in nutrient intake over the pregnancy was attributable to a higher energy intake ( % energy ) of PUFA by 0.5%energy ( 95 % CI 0.1 , 0.8 ) and to a lower intake of SFA by 0.8 % energy ( 95 % CI -1.4 , -0.4 ) in the intervention group . Dietary intake of vitamin E was 1.4 mg ( 95 % CI 0.6 , 2.2 ) , folate 20.9 microg ( 95 % CI 0.8 , 41.0 ) and ascorbic acid 19.8 mg ( 95 % CI 3.5 , 36.0 ) higher in the intervention group compared to the controls , while no differences in other nutrients were detected . Dietary counselling combined with the provision of food products during pregnancy is of importance in modifying food and nutrient intake , with potential health benefits BACKGROUND Despite normal gestational weight gain , dietary studies in pregnant women show intakes below the recommendations for energy and micronutrients . OBJECTIVE This study compared changes in dietary intake from the second to third trimester with emphasis on energy intake and carbohydrate quality . DESIGN These post hoc analyses were based on 566 women participating in the Pregnancy and Glycemic Index Outcomes study , a r and omized controlled trial comparing the effect of low-glycemic index ( GI ) dietary advice with healthy eating advice on selected pregnancy outcomes . With the use of multilevel mixed-regression analysis , changes in total energy intake , starch , sugar , fiber intake , GI , and glycemic load ( GL ) were correlated with intake of different micronutrients . RESULTS Energy intake decreased in the third trimester , and most women did not meet the national recommended amounts for iron , folate , and dietary fiber from food sources alone . After adjustment for age , ethnicity , prepregnancy body mass index , and intervention group , change in energy intake was positively related to change in intake of all micronutrients ( P < 0.001 ) . GI , GL , and starch intake were inversely related to micronutrient intake ( P < 0.001 ) , whereas higher total sugars predicted higher intake ( P < 0.001 ) . Associations with dietary fiber were inconsistent . CONCLUSIONS Normal pregnancy can be associated with a decline in energy and micronutrient intake from diet . Low dietary GI and GL were the best predictors of a favorable micronutrient profile . This trial was registered at www.anzctr.org.au as ACTRN12610000174088 The incidence of gestational diabetes mellitus ( GDM ) is increasing and GDM might be prevented by improving diet . Few interventions have assessed the effects of dietary counselling on dietary intake of pregnant women . This study examined the effects of dietary counselling  on food habits and dietary intake of Finnish pregnant women as secondary outcomes of a trial primarily aim ing at preventing GDM . A cluster-r and omized controlled trial was conducted in 14 municipalities in Finl and , including 399 pregnant women at increased risk for developing GDM . The intervention consisted of dietary counselling focusing on dietary fat , fibre and saccharose intake at four routine maternity clinic visits . Usual counselling practice s were continued in the usual care municipalities . A vali date d 181-item food frequency question naire was used to assess changes in diet from baseline to 26 - 28 and 36 - 37 weeks gestation . The data were analysed using multilevel mixed-effects linear regression models . By 36 - 37 weeks gestation , the intervention had beneficial effects on total intake of vegetables , fruits and berries ( coefficient for between-group difference in change 61.6 g day(-1 ) , 95 % confidence interval 25.7 - 97.6 ) , the proportions of high-fibre bread of all bread ( 7.2 % units , 2.5 - 11.9 ) , low-fat cheeses of all cheeses ( 10.7 % units , 2.6 - 18.9 ) and vegetable fats of all dietary fats ( 6.1 % -units , 2.0 - 10.3 ) , and the intake of saturated fatty acids ( -0.67 energy-%-units , -1.16 to -0.19 ) , polyunsaturated fatty acids ( 0.38 energy-%-units , 0.18 - 0.58 ) , linoleic acid ( 764 mg day(-1 ) , 173 - 1354 ) and fibre ( 2.07 g day(-1 ) , 0.39 - 3.75 ) . The intervention improved diet towards the recommendations in pregnant women at increased risk for GDM suggesting the counselling methods could be implemented in maternity care OBJECTIVE Our purpose was to assess to what extent disturbances in antepartum maternal metabolism and perinatal complications and morbidities contribute to poorer psychomotor development in offspring of diabetic mothers . STUDY DESIGN One hundred ninety-six pregnant women and their singleton offspring participated in this prospect i ve cohort-analytic study . Ninety-five women had pregestational diabetes mellitus , and 101 women had gestational diabetes mellitus . Serial estimates of circulating maternal fuels were obtained throughout each index pregnancy along with detailed records of the perinatal course and outcome . Offspring were administered the psychomotor development index of the Bayley Scales of Infant Development at age 2 years and the  Bruininks-Oseretsky Test Of Motor Proficiency at ages 6 , 8 , and 9 years . Tests were performed blinded to the mother 's antepartum metabolic status , and perinatal history , and the child 's previous test scores . Partial correlations and analyses of covariance were used to control for other influences and confounds , such as family socioeconomic status , racial or ethnic origin , patient group ( i.e. , pregestational or gestational diabetes mellitus ) , and sex of child . RESULTS Children 's average score on the Bruininks-Oseretsky test at ages 6 to 9 years correlated significantly with maternal second ( p < 0.02 ) and third trimester ( p < 0.001 ) beta-hydroxybutyrate . There was also a borderline association between the children 's scores on the psychomotor development index at age 2 years and maternal third-trimester beta-hydroxybutyrate levels ( p = 0.06 ) . No other correlations approached significance . CONCLUSIONS Intrauterine metabolic experiences continue to influence the neurodevelopmental course in offspring of diabetic mothers . Prevailing practice s in diabetes management and obstetric and neonatal care appear to effectively mitigate the potential long-term effects of most perinatal complications and morbidities . Management and obstetric and neonatal care appear to effectively miltigate the potential long-term effects of most perinatal complications and morbidities BACKGROUND Low-carbohydrate diets ( LCDs ) have been vastly popular for weight loss . The association between a low-carbohydrate dietary pattern and risk of  gestational diabetes mellitus ( GDM )  remains unknown . OBJECTIVE We aim ed to prospect ively examine the association of 3  prepregnancy low-carbohydrate dietary patterns with risk of GDM . DESIGN We included 21,411 singleton pregnancies in the Nurses ' Health Study II . Prepregnancy LCD scores were calculated from vali date d food-frequency question naires , including an overall LCD score on the basis of intakes of carbohydrate , total protein , and total fat ; an animal LCD score on the basis of intakes of carbohydrate , animal protein , and animal fat ; and a vegetable LCD score on the basis of intakes of carbohydrate , vegetable protein , and vegetable fat . A higher score reflected a higher intake of fat and protein and a lower intake of carbohydrate , and it indicated closer adherence to a low-carbohydrate dietary pattern . RRs and 95 % CIs were estimated by using generalized estimating equations with log-binomial models . RESULTS We documented 867 incident GDM pregnancies during 10 y follow-up . Multivariable-adjusted RRs ( 95 % CIs ) of GDM for comparisons of highest with lowest quartiles were 1.27 ( 1.06 , 1.51 ) for the overall LCD score ( P-trend = 0.03 ) , 1.36 ( 1.13 , 1.64 ) for the animal LCD score ( P-trend = 0.003 ) , and 0.84 ( 0.69 , 1.03 ) for the vegetable LCD score ( P-trend = 0.08 ) . Associations between LCD scores and GDM risk were not significantly modified by age , parity , family history of diabetes , physical activity , or overweight status . CONCLUSIONS A prepregnancy low-carbohydrate dietary pattern with high protein and fat from animal-food sources is positively associated with GDM risk , whereas a prepregnancy low-carbohydrate dietary pattern with high protein and fat from vegetable food sources is not associated with the risk . Women of reproductive age who follow a low-carbohydrate dietary pattern may consider consuming vegetable rather than animal sources of protein and fat to minimize their risk of GDM Summary Non-obese women in the second half of pregnancy were r and omised into a control group receiving st and ard dietary advice and a group advised to make high fibre whole-food substitutions in their diets at every opportunity . Glucose and insulin profiles were performed over 24-h periods at 29 and 35 weeks gestation when the diets were equivalent in available carbohydrate , protein and fat , but the control group ingested 12.4 g dietary fibre/24 h and the high fibre group 51.4g/24h . Glucose homeostasis was similar in both groups but there was a significant attenuation of post-pr and ial insulin secretion in the high fibre group . It is suggested that the characteristic post-pr and ial peaks of plasma insulin observed in Western pregnant women are an unphysiological response to dietary fibre depletion Abstract We aim ed to explore whether maternal dietary counseling to increase the intake of unsaturated fatty acids ( FA ) is reflected in infant FA status . Serum cholesteryl ester ( CE ) and triacylglycerol ( TAG ) FA were analyzed from infants of 45 women r and omized to receive dietary counseling from the first trimester of pregnancy and 45 control women . Counseling result ed in a higher intake of polyunsaturated FA and a lower intake of saturated FA . The dietary intake was reflected in cord blood TAGs : the n−6 to n−3 FA ratio was lower [ mean difference −0.50 ( 95%CI −0.95 to −0.06 ) ] and the sum of n−3 FA was higher in the intervention than in the control group [ 1.46 ( 0.44 to 2.48)% of total FA ] . Reasons for the lack of changes in the cord blood CE fraction and FA fractions at 1-month remain unclear , but may indicate that the changes achieved in the maternal diet through counseling were too modest BACKGROUND There is uncertainty regarding the efficacy of increasing n-3 long-chain PUFA ( LCPUFA ) intake during pregnancy in reducing the risk of  gestational diabetes mellitus ( GDM ) and preeclampsia .  OBJECTIVES The objective was to determine whether n-3 LCPUFA supplementation in pregnancy reduces the incidence of GDM or preeclampsia . A secondary objective was to assess the effect of n-3 LCPUFA supplementation on perinatal complications . DESIGN This was a double-blind , multicenter r and omized control trial-the DHA to Optimize Mother Infant Outcome ( DOMInO ) trial . Pregnant women ( n = 2399 ) of < 21 wk gestation were r and omly assigned to receive DHA-enriched fish oil ( 800 mg/d ) or vegetable oil capsules without DHA from trial entry to birth . The presence of GDM or preeclampsia was assessed through a blinded audit of medical records . Birth outcomes and prenatal complications were also assessed . RESULTS The overall incidences of GDM and preeclampsia were 8 % and 5 % , respectively , based on clinical diagnosis . The RR of GDM was 0.97 ( 95 % CI : 0.74 , 1.27 ) and of preeclampsia was 0.87 ( 95 % CI : 0.60 , 1.25 ) , and they did not differ significantly between the groups . Birth weight , length , and head circumference z scores also did not differ between the groups . There were 12 perinatal deaths and 5 neonatal convulsions in the control group compared with 3 perinatal deaths and no neonatal convulsions in the DHA group ( P = 0.03 in both cases ) . CONCLUSION DHA supplementation of 800 mg/d in the second half of pregnancy does not reduce the risk of GDM or preeclampsia . Whether supplementation reduces the risk of perinatal death and neonatal convulsions requires further investigation . The DOMInO trial was registered with the Australian New Zeal and Clinical Trials Registry as TRN12605000569606 Background Annual prevalence of gestational diabetes mellitus ( GDM ) is 12.5 % among Finnish pregnant women . The prevalence is expected to rise with the increasing overweight among women before pregnancy .  Physical activity and diet are both known to have favourable effects on insulin resistance and possibly on the risk of GDM . We aim ed to investigate , whether GDM can be prevented by counseling on diet , physical activity and gestational weight gain during pregnancy . Methods / Design A cluster-r and omized controlled trial was conducted in 14 municipalities in the southern part of Finl and . Pairwise r and omization was performed in order to take into account socioeconomic differences . Recruited women were at 8 - 12 weeks ' gestation and fulfilled at least one of the following criteria : body mass index ≥ 25 kg/m2 , history of earlier gestational glucose intolerance or macrosomic newborn ( > 4500 g ) , age ≥ 40 years , first or second degree relative with history of type 1 or 2 diabetes . Main exclusion criterion was pathological oral glucose tolerance test ( OGTT ) at 8 - 12 weeks ' gestation . The trial included one counseling session on physical activity at 8 - 12 weeks ' gestation and one for diet at 16 - 18 weeks ' gestation , and three to four booster sessions during other routine visits . In the control clinics women received usual care . Information on height , weight gain and other gestational factors was obtained from maternity cards . Physical activity , dietary intake and quality of life  were followed by question naires during pregnancy and at 1-year postpartum . Blood sample s for lipid status , hormones , insulin and OGTT were taken at 8 - 12 and 26 - 28 weeks ' gestation and 1 year postpartum . Workability and return to work were elicited by a question naire at 1- year postpartum . Linkage to the national birth register of years 2007 - 2009 will provide information on perinatal complications and GDM incidence among the non- participants of the study . Cost-effectiveness evaluation will be based on quality -adjusted life years . This study has received ethical approval from the Ethical board of Pirkanmaa Hospital District . Discussion The study will provide information on the effectiveness and cost-effectiveness  of gestational physical activity and dietary counseling on prevention of GDM in a risk group of women . Also information on the prevalence of GDM and postpartum metabolic syndrome will be gained . Results on maintaining the possible health behaviour changes are important in order to prevent chronic diseases such as cardiovascular disease and diabetes . Trial registration The trial is registered IS RCT N OBJECTIVE Large for gestational age infants are at increased risk of childhood obesity and maternal nutrition impacts birthweight . The aim of this study was to assess the impact of a maternal low glycaemic index ( GI ) diet on neonatal anthropometry . METHODS The ROLO ( R and omised Control Trial of Low Glycaemic Index Diet in Pregnancy ) study was a r and omized controlled trial to assess the impact of a low GI diet versus usual diet on birthweight . It took place in a tertiary maternity hospital in Irel and and women were r and omized to receive either a low GI diet or no dietary intervention from early pregnancy to term . Two hundred sixty-five neonates had anthropometric measurements  on day 1 - 2 of life , 126 in the intervention group and 139 in the control group . Measurements included birthweight , length and circumferences of the head , chest , abdominal , thigh and mid-upper arm . A subgroup of 219 ( 82 % ) neonates also had skin-fold measurements . RESULTS Neonates whose mothers had a low GI diet in pregnancy had lower thigh circumference ( 15.9 ± 1.7 cm vs. 16.6 ± 1.5 cm , P = 0.04 ) . There was no difference between the intervention and control groups in head , chest abdominal or mid-upper arm circumferences . No difference was noted between the two groups for any skin-fold measurements ( subscapular , thigh , biceps and triceps ) . CONCLUSION Neonatal thigh circumference was altered by maternal low GI diet in pregnancy . These findings suggest that maternal low GI diet is safe in pregnancy and may positively impact infant adiposity OBJECTIVE To investigate the relationship between gestational diabetes mellitus ( GDM ) and the usual intake of fatty acids and indices of dietary fat quality [ the atherogenicity ( AI ) and thrombogenicity indices ( TI ) , and the ratios of hypo- and hypercholesterolemic ( hH ) , ∑n-3/∑n-6 , and polyunsaturated/saturated fatty acids ( P : S ) ] , during mid-pregnancy . METHODS 799 adult pregnant women living in Ribeirão Preto , SP , Brazil were screened and accepted for this cross-sectional GDM study . The Multiple Source Method was used to estimate participants ' usual diet , using two 24-hour dietary recalls during mid-pregnancy . Diagnosis of GDM was defined by the American Diabetes Association criteria of 2015 . Logistic regression analysis were used to assess the association between GDM and dietary fat , adjusted for age , education , parity , gestational age at the time of the interview , pre-pregnancy and current BMI , prior GDM , family history of diabetes , smoking , physical activity , energy , fiber , and fatty acids . RESULTS The mean ( st and ard deviation ) age of the women was 28 ( 5 ) years , and 19 % had GDM . After multiple adjustments , inverse associations between the highest tertile of ∑n-3 fatty acids intake [ 0.21 ( 0.08 - 0.56 ) ] ,  α-linolenic intake [ 0.15 ( 0.05 - 0.42 ) ] , and GDM were found . A positive association between GDM and the highest tertile of TI [ 2.66 ( 1.34 - 5.29 ) ] , and a negative association with the highest tertile of hH ratio [ 0.41 ( 0.22 - 0.77 ) ] , were observed . No association between GDM and other indices of dietary fat quality were found . CONCLUSION The quality of dietary fat during pregnancy is strongly associated with GDM . R and omized clinical trial are needed to confirm these findings In a cluster-r and omized trial , Riitta Luoto and colleagues find that counseling on diet and activity can reduce the birthweight of babies born to women at risk of developing  gestational diabetes mellitus ( GDM  ) , but fail to find an effect on GDM BACKGROUND Excessive weight gain during pregnancy is a major risk factor for  postpartum weight retention and future weight gain and obesity in women , but few adequately powered r and omized controlled trials have examined the efficacy of a behavioral weight-control intervention during pregnancy . OBJECTIVE This study examined whether a behavioral intervention during pregnancy could decrease the proportion of women who exceeded the 1990 Institute of Medicine ( IOM ) recommendations for gestational weight gains and increase the proportion of women who returned to pregravid weights by 6 mo postpartum . DESIGN This study was a r and omized , assessor-blind , controlled trial . Participants were pregnant ( 13.5 wk gestation ) , normal-weight ( NW ; n = 201 ) and overweight or obese ( OW/OB ; n = 200 ) women whose average age was 28.8 y. Participants were r and omly assigned within the 1990 IOM weight category ( NW compared with OW/OB ) to st and ard care ( n = 200 ) or to a behavioral intervention to prevent excessive gestational weight gain ( n = 201 ) . The intervention included one face-to-face visit ; weekly mailed material s that promoted an appropriate weight gain , healthy eating , and exercise ; individual graphs of weight gain ; and telephone-based feedback . The retention at the 6-mo postpartum assessment was 82 % . RESULTS Intent-to-treat analyses showed that the intervention , compared with st and ard care , decreased the percentage of NW women who exceeded IOM recommendations ( 40.2 % compared with 52.1 % ; P = 0.003 ) and increased the percentages of NW and OW/OB women who returned to their pregravid weights or below by 6 mo postpartum ( 30.7 % compared with 18.7 % ; P = 0.005 ) . CONCLUSION A low-intensity behavioral intervention during pregnancy reduced excessive gestational weight gains in NW women and prevented postpartum weight retention in NW and OW/OB women . This trial was registered at clinical trials.gov as NCT01117961
BACKGROUND Gestational diabetes mellitus ( GDM ) is a form of diabetes occurring during pregnancy which can result in short- and long-term adverse outcomes for women and babies .
With an increasing prevalence worldwide , there is a need to assess strategies , including dietary advice interventions , that might prevent GDM .
OBJECTIVES To assess the effects of dietary advice interventions for preventing GDM and associated adverse health outcomes for women and their babies .