The effects of antenatal dietary and lifestyle advice for women who are overweight or obese on maternal diet and physical activity: the LIMIT randomised trial Limiting weight gain in overweight and obese women during pregnancy to improve health outcomes: the LIMIT randomised controlled trial Primary prevention of gestational diabetes for women who are overweight and obese: a randomised controlled trial Lifestyle intervention for gestational diabetes mellitus prevention: A cluster-randomized controlled study Health care costs associated with gestational diabetes mellitus among high-risk women – results from a randomised trial Anthropometrics and Body Composition by Dual Energy X-Ray in Children of Obese Women: A Follow-Up of a Randomized Controlled Trial (the Lifestyle in Pregnancy and Offspring [LiPO] Study) Lifestyle counseling during pregnancy and offspring weight development until four years of age: follow-up study of a controlled trial Preventing Obesity in the Military Community (POMC): The Development of a Clinical Trials Research Network Feasibility of a lifestyle intervention in early pregnancy to prevent deterioration of glucose tolerance Protocol for a randomized controlled trial of a specialized health coaching intervention to prevent excessive gestational weight gain and postpartum weight retention in women: the HIPP study 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 NUTRITIONAL STATUS OF CHILDREN ADMITTED FOR DIARRHOEAL DISEASES IN A REFERRAL HOSPITAL IN WESTERN KENYA. The effects of antenatal dietary and lifestyle advice for women who are overweight or obese on neonatal health outcomes: the LIMIT randomised trial Effect of lifestyle interventions of pregnant women on their dietary habits, lifestyle behaviors, and weight gain: a randomized controlled trial Postpartum Weight Retention is Associated with Elevated Ratio of Oxidized LDL Lipids to HDL-Cholesterol The effect of dietary counselling on food intakes in pregnant women at risk for gestational diabetes: a secondary analysis of a randomised controlled trial RADIEL Physical activity and gestational diabetes mellitus among Hispanic women. Safety and efficacy of a lifestyle intervention for pregnant women to prevent excessive maternal weight gain: a cluster-randomized controlled trial 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 Prevention of gestational diabetes through lifestyle intervention: study design and methods of a Finnish randomized controlled multicenter trial (RADIEL) Study protocol: fit for delivery - can a lifestyle intervention in pregnancy result in measurable health benefits for mothers and newborns? A randomized controlled trial Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. Optimizing healthy gestational weight gain in women at high risk of gestational diabetes: a randomized controlled 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 The effect of a personalized intervention on weight gain and physical activity among pregnant women in China. Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. Lifestyle intervention on diet and exercise reduced excessive gestational weight gain in pregnant women under a randomised controlled trial Nutrition and exercise reduce excessive weight gain in normal-weight pregnant women. Limiting postpartum weight retention through early antenatal intervention: the HeLP-her randomised controlled trial Preventing Excessive Weight Gain During Pregnancy Through Dietary and Lifestyle Counseling: A Randomized Controlled Trial Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. Design of the New Life(style) study: a randomised controlled trial to optimise maternal weight development during pregnancy. [ISRCTN85313483] Dietary and Lifestyle Advice for Pregnant Women Who Are Overweight or Obese: The LIMIT Randomized Trial Effectiveness of a normative nutrition intervention (diet, physical activity and breastfeeding) on maternal nutrition and offspring growth: the Chilean maternal and infant nutrition cohort study (CHiMINCs) Effect of the Healthy MOMs Lifestyle Intervention on Reducing Depressive Symptoms Among Pregnant Latinas Effects of an antenatal dietary intervention on maternal anthropometric measures in pregnant women with obesity A randomised control trial of low glycaemic index carbohydrate diet versus no dietary intervention in the prevention of recurrence of macrosomia Physical Activity During Pregnancy: Predictors of Change, Perceived Support and Barriers Among Women at Increased Risk of Gestational Diabetes Introduction of IADPSG Criteria for the Screening and Diagnosis of Gestational Diabetes Mellitus Results in Improved Pregnancy Outcomes at a Lower Cost in a Large Cohort of Pregnant Women: The St. Carlos Gestational Diabetes Study Lifestyle intervention to prevent excessive maternal weight gain: mother and infant follow-up at 12 months postpartum Results From a European Multicenter Randomized Trial of Physical Activity and/or Healthy Eating to Reduce the Risk of Gestational Diabetes Mellitus: The DALI Lifestyle Pilot Pre-Pregnancy Fast Food Consumption Is Associated with Gestational Diabetes Mellitus among Tehranian Women DALI: Vitamin D and lifestyle intervention for gestational diabetes mellitus (GDM) prevention: an European multicentre, randomised trial – study protocol Pragmatic cluster randomised trial of a free telephone-based health coaching program to support women in managing weight gain during pregnancy: the Get Healthy in Pregnancy Trial The IDEAL study: investigation of dietary advice and lifestyle for women with borderline gestational diabetes: a randomised controlled trial - study protocol Assessing use of a printed lifestyle intervention tool by women with borderline gestational diabetes and their achievement of diet and exercise goals: a descriptive study Use of a DVD to provide dietary and lifestyle information to pregnant women who are overweight or obese: a nested randomised trial Healthy living in pregnancy: a cluster-randomized controlled trial to prevent excessive gestational weight gain - rationale and design of the GeliS study Preventing excessive gestational weight gain among African American 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 Proyecto Mamá: a lifestyle intervention in overweight and obese Hispanic women: a randomised controlled trial – study protocol Determinants of Pregnant Women’s Online Self-Regulatory Activities for Appropriate Gestational Weight Gain Effects of lifestyle intervention on dietary intake, physical activity level, and gestational weight gain in pregnant women with different pre-pregnancy Body Mass Index in a randomized control trial Cost-Effectiveness of Lifestyle Counselling as Primary Prevention of Gestational Diabetes Mellitus: Findings from a Cluster-Randomised Trial Physical activity counseling in maternity and child health care – a controlled trial Infant adiposity following a randomised controlled trial of a behavioural intervention in obese pregnancy A pregnancy lifestyle intervention to prevent gestational diabetes risk factors in overweight Hispanic women: a feasibility randomized controlled trial. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. Does behavioral intervention in pregnancy reduce postpartum weight retention? Twelve-month outcomes of the Fit for Delivery randomized trial. Randomized controlled trial to prevent excessive weight gain in pregnant women Healthy Moms, a randomized trial to promote and evaluate weight maintenance among obese pregnant women: study design and rationale. Mediators and Moderators of the Effectiveness of a Community Health Worker Intervention That Improved Dietary Outcomes in Pregnant Latino Women The design of maternal centered life-style modification program for weight gain management during pregnancy — a study protocol Association between Physical Activity in Obese Pregnant Women and Pregnancy Outcomes: The UPBEAT Pilot Study Design of lifestyle intervention trials to prevent excessive gestational weight gain in women with overweight or obesity. Physical Activity and Health-Related Quality of Life During Pregnancy: A Secondary Analysis of a Cluster-Randomised Trial From Theory to Practice Women's behaviour, beliefs and information sources about physical exercise in pregnancy. Health coaching to prevent excessive gestational weight gain: A randomized-controlled trial. Effects of maternal lifestyle intervention during pregnancy on untreated partner weight: Results from fit for delivery study. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study Gestational Diabetes Mellitus Can Be Prevented by Lifestyle Intervention: The Finnish Gestational Diabetes Prevention Study (RADIEL) Who are we missing? Examining non-participants in "Fit for Delivery", a randomized, controlled trial of a lifestyle intervention in pregnancy. How effective is self‐weighing in the setting of a lifestyle intervention to reduce gestational weight gain and postpartum weight retention? Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. 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. Effect of a diet intervention during pregnancy on dietary behavior in the randomized controlled Norwegian Fit for Delivery study. The effects of mindfulness eating and yoga exercise on blood sugar levels of pregnant women with gestational diabetes mellitus. Interaction between rs10830963 polymorphism in MTNR1B and lifestyle intervention on occurrence of gestational diabetes Continuing regular exercise during pregnancy: effect of exercise volume on fetoplacental growth. Pregnancy, exercise and nutrition research study with smart phone app support (Pears): Study protocol of a randomized controlled trial. Prevention of Gestational Diabetes: Design of a Cluster-Randomized Controlled Trial and One-Year Follow-Up Maternal body size prior to pregnancy, gestational diabetes and weight gain: associations with insulin resistance in children at 9-10 years. Simple lifestyle recommendations and the outcomes of gestational diabetes. A 2×2 factorial randomized trial A multicenter, randomized trial of treatment for mild gestational diabetes. Adherence to a lifestyle programme in overweight/obese pregnant women and effect on gestational diabetes mellitus: a randomized controlled trial Primary Prevention of Gestational Diabetes Mellitus and Large-for-Gestational-Age Newborns by Lifestyle Counseling: A Cluster-Randomized Controlled Trial Gestational weight gain in overweight and obese women enrolled in a healthy lifestyle and eating habits program Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the Fit for Delivery Study.
Background Overweight and obesity is a significant health concern during pregnancy . Our aim was to investigate the effect of providing antenatal dietary and lifestyle advice to women who are overweight or obese on components of maternal diet and physical activity . Methods We conducted a r and omised controlled trial , in which pregnant women with a body mass index ≥25 kg/m2 , and singleton gestation between 10 + 0 to 20 + 0 weeks were recruited and r and omised to Lifestyle Advice ( involving a comprehensive dietary and lifestyle intervention over their pregnancy ) or St and ard Care . Within the intervention group , we conducted a nested r and omised trial in which a subgroup of women were further r and omised to receive access to supervised group walking sessions in addition to the st and ard information presented during the intervention contacts ( the Walking group ) or st and ard information only . The outcome measures were maternal dietary intake , ( including food groups , macronutrient and micronutrient intake , diet quality ( using the Healthy Eating Index ; HEI ) , dietary glycaemic load , and glycaemic index ) and maternal physical activity . Women completed the Harvard Semi-Structured Food Frequency Question naire , and the Short Question naire to Assess Health-enhancing Physical Activity ( SQUASH ) , at trial entry , 28 and 36 weeks ’ gestational age , and 4 months postpartum . Analyses were performed on an intention-to-treat basis , using linear mixed effects models with adjustment for the stratification variables . Results Women r and omised to Lifestyle Advice demonstrated a statistically significant increase in the number of servings of fruit and vegetables consumed per day , as well as increased consumption of fibre , and reduced percentage energy intake from saturated fats ( P < 0.05 for all ) . Maternal HEI was significantly improved at both 28 ( 73.35 ± 6.62 versus 71.86 ± 7.01 ; adjusted difference in means 1.58 ; 95 % CI 0.89 to 2.27 ; P < 0.0001 ) and 36 ( 72.95 ± 6.82 versus 71.17 ± 7.69 ; adjusted difference in means 1.77 ; 95 % CI 1.01 to 2.53 ; P < 0.0001 ) weeks . There were no differences in dietary glycaemic index or glycaemic load . Women r and omised to Lifestyle Advice also demonstrated greater total physical activity ( adjusted difference in means 359.76 metabolic equivalent task units ( MET ) minutes/week ; 95 % CI 74.87 to 644.65 ; P = 0.01 ) compared with women receiving St and ard Care . The supervised walking group was poorly utilised . Conclusions For women who are overweight or obese , antenatal lifestyle advice improves maternal diet and physical activity during pregnancy . Please see related articles : http://www.biomed central .com/1741 - 7015/12/163 and http://www.biomed central .com/1741 - 7015/12/201.Trial registration Australian and New Zeal and Clinical Trials Registry ( http://ACTRN12607000161426 Background Obesity is a significant global health problem , with the proportion of women entering pregnancy with a body mass index greater than or equal to 25 kg/m2 approaching 50 % . Obesity during pregnancy is associated with a well-recognised increased risk of adverse health outcomes both for the woman and her infant , however there is more limited information available regarding effective interventions to improve health outcomes .The aims of this r and omised controlled trial are to assess whether the implementation of a package of dietary and lifestyle advice to overweight and obese women during pregnancy to limit gestational weight gain is effective in improving maternal , fetal and infant health outcomes . Methods / Design Design : Multicentred r and omised , controlled trial . Inclusion Criteria : Women with a singleton , live gestation between 10 + 0 - 20 + 0 weeks who are obese or overweight ( defined as body mass index greater than or equal to 25 kg/m2 ) , at the first antenatal visit . Trial Entry & R and omisation : Eligible , consenting women will be r and omised between 10 + 0 and 20 + 0 weeks gestation using a central telephone r and omisation service , and r and omisation schedule prepared by non- clinical research staff with balanced variable blocks . Stratification will be according to maternal BMI at trial entry , parity , and centre where planned to give birth . Treatment Schedules : Women r and omised to the Dietary and Lifestyle Advice Group will receive a series of inputs from research assistants and research dietician to limit gestational weight gain , and will include a combination of dietary , exercise and behavioural strategies .  Women r and omised to the St and ard Care Group will continue to receive their pregnancy care according to local hospital guidelines , which does not currently include routine provision of dietary , lifestyle and behavioural advice . Outcome assessors will be blinded to the allocated treatment group . Primary Study Outcome : infant large for gestational age ( defined as infant birth weight ≥ 90th centile for gestational age ) . Sample Size : 2,180 women to detect a 30 % reduction in large for gestational age infants from 14.40 % ( p = 0.05 , 80 % power , two-tailed ) . Discussion This is a protocol for a r and omised trial . The findings will contribute to the development of evidence based clinical practice guidelines .Trial Registration Australian and New Zeal and Clinical Trials Registry Background Gestational Diabetes Mellitus ( GDM ) has well recognised adverse health implication s for the mother and her newborn that are both short and long term . Obesity is a significant risk factor for developing GDM and the prevalence of obesity is increasing globally . It is a matter of public health importance that clinicians have evidence based strategies to inform practice and currently there is insufficient evidence regarding the impact of dietary and lifestyle interventions on improving maternal and newborn outcomes . The primary aim of this study is to measure the impact of a telephone based intervention  that promotes positive lifestyle modifications on the incidence of GDM . Secondary aims include : the impact on gestational weight gain ; large for gestational age babies ; differences in blood glucose levels taken at the Oral Glucose Tolerance Test ( OGTT ) and selected factors relating to self-efficacy and psychological wellbeing . Method / design A r and omised controlled trial ( RCT ) will be conducted involving pregnant women who are overweight ( BMI > 25 to 29.9 k/gm2 ) or obese ( BMI > 30 kgm/2 ) , less than 14 weeks gestation and recruited from the Barwon South West region of Victoria , Australia . From recruitment until birth , women in the intervention group will receive a program informed by the Theory of Self-efficacy and employing Motivational Interviewing . Brief ( less than 5 minute ) phone contact will alternate with a text message/email and will involve goal setting , behaviour change reinforcement with weekly weighing and charting , and the provision of health information . Those in the control group will receive usual care . Data for primary and secondary outcomes will be collected from medical record review and a question naire at 36 weeks gestation . Discussion Evidence based strategies that reduce the incidence of GDM are a priority for contemporary maternity care . Changing health behaviours is a complex undertaking and trialling a composite intervention that can be adopted in various primary health setting s is required so women can be accessed as early in pregnancy as possible . Using a sound theoretical base to inform such an intervention will add depth to our underst and ing of this approach and to the interpretation of results , contributing to the evidence base for practice and policy . Trial registration This trial is registered with the Australian New Zeal and Clinical Trials Registry ( ANZCTR ) : Objective The study was to examine whether gestational diabetes mellitus ( GDM ) can be prevented by early trimester lifestyle counseling in a high-risk population . Methods From September 2012 to January 2013 , 1664 pregnancies in the Department of Obstetrics and Gynecology of First Hospital of Peking University were enrolled in the study during their first prenatal care visit before the 8 gestational weeks visit and asked to fill out a question naire on GDM risk evaluation . According to the question naire and medical records , those with at least one risk factor of GDM were included in the intervention study and r and omly allocated to two groups , intervention group and control group . Routine prenatal care was offered , while st and ardized two-step lifestyle intervention was provided to the intervention group during 6–8 gestational weeks , and at 12–13 gestational weeks , enforcement intervention based on maternal anthropometrics were offered . Both groups were followed until 75 g oral glucose tolerance test ( OGTT ) testing at 24–28 gestational weeks . The weight gain after intervention and the prevalence of GDM were used to evaluate the effect . Results ( 1 ) According to the International Association of Diabetes and Pregnancy Study Groups ( IADPSG ) criteria , the positive rate of GDM for the intervention group was 17.16 % ( 23/134 ) , lower than the control group which was 23.91 % ( 33/138 ) , P = 0.168 . ( 2 ) The weight gain during the first and second trimester for the intervention group was ( 1.38 ± 2.34 ) kg and ( 5.51 ± 2.18 ) kg , lower than in the control group which was ( 1.41 ± 2.58 ) kg and ( 5.66 ± 2.25 ) kg , ( P = 0.905 , P = 0.567 ) . ( 3 ) Positive rate of GDM for those fasting plasma glucose ( FPG ) ≥5.1 mmol/L during early pregnancy was 11/36 ( 30.55 % ) for the intervention group that was lower than 17/37 ( 45.95 % ) for the control group , but the statistical difference was not significant ( P = 0.076 ) . Conclusion The positive rate of GDM could be reduced by a certain amount lifestyle intervention from the beginning of pregnancy . More vali date d effective intervention should be explored in the high-risk pregnant women 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 Objective In obese women , 1 ) to assess whether lower gestational weight gain ( GWG ) during pregnancy in the lifestyle intervention group of a r and omized controlled trial ( RCT ) result ed in differences in offspring anthropometrics and body composition , and 2 ) to compare offspring outcomes to a reference group of children born to women with a normal Body Mass Index ( BMI ) . Research design and methods The LiPO ( Lifestyle in Pregnancy and Offspring ) study was an offspring follow-up of a RCT with 360 obese pregnant women with a lifestyle intervention during pregnancy including dietary advice , coaching and exercise .  The trial was completed by 301 women who were eligible for follow-up . In addition , to the children from the RCT , a group of children born to women with a normal BMI were included as a reference group . At 2.8 ( range 2.5–3.2 ) years , anthropometrics were measured in 157 children of the RCT mothers and in 97 reference group children with Body Mass Index ( BMI ) Z-score as a primary outcome . Body composition was estimated by Dual Energy X-ray ( DEXA ) in 123 successful scans out of 147 ( 84 % ) . Results No differences between r and omized groups were seen in mean ( 95 % C.I. ) BMI Z-score ( intervention group 0.06 [ −0.17 ; 0.29 ] vs. controls −0.18 [ −0.43 ; 0.05 ] ) , in the percentage of overweight or obese children ( 10.9 % vs. 6.7 % ) , in other anthropometrics , or in body composition values by DEXA . Outcomes between children from the RCT and the reference group children were not significantly different . Conclusions The RCT with lifestyle intervention in obese pregnant women did not result in any detectable effect on offspring anthropometrics or body composition by DEXA at 2.8 years of age . This may reflect the limited difference in GWG between intervention and control groups . Offspring of obese mothers from the RCT were comparable to offspring of mothers with a normal BMI . Trial registration clinical trials.gov NCT00530439 , NCT01918319 and NCT01918423 . URL : NCT00530439?term = NCT00530439&rank = 1 , NCT01918319?term = NCT00530439&rank = 2 and NCT01918423?term = NCT00530439&rank = 3 Background Fetal conditions are known to be partly responsible for the child ’s risk for obesity . Our pilot study aim ed to determine the effect of gestational lifestyle counseling on the  offspring weight gain until 4 years of age and to estimate power for future studies . Design and methods First-time pregnant mothers participated in a controlled trial conducted in maternity health clinics during 2004 – 2006 . The intervention included individual counseling on physical activity and diet , and an option to attend supervised group exercise sessions .  The participant mothers ( N = 109 ) received a follow-up question naire concerning 13 repeated growth measurements of their offspring . Response rate to the follow-up question naire was 66.1 % ( N = 72/109 ) . Results The increase of BMI z-score between 24–48 months was not significantly slower among the intervention group offspring ( 95 % CI −0.025 to 0.009 , p = 0.34 ) compared to control group . Z-scores for weight-for-length/height did not differ between groups when the period 0–48 months was analyzed ( 95 % CI −0.010 to 0.014 , p = 0.75 ) . Conclusions In this pilot study gestational lifestyle counseling did not significantly slow the weight gain of the offspring . Gestational intervention studies with at least 300 mothers per group are needed to confirm the possible effect on offspring ’s risk for obesity . Trial registration Current Controlled Trials IS RCT N21512277 Obesity impacts the U.S. military by affecting the health and readiness of active duty service members and their families .  Preventing Obesity in Military Communities ( POMC ) is a comprehensive research program within Patient Centered Medical Homes ( PCMHs ) in three Military Training Facilities . This paper describes three pilot r and omized controlled trials that target critical high risk periods for unhealthy weight gain from birth to young adulthood : ( 1 ) pregnancy and early infancy ( POMC-Mother-Baby ) , ( 2 ) adolescence ( POMC-Adolescent ) , and ( 3 ) the first tour of duty after boot camp ( POMC-Early Career ) . Each study employs a two-group r and omized treatment or prevention program with follow up . POMC offers a unique opportunity to bring together research and clinical expertise in obesity prevention to develop state-of-the-art programs within PCMHs in Military Training Facilities . This research builds on existing infrastructure that is expected to have immediate clinical benefits to DoD and far-reaching potential for ongoing collaborative work . POMC may offer an economical approach for widespread obesity prevention , from conception to young adulthood , in the U.S. military as well as in civilian communities Background In conjunction with the growing prevalence of obesity and the older age of pregnant women gestational diabetes ( GDM ) is a major health problem . The aim of the study was to evaluate if a lifestyle intervention since early pregnancy is feasible in improving the glucose tolerance of women at a high-risk for GDM in Finl and . Methods A 75-g oral glucose tolerance test ( OGTT ) was performed in early pregnancy ( n = 102 ) . Women at high risk for GDM ( n = 54 ) were r and omized at weeks 8 - 12 from Apr 2005 to May 2006 to a lifestyle intervention group ( n = 27 ) or to a close follow-up group ( n = 27 ) . An OGTT was performed again at weeks 26 - 28 for the lifestyle intervention and close follow-up groups . Results The values of the OGTT during the second trimester did not differ between the lifestyle intervention and close follow-up groups . In the lifestyle intervention group three women had GDM in the second trimester and respectively one woman in the close follow up group . Insulin therapy was not required in both groups . The intervention result ed in somewhat lower weight gain 11.4 ± 6.0 kg vs. 13.9 ± 5.1 kg , p = 0.062 , adjusted by the prepregnancy weight . Conclusions Early intervention with an OGTT and simple lifestyle advice is feasible . A more intensive lifestyle intervention did not offer additional benefits with respect to glucose tolerance , although it tended to ameliorate the weight gain . Trial Registration Clinical Trials.gov : Background Pregnancy is a time of significant physiological and physical change for women . In particular , it is a time at which many women are at risk of gaining excessive weight . We describe the rationale and methods of the Health in Pregnancy and Post-birth ( HIPP ) Study , a study which aims primarily to determine the effectiveness of a specialized health coaching ( HC ) intervention during pregnancy , compared to education alone , in preventing excessive gestational weight gain and postpartum weight retention 12 months post birth . A secondary aim of this study is to evaluate the mechanisms by which our HC intervention impacts on weight management both during pregnancy and post birth . Methods / Design The r and omized controlled trial will be conducted with 220 women who have a BMI > 18.5 ( American IOM cut-off for normal weight ) , are 18 years of age or older , English speaking , no history of disordered eating or diabetes and are less than 18 weeks gestation at recruitment . Women will be r and omly allocated to either a specialized HC intervention group or an Education Alone group . Our specialized HC intervention has two components : ( 1 ) one-on-one sessions with a Health Coach , and ( 2 ) two by two hour educational group sessions led by a Health Coach . Women in the Education Alone group will receive two by two hour educational group sessions with no HC components .  Body Mass Index , waist circumference , and psychological factors including motivation , readiness to change , symptoms of depression and anxiety , and body dissatisfaction will be assessed at baseline ( 14 - 16 weeks gestation ) , and again at follow-up : 32 weeks gestation , 6 weeks , 6 months and 12 months postpartum . Discussion Our study responds to the urgent need to design effective interventions in pregnancy to prevent excessive gestational weight gain and postpartum weight retention . Our pregnancy HC intervention is novel and innovative and has been design ed to be easily adopted by health professionals who work with pregnant women , such as obstetricians , midwives , allied health professionals and health psychologists . Trial registration Australian New Zeal and Clinical Trials Registry 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 OBJECTIVES To determine the prevalence of malnutrition among children admitted with acute diarrhoea disease at Moi Teaching and Referral Hospital and to establish the effect of malnutrition on duration of hospital stay . DESIGN Prospect i ve observational study . SETTING Paediatric wards of Moi Teaching and Referral Hospital , Eldoret , Kenya . SUBJECTS A total of 191 children aged 6 and 59 months admitted with acute diarrhoea disease , without chronic co-morbidities or visible severe malnutrition , were systematic ally enrolled into the study between November 2011 and March 2012 . OUTCOME MEASURES Nutritional status based on WHO WHZ scores taken at admission and duration of hospital stay . RESULTS The mean age was 13.2 months with a male to female sex ratio of 1.16:1 . Of all the children seen with acute diarrhoeal diseases , 43.9 % had acute malnutrition ( < -2 WHZ score ) , with 12 % being severely malnourished ( < -3 Z score ) . Average duration of hospital stay was 3.36 ( SD=1.54 ) days . Among those with malnutrition the average duration of stay was 3.39 ( SD=1.48 ) days while for those without malnutrition it was 3.21(SD=1.20 ) days , which was not statistically different . No death was reported . WHO weight for Height Z scores picked 12 % of severe form of malnutrition missed out by Welcome Trust classification ( weight for age ) . CONCLUSION Routine anthrometry including weight for height identifies more children with malnutrition in acute diarrhoeal diseases . Presence of malnutrition did not affect duration of hospital stay Background Overweight and obesity during pregnancy represents a considerable health burden . While research has focused on interventions to limit gestational weight gain , there is little information describing their impact on neonatal health . Our aim was to investigate the effect on a range of pre-specified secondary neonatal outcomes of providing antenatal dietary and lifestyle advice to women who are overweight or obese . Methods We report a range of pre-specified secondary neonatal outcomes from a large r and omised trial in which antenatal dietary and lifestyle advice was provided to women who were overweight or obese . Pregnant women were eligible for participation with a body mass index of 25 kg/m2 or over , and singleton gestation between 10 + 0 and 20 + 0 weeks . Outcome measures included gestational age at birth ; Apgar score below 7 at 5 minutes of age ; need for resuscitation at birth ; birth weight above 4.5 kg or below 2.5 kg ; birth weight , length and head circumference ( and Z-scores ) ; admission to the nursery ; respiratory distress syndrome ; and postnatal length of stay . Data relating to the primary outcome ( large for gestational age infants defined as birth weight above the 90th centile ) and birth weight above 4 kg have been reported previously . Analyses used intention-to-treat principles . Results In total , 2,142 infants were included in the analyses . Infants born to women following lifestyle advice were significantly less likely to have birth weight above 4.5 kg ( 2.15 % versus 3.69 % ; adjusted risk ratio ( aRR ) = 0.59 ; 95 % confidence interval ( CI ) 0.36 to 0.98 ; P = 0.04 ) , or respiratory distress syndrome ( 1.22 % versus 2.57 % ; aRR = 0.47 ; 95 % CI 0.24 to 0.90 ; P = 0.02 ) , particularly moderate or severe disease , and had a shorter length of postnatal hospital stay ( 3.94 ± 7.26 days versus 4.41 ± 9.87 days ; adjusted ratio of means 0.89 ; 95 % CI 0.82 to 0.97 ; P = 0.006 ) compared with infants born to women who received St and ard Care . Conclusions For women who are overweight or obese , antenatal dietary and lifestyle advice has health benefits for infants , without an increase in the risk of harm . Continued follow-up into childhood will be important to assess the longer-term effects of a reduction in high infant birth weight on risk of child obesity . Please see related articles : http://www.biomed central .com/1741 - 7015/12/161 and http://www.biomed central .com/1741 - 7015/12/201 . Clinical trial registration Australian and New Zeal and Clinical Trials Registry ( http://ACTRN12607000161426 Background Although it is known that lifestyle behaviors of pregnant women are closely related to maternal and fetal health , number of data concerning efficacy of intervention on lifestyle during pregnancy is limited . The purpose of this study is to determine the effect of lifestyle interventions on improving dietary habits and lifestyle behaviors , ensuring gestational weight gain ( GWG ) within recommended levels and limiting postpartum weight retention ( PWR ) . Methods The study was conducted as a r and omized controlled trial in a family health center located in Istanbul , Turkey , between June 2011 and July 2012 . The primary outcomes were GWG , and the proportion of pregnant women whose GWG was within the Institute of Medicine ( IOM ) guidelines . One hundred two pregnant women with gestation ≤12 weeks , age ≥18 years , gravidity ≤2 , and who did not intend to lose weight in prepregnancy period were r and omly included in this study as intervention ( n = 51 ) and control ( n = 51 ) groups . The study was completed with 45 women for each group . The control group received routine antenatal care . The intervention group was received an individualized lifestyle intervention focusing on healthy lifestyle , diet , exercise , and weight monitoring as four sessions at 12–15 , 16–18 , 20–24 , and 37 weeks gestation . Lifestyle behaviors were evaluated with Health-Promoting Lifestyle Profile-II . Dietary habits were assessed by 3-day dietary recalls , and weight was followed from pregnancy until 6 weeks postpartum . Results The lifestyle interventions had a significant effect on improving lifestyle behaviors , protein intake , percentage of energy from protein , calcium , magnesium , iron , zinc , and vegetable intakes when adjusted for confounders ( p < 0.05 ) . The proportion of women who were within the IOM recommendations was higher in the intervention group ( 51.1 % ) than in the control group ( 28.9 % ) The odds ratio for GWG within IOM was statistically significant between the groups ( OR = 0.59 , 95 % CI , 0.45–0.72 ) . There were no difference between groups in terms of the other dietary intakes , total GWG , and PWR ( p > 0.05 ) . Conclusions Lifestyle intervention improves the lifestyle behaviors during pregnancy and increases the appropriate GWG for prepregnancy body mass index ( BMI ) , but it has a limited effect in terms of improving dietary habits and has no effect on PWR 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 Background / Objectives : The prevalence of gestational diabetes mellitus ( GDM ) is increasing worldwide . GDM may be prevented by improving the diets of pregnant women . The objective of this study was to evaluate the effect of dietary counselling on the diets of pregnant women at GDM risk . Subjects/ Methods : This study was a secondary analysis of a r and omised controlled trial the Finnish gestational diabetes prevention study ( RADIEL ) in which pre-pregnant and pregnant women with previous GDM or BMI ⩾30 kg/m2 were allocated into two groups , namely the control and the intervention groups . The control group received st and ard antenatal dietary counselling according to the Finnish Nutrition Recommendations . The intervention group participated in one individual dietary counselling session and one group dietary counselling session in addition to the st and ard counselling .  This study included women who were recruited during pregnancy . To assess changes in food intake , food-intake question naires were collected during the first and the second trimester of pregnancy . Bootstrap type analysis of covariance was used , and 242 participants were included in the final analysis to study changes in food intake . Results : The intakes of low-fat cheese ( baseline adjusted mean 0.09 times/day ; 95 % confidence interval ( CI ) 0.07 , 0.24 ; P=0.040 ) and fish ( baseline adjusted mean 0.28 times per week ; 95 % CI 0.08 , 0.49 ; P=0.011 ) showed a significant increase in the intervention group compared with the control group . Conclusions : This study showed that dietary counselling in early pregnancy can lead to modest dietary improvements in pregnant women at GDM risk OBJECTIVE Studies in predominantly non-Hispanic white population s have suggested that physical activity during pregnancy is associated with a reduced risk of gestational diabetes mellitus ( GDM ) . There are few such studies in Hispanic women , a group at increased risk for GDM . METHODS We conducted a prospect i ve cohort study of household/caregiving , occupational , sports/exercise , and active living habits and the risk of GDM among 1006 Hispanic ( predominantly Puerto Rican ) prenatal care patients in western Massachusetts from 2000 to 2004 . Prepregnancy , early pregnancy , and midpregnancy physical activity was assessed using the Kaiser Physical Activity Survey . RESULTS A total of 33 women ( 3.3 % ) were diagnosed with GDM , and 119 women ( 11.8 % ) were diagnosed with abnormal glucose tolerance . There were no significant associations between GDM risk and occupational and active living activities  in prepregnancy , early pregnancy , and midpregnancy or with a change in levels of household/caregiving , occupational , and active living activities from prepregnancy to during pregnancy . However , after controlling for age and prepregnancy body mass index ( BMI ) , women in the highest quartile of prepregnancy ( OR = 0.2 , 95 % CI 0.1 - 0.8 , p(trend ) = 0.03 ) and midpregnancy ( OR = 0.2 , 95 % CI 0.1 - 0.8 , p(trend ) = 0.004 ) household/caregiving activities  as well as midpregnancy sports/exercise ( 0.1 , 95 % CI 0.0 - 0.7 , p(trend ) = 0.12 ) had a reduced risk of GDM compared with women in the lowest quartile . CONCLUSIONS Findings in this Hispanic population , although based on small numbers of cases , are consistent with prior research among predominantly non-Hispanic white population Background Excessive gestational weight gain ( GWG ) is associated with short- and long-term health problems among mothers and their offspring . There is a strong need for effective intervention strategies targeting excessive GWG to prevent adverse outcomes . Methods We performed a cluster-r and omized controlled intervention trial in eight gynecological practice s evaluating the feasibility and effectiveness of a lifestyle intervention presented to all pregnant women ; 250 healthy , pregnant women were recruited for the study . The intervention program consisted of two individually delivered counseling sessions focusing on diet , physical activity , and weight monitoring . The primary outcome was the proportion of pregnant women exceeding weight gain recommendations of the Institute of Medicine ( IOM ) . Secondary outcome variables were maternal weight retention and short-term obstetric and neonatal outcomes . Results The intervention result ed in a lower proportion of women exceeding IOM guidelines among women in the intervention group ( 38 % ) compared with the control group ( 60 % ) ( odds ratio ( OR ) : 0.5 ; 95 % confidence interval ( CI ) : 0.3 to 0.9 ) without prompting an increase in the proportion of pregnancies with suboptimal weight gain ( 19 % vs. 21 % ) . Participants in the intervention group gained significantly less weight than those in the control group . Only 17 % of the women in the intervention group showed substantial weight retention of more than 5 kg compared with 31 % of those in the control group at month four postpartum ( pp ) ( OR : 0.5 ; 95 % CI : 0.2 to 0.9 ) . There were no significant differences in obstetric and neonatal outcomes . Conclusions Lifestyle counseling given to pregnant women reduced the proportion of pregnancies with excessive GWG without increasing suboptimal weight gain , and may exert favorable effects on pp weight retention . Trial registration German Clinical Trials Register DRKS00003801 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 ) Background Maternal overweight , obesity and consequently the incidence of gestational diabetes are increasing rapidly worldwide . The objective of the study was to assess the efficacy and cost-effectiveness of a combined diet and physical activity intervention implemented before , during and after pregnancy in a primary health care setting for preventing gestational diabetes , later type 2 diabetes and other metabolic consequences . Methods RADIEL is a r and omized controlled multi-center intervention trial in women at high risk for diabetes ( a previous history of gestational diabetes or prepregnancy BMI ≥30 kg/m2 ) . Participants planning pregnancy or in the first half of pregnancy were parallel-group r and omized into an intervention arm which received lifestyle counseling and a control arm which received usual care given at their local antenatal clinics . All participants visited a study nurse every three months before and during pregnancy , and at 6 weeks , 6 and 12 months postpartum . Measurements and laboratory tests were performed on all participants with special focus on dietary and exercise habits and metabolic markers . Of the 728 women [ mean age 32.5 years ( SD 4.7 ) ; median parity 1 ( range 0 - 9 ) ] considered to be eligible for the study 235 were non-pregnant and 493 pregnant [ mean gestational age 13 ( range 6 to 18 ) weeks ] at the time of enrollment . The proportion of nulliparous women was 29.8 % ( n = 217 ) . Out of all participants , 79.6 % of the non-pregnant and 40.4 % of the pregnant women had previous gestational diabetes and 20.4 % of the non-pregnant and 59.6 % of the pregnant women were recruited because of a prepregnancy BMI  ≥30 kg/m2 . Mean BMI at first visit was 30.1 kg/m2 ( SD 6.2 ) in the non-pregnant and 32.7 kg/m2 ( SD 5.6 ) in the pregnant group . Discussion To our knowledge , this is the first r and omized lifestyle intervention trial , which includes , besides the pregnancy period , both the prepregnancy and the postpartum period . This study design also provides an opportunity to focus upon the health of the next generation . The study is expected to produce novel information on the optimal timing and setting of interventions and for allocating re sources to prevent obesity and diabetes in women of reproductive age . Trial registration Clinical trials.gov Identifier : Background The global obesity epidemic has led to increased attention on pregnancy , a period when women are at risk of gaining excessive weight . Excessive gestational weight gain is associated with numerous complications , for both mother and child . Though the problem is widespread , few studies have examined the effect of a lifestyle intervention in pregnancy design ed to limit maternal weight gain . The Fit for Delivery study will explore the effectiveness of nutritional counseling coupled with exercise classes compared with st and ard prenatal care . The aims of the study are to examine the effect of the intervention on maternal weight gain , newborn birth weight , glucose regulation , complications of pregnancy and delivery , and maternal weight retention up to 12 months postpartum . Methods / design Fit for Delivery is a r and omized controlled trial that will include 600 women expecting their first child . To be eligible , women must be 18 years of age or older , of less than 20 weeks gestational age , with a singleton pregnancy , and have a Body Mass Index ( BMI ) ≥ 19 kg/m2 . The women will be r and omly allocated to either an intervention group or a control group . The control group will receive st and ard prenatal care . The intervention group will , in addition , receive nutritional counseling by phone , access to twice-weekly exercise sessions , and information on healthy eating and physical activity provided in pamphlets , evening meetings and an interactive website . Both groups will be monitored by weighing ( including bioimpedance measurements of percent body fat ) , blood tests , self-report question naires and hospital record review . Discussion Weight gained in pregnancy affects the health of both the mother and her unborn child , and simple models for efficient intervention are in high dem and . The Fit for Delivery intervention provides concrete advice on limiting energy intake and practical training in increasing physical activity . This lifestyle intervention is simple , reproducible , and inexpensive . The design of the study reflects the realities of clinical practice , where patients are free to choose whether or not they respond to health initiatives . If we find measurable health benefits associated with the intervention , it may be an easily adopted supplement to routine prenatal care , in the prevention of obesity . Trial registration Clinical Trial.gov , CONTEXT A past history of gestational diabetes mellitus ( GDM ) confers a very high risk of postpartum development of diabetes , particularly type 2 diabetes . OBJECTIVE The Diabetes Prevention Program ( DPP ) sought to identify individuals with impaired glucose tolerance ( IGT ) and intervene in an effort to prevent or delay their progression to diabetes . This analysis examined the differences between women enrolled in DPP with and without a reported history of GDM . DESIGN The DPP was a r and omized , controlled clinical trial . SETTING The study was a multicenter , National Institutes of Health-sponsored trial carried out at 27 centers including academic and Indian Health Services sites . PATIENTS A total of 2190 women were r and omized into the DPP and provided information for past history of GDM . This analysis addressed the differences between those 350 women providing a past history of GDM and those 1416 women with a previous live birth but no history of GDM . INTERVENTIONS Subjects were r and omized to either st and ard lifestyle and placebo or metformin therapy or to an intensive lifestyle intervention . MAIN OUTCOMES The primary outcome was the time to development of diabetes ascertained by semiannual fasting plasma glucose and annual oral glucose tolerance testing . Assessment s of insulin secretion and insulin sensitivity were also performed . RESULTS Whereas entering the study with similar glucose levels , women with a history of GDM r and omized to placebo had a crude incidence rate of diabetes 71 % higher than that of women without such a history . Among women reporting a history of GDM , both intensive lifestyle and metformin therapy reduced the incidence of diabetes by approximately 50 % compared with the placebo group , whereas this reduction was 49 and 14 % , respectively in parous women without GDM . These data suggest that metformin may be more effective in women with a GDM history as compared with those without . CONCLUSIONS Progression to diabetes is more common in women with a history of GDM compared with those without GDM history despite equivalent degrees of IGT at baseline . Both intensive lifestyle and metformin are highly effective in delaying or preventing diabetes in women with IGT and a history of GDM OBJECTIVE Optimizing gestational weight gain ( GWG ) in early pregnancy is of clinical and public health importance , especially in higher risk pregnancies . DESIGN AND METHODS In a robustly design ed , r and omized controlled trial , 228 pregnant women at risk of developing gestational diabetes mellitus ( GDM ) were allocated to either control ( written health information only ) or intervention ( four-session lifestyle program ) . All women received st and ard maternal care . Measures were completed at 12 - 15 and 26 - 28 weeks gestation . Measures included anthropometrics ( weight and height ) , physical activity ( pedometer and International Physical Activity Question naire ) , question naires ( risk perception ) , and GDM screening . RESULTS The mean ( SD ) age [ 31.7 ( 4.5 ) and 32.4 ( 4.7 ) years ] and body mass index [ BMI ; 30.3 ( 5.9 ) and 30.4 ( 5.6 ) kg/m(2 ) ] were similar between control and intervention groups , respectively . By 28 weeks , GWG was significantly different between control and intervention groups [ 6.9 ( 3.3 ) vs. 6.0 ( 2.8 ) kg , P < 0.05 ] . When stratified according to baseline BMI , overweight women in the control group gained significantly more weight compared to overweight women in the intervention group [ 7.8 ( 3.4 ) vs. 6.0 ( 2.2 ) kg , P < 0.05 ] , yet in obese women , GWG was similar in both groups . Physical activity levels declined by 28 weeks gestation overall ( P < 0.01 ) ; however , the intervention group retained a 20 % higher step count compared to controls [ 5,203 ( 3,368 ) vs. 4,140 ( 2,420 ) steps/day , P < 0.05 ] . Overall , GDM prevalence was 22.8 % [ Corrected ] , with a trend toward less cases in the intervention group ( P = 0.1 ) . CONCLUSIONS Results indicate that a low-intensity lifestyle intervention , integrated with antenatal care , optimizes healthy GWG and attenuates physical activity decline in early pregnancy . Efficacy in limiting weight gain was greatest in overweight women and in high-risk ethnically diverse women 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 OBJECTIVE To examine whether personalized interventions could improve dietary intake and physical activity among pregnant women . METHODS A r and omized controlled trial was conducted at a center in Chengdu , China , between September 2012 and February 2013 . Women with a singleton pregnancy ( aged ≥18years , could underst and written Chinese , did not have pre-existing diabetes ) were enrolled at approximately 12weeks of pregnancy . They were r and omly assigned ( 1:1 ) to an intervention group ( received personalized educational material s ) or a control group ( conventional interventions only ) . Data for dietary intake and physical activity were recorded via question naires . Only pregnant women who completed the study were included in the analysis . RESULTS Analyses included 106 women in the control group and 115 in the intervention group . After intervention , the intake of energy , protein , fruit , milk , seafood , and nuts differed significantly between groups ( P<0.05 ) , with intakes closer to the recommended amounts in the intervention group . Women in the intervention group spent significantly less time resting ( P=0.033 ) and more time doing mild activity ( P=0.016 ) . Mean weight gain per week was significantly lower in the intervention group ( P=0.023 ) , and significantly fewer women in this group developed gestational diabetes ( P=0.043 ) . CONCLUSION Personalized educational interventions can improve dietary behavior and physical activity levels , and reduce prevalence of gestational diabetes among pregnant women in China . Chinese Clinical Trial Register : ChiCTR-IPR-15005809 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 Please cite this paper as : Hui A , Back L , Ludwig S , Gardiner P , Sevenhuysen G , Dean H , Sellers E , McGavock J , Morris M , Bruce S , Murray R , Shen G. Lifestyle intervention on diet and exercise reduced excessive gestational weight gain in pregnant women under a r and omised controlled trial . BJOG 2012;119:70–77 PURPOSE This study aim ed to evaluate the effect of an exercise program of two different intensities , with nutritional control , on gestational weight gain ( GWG ) , infant birth weight , and maternal weight retention at 2 months postpartum ( 2 mopp ) . METHODS Pregnant women ( prepregnancy body mass index = 18.5 - 24.9 kg·m ) were r and omized at study entry ( 16 - 20 wk of gestation ) to a low-intensity ( LI , 30 % HR reserve ( HRR ) , n = 23 ) or moderate-intensity ( MI , 70 % HRR , n = 26 ) exercise program , with nutritional control . The exercise program consisted of walking sessions three to four times per week , gradually increasing exercise time from 25 to 40 min per session . Forty-five normal-weight women who did not participate in any structured exercise program during pregnancy and had singleton births were used as a historical control group .  RESULTS Total GWG was higher in the control group ( 18.3 ± 5.3 kg ) compared with the LI ( 15.3 ± 2.9 kg , P = 0.01 ) and MI ( 14.9 ± 3.8 kg , P = 0.003 ) groups . During the intervention , GWG was similar in both intervention groups , with weekly rates of weight gain of 0.49 ± 0.1 and 0.47 ± 0.1 kg·wk in the LI and MI groups , respectively . Excessive GWG during the intervention was prevented in 70 % of the women in the LI group and 77 % of those in the MI group . Excessive GWG occurred before the intervention began . At 2 mopp , 18 % and 28 % of the women in the LI and MI groups , respectively , retained ≤2.0 kg compared with only 7 % of those in the control group . Infant birth weight was not different between the groups . CONCLUSIONS Results suggest that a prenatal nutrition and exercise program regardless of exercise intensity , reduced excessive GWG and decreased weight retention at 2 mopp in women of normal weight before pregnancy Background Pregnancy is a recognised high risk period for excessive weight gain , contributing to postpartum weight retention and obesity development long-term . We aim ed to reduce postpartum weight retention following a low-intensity , self-management intervention integrated with routine antenatal care during pregnancy . Methods 228 women at increased risk of gestational diabetes , < 15 weeks gestation were r and omised to intervention ( 4 self-management sessions ) or control ( generic health information ) . Outcomes , collected at baseline and 6 weeks postpartum , included anthropometrics ( weight and height ) , physical activity ( pedometer ) and question naires ( health behaviours ) . Results Mean age ( 32.3 ± 4.7 and 31.7 ± 4.4 years ) and body mass index ( 30.4 ± 5.6 and 30.3 ± 5.9 kg/m2 ) were similar between intervention and control groups , respectively at baseline . By 6 weeks postpartum , weight change in the control group was significantly higher than the intervention group with a between group difference of 1.45 ± 5.1 kg ( 95 % CI : -2.86,-0.02 ; p < h0.05 ) overall , with a greater difference in weight found in overweight , but not obese women . Intervention group allocation , higher baseline BMI , GDM diagnosis , country of birth and higher age were all independent predictors of lower weight retention at 6 weeks postpartum on multivariable linear regression . Other factors related to weight including physical activity , did not differ between groups . Conclusions A low intensity intervention , integrated with st and ard antenatal care is effective in limiting postpartum weight retention . Implementation research is now required for scale-up to optimise antenatal health care . Trial registration Australian New Zeal and Clinical Trial Registry Number : ACTRN12608000233325 . Registered 7/5/2008 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 We conducted a r and omized clinical trial to determine whether treatment of women with gestational diabetes mellitus reduced the risk of perinatal complications . METHODS We r and omly assigned women between 24 and 34 weeks ' gestation who had gestational diabetes to receive dietary advice , blood glucose monitoring , and insulin therapy as needed ( the intervention group ) or routine care . Primary outcomes included serious perinatal complications ( defined as death , shoulder dystocia , bone fracture , and nerve palsy ) , admission to the neonatal nursery , jaundice requiring phototherapy , induction of labor , cesarean birth , and maternal anxiety , depression , and health status . RESULTS The rate of serious perinatal complications was significantly lower among the infants of the 490 women in the intervention group than among the infants of the 510 women in the routine-care group ( 1 percent vs. 4 percent ; relative risk adjusted for maternal age , race or ethnic group , and parity , 0.33 ; 95 percent confidence interval , 0.14 to 0.75 ; P=0.01 ) . However , more infants of women in the intervention group were admitted to the neonatal nursery ( 71 percent vs. 61 percent ; adjusted relative risk , 1.13 ; 95 percent confidence interval , 1.03 to 1.23 ; P=0.01 ) . Women in the intervention group had a higher rate of induction of labor than the women in the routine-care group ( 39 percent vs. 29 percent ; adjusted relative risk , 1.36 ; 95 percent confidence interval , 1.15 to 1.62 ; P<0.001 ) , although the rates of cesarean delivery were similar ( 31 percent and 32 percent , respectively ; adjusted relative risk , 0.97 ; 95 percent confidence interval , 0.81 to 1.16 ; P=0.73 ) . At three months post partum , data on the women 's mood and quality of life , available for 573 women , revealed lower rates of depression and higher scores , consistent with improved health status , in the intervention group . CONCLUSIONS Treatment of gestational diabetes reduces serious perinatal morbidity and may also improve the woman 's health-related quality of life 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 Overweight and obesity during pregnancy are common and are associated with an increased risk of adverse health outcomes for both the mother and the infant . However , robust evidence about the effect of antenatal dietary and lifestyle interventions on health outcomes is lacking . We conducted a multicenter , r and omized trial , recruiting 2,212 women ( from 3 public maternity hospitals across South Australia ) with a singleton pregnancy between 10 + 0 and 20 + 0 weeks ' gestation and a BMI ≥25 . The women were r and omized to lifestyle advice  ( n = 1,108 ) or st and ard care ( n = 1,104 ) . Women r and omized to lifestyle advice participated in a comprehensive dietary and lifestyle intervention over the course of their pregnancy ( delivered by research staff ) , while women r and omized to st and ard care received pregnancy care according to local guidelines , which did not include such information . Provision of the lifestyle intervention was associated with a significant 18 % relative risk reduction in the chance of infants being born with a birth weight above 4 kg . No other significant differences were identified in maternal pregnancy and birth outcomes between the two treatment groups . Observational studies highlight the association between a high infant birth weight and the subsequent risk of childhood and adulthood obesity .  Antenatal interventions that are effective in reducing high infant birth weights therefore represent a significant strategy to tackle obesity from a population health perspective , while ongoing interrogation of the biospecimens and measurements , including ongoing childhood follow-up , will provide a unique opportunity to evaluate the mechanistic pathways of maternal-to-infant/childhood obesity Background Maternal obesity before and during pregnancy predicts maternal and infant risks of obesity and its associated metabolic conditions . Dietary and physical activity recommendations during pregnancy as well as weight monitoring are currently available in the Chilean primary health care system . However some of these recommendations are not up date d and most of them are poorly implemented . We seek to assess the effectiveness of an intervention that enhances the implementation of up date d nutrition health care st and ards ( diet , physical activity , and breastfeeding promotion ) during pregnancy on maternal weight gain and infant growth . Methods Design & Setting : Cluster r and omized controlled trial . The cluster units will be 12 primary health care centers from two counties ( La Florida and Puente Alto ) from the South-East Area of Santiago r and omly allocated to : 1 ) enhanced nutrition health care st and ards ( intervention group ) or 2 ) routine care ( control group ) . Participants : Women seeking prenatal care before 15 weeks of gestation , residing within a catchment area of selected health centers , and who express that they are not planning to change residence will be invited to participate in the study . Pregnant women classified as high risk according to the Chilean norms ( i.e age < 16 or > 40 years , multiple gestation , pre-gestational medical conditions , previous pregnancy-related issues ) and /or underweight will be excluded . Intervention : Pregnant women who attend intervened health care centers starting at their first prenatal visit will receive advice regarding optimal weight gain during pregnancy and diet and physical activity counseling-support .  Pregnant women who attend control health clinics will receive routine antenatal care according to national guidelines . We plan to recruit 200 women in each health center . Assuming a 20 % loss to follow up , we expect to include 960 women per arm . Main outcome measures : 1 ) Achievement of adequate weight gain based on IOM 2009 recommendations and adequate glycaemic control at 24 - 28 weeks of pregnancy according to ADA 2011 , and 2 ) healthy infant growth during the first year of age based on WHO st and ards . Discussion We expect that the intervention will benefit the participants in achieving adequate weight gain & metabolic control during pregnancy as well as adequate infant growth as a result of an increased impact of st and ard nutrition and health care practice s. Gathered information should contribute to a better underst and ing of how to develop effective interventions to halt the maternal obesity epidemic and its associated co-morbidities in the Chilean population .Trial registration Clinical trials.gov Identifier : Depression during the prenatal and postpartum periods is associated with poor maternal , perinatal and child outcomes . This study examines the effectiveness of a culturally and linguistically tailored , social support-based , healthy lifestyle intervention led by trained community health workers in reducing depressive symptoms among pregnant and early postpartum Latinas . A sample of 275 pregnant Latinas was r and omized to the Healthy MOMs Healthy Lifestyle Intervention ( MOMs ) or the Healthy Pregnancy Education ( control ) group .  More than one-third of participants were at risk for depression at baseline . MOMs participants were less likely than control group participants to be at risk for depression at follow-up . Between baseline and 6 weeks postpartum , MOMs participants experienced a significant decline in depressive symptoms ; control participants experienced a marginally significant decline . For MOMs participants , most of this decline occurred during the pregnancy intervention period , a time when no change occurred for control participants . The change in depressive symptoms during this period was greater among MOMs than control participants ( “ intervention effect ” ) . From baseline to postpartum , there was a significant intervention effect among non-English-speaking women only . These findings provide evidence that a community-planned , culturally tailored healthy lifestyle intervention led by community health workers can reduce depressive symptoms among pregnant , Spanish-speaking Latinas Objective The effect of providing antenatal dietary and lifestyle advice on secondary measures of maternal anthropometry was evaluated and their correlation with both gestational weight gain and infant birth weight was assessed . Methods In a multicenter , r and omized controlled trial , pregnant women with BMI of ≥25 kg/m2 received either Lifestyle Advice or St and ard Care .  Maternal anthropometric outcomes included arm circumference , biceps , triceps , and subscapular skinfold thickness measurements ( SFTM ) , percentage body fat ( BF ) , gestational weight gain , and infant birth weight . The intention to treat principles were utilized by the analyses . Results The measurements were obtained from 807 ( 74.7 % ) women in the Lifestyle Advice Group and 775 ( 72.3 % ) women in the St and ard Care Group . There were no statistically significant differences identified between the treatment groups with regards to arm circumference , biceps , triceps , and subscapular SFTM , or percentage BF at 36‐week gestation . Maternal anthropometric measurements were not significantly correlated with either gestational weight gain or infant birth weight . Conclusions Among pregnant women with a BMI of ≥25 kg/m2 , maternal SFTM were not modified by an antenatal dietary and lifestyle intervention . Furthermore , maternal SFTM correlate poorly with both gestational weight gain and infant birth weight 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 The aim of this study was to examine the predictors of change in intensity-specific leisure-time physical activity ( LTPA ) during pregnancy , and the perceived support and barriers of LTPA in Finnish pregnant women at increased risk of gestational diabetes . The study population consisted of 399 pregnant women who participated in a r and omized controlled trial aim ing to prevent gestational diabetes . Evaluation of LTPA was based on a self-report at baseline , 26–28 , and 36–37 weeks ’ gestation . Data on predictors of change , perceived support and barriers were collected with question naires and from the maternity cards . Multinomial logistic regression was used to assess associations between the variables . The average weekly minutes of light-intensity LTPA were 179 at baseline , 161 at 26–28 weeks ’ gestation , and 179 at 36–37 weeks ’ gestation . The corresponding minutes of moderate-to-vigorous-intensity LTPA were 187 , 133 and 99 . At 26–28 weeks ’ gestation , the strongest predictors for light-intensity LTPA were meeting the PA recommendations prior to pregnancy , having polytechnic education and working part-time , while having a physically active spouse prior to pregnancy was the strongest predictor for moderate-to-vigorous-intensity LTPA . The people and /or factors that encouraged women to LTPA the most were the spouse , a child , other family members and weather , whereas tiredness , nausea , perceived health , work and lack of time restricted their LTPA the most . The strongest predictors for maintaining LTPA during pregnancy were pre-pregnancy LTPA , education , working part-time and a spouse ’s LTPA . Most common barriers were perceived health , work and lack of time OBJECTIVE The use of the new International Association of the Diabetes and Pregnancy Study Groups criteria ( IADPSGC ) for the diagnosis of gestational diabetes mellitus ( GDM ) results in an increased prevalence of GDM . Whether their introduction improves pregnancy outcomes has yet to be established . We sought to evaluate the cost-effectiveness of one-step IADPSGC for screening and diagnosis of GDM compared with traditional two-step Carpenter-Coustan ( CC ) criteria . RESEARCH DESIGN AND METHODS GDM risk factors and pregnancy and newborn outcomes were prospect ively assessed in 1,750 pregnant women from April 2011 to March 2012 using CC and in 1,526 pregnant women from April 2012 to March 2013 using IADPSGC between 24 and 28 weeks of gestation . Both groups received the same treatment and follow-up regimes . RESULTS The use of IADPSGC result ed in an important increase in GDM rate ( 35.5 % vs. 10.6 % ) and an improvement in pregnancy outcomes , with a decrease in the rate of gestational hypertension ( 4.1 to 3.5 % : −14.6 % , P < 0.021 ) , prematurity ( 6.4 to 5.7 % : −10.9 % , P < 0.039 ) , cesarean section ( 25.4 to 19.7 % : −23.9 % , P < 0.002 ) , small for gestational age ( 7.7 to 7.1 % : −6.5 % , P < 0.042 ) , large for gestational age ( 4.6 to 3.7 % : −20 % , P < 0.004 ) , Apgar 1-min score < 7 ( 3.8 to 3.5 % : −9 % , P < 0.015 ) , and admission to neonatal intensive care unit ( 8.2 to 6.2 % : −24.4 % , P < 0.001 ) . Estimated cost savings was of € 14,358.06 per 100 women evaluated using IADPSGC versus the group diagnosed using CC . CONCLUSIONS The application of the new IADPSGC was associated with a 3.5-fold increase in GDM prevalence in our study population , as well as significant improvements in pregnancy outcomes , and was cost-effective . Our results support their adoption Background Excessive gestational weight gain ( GWG ) is associated with elevated weight retention in mothers and might be related to adiposity of their offspring . Little is known if lifestyle intervention during pregnancy has beneficial effects for mothers and children beyond gestation . Methods A cluster-r and omized controlled intervention trial was performed with 250 pregnant women in 8 gynaecological practice s.  Lifestyle intervention was carried out twice with individual counselling sessions on nutrition , physical activity and weight monitoring . Participants in the control group received routine prenatal care and an information leaflet . Follow-up data of women and their offspring were collected one year postpartum ( pp ) by phone call and /or via e-mail using a structured question naire . Maternal weight retention at 12 months pp and weight development of the children in their first year of life was compared between groups using linear regression . The association between energy and macronutrient intake during pregnancy with maternal weight retention and children weight development was also assessed . Results The intervention result ed in a trend towards lower mean weight retention 12 months pp ( 0.2 vs. 0.8 kg ) , but was not statistically significant ( p = 0.321 ) . Among women receiving lifestyle counselling , only 8 % retained more than 5 kg weight while 17 % in the control group retained > 5 kg ( OR : 0.40 ( 95 % CI : 0.16 , 0.97 ) ) . For the whole study cohort , an association between higher GWG and increased 12 month weight retention was found ( 0.4 kg weight retention per 1 kg increase in GWG , p < 0.001 ) . Weight development of the infants did not differ between groups in the first months after birth . At the 10th–12th month weight measurement , infants born to mothers in the intervention group tended towards lower body weights . Both energy intake and macronutrient composition of the diet during pregnancy did not affect maternal weight retention and weight development of the infants . Conclusions Lifestyle counselling during pregnancy to avoid GWG had a rather modest effect on maternal pp weight retention and weight development of the infants . However , larger intervention studies and longer follow-up are required to be able to draw definite conclusions .Trial registration German Clinical Trials Register DRKS00003801 OBJECTIVE Ways to prevent gestational diabetes mellitus ( GDM ) remain unproven . We compared the impact of three lifestyle interventions ( healthy eating [ HE ] , physical activity [ PA ] , and both HE and PA [ HE+PA ] ) on GDM risk in a pilot multicenter r and omized trial . RESEARCH DESIGN AND METHODS Pregnant women at risk for GDM ( BMI ≥29 kg/m2 ) from nine European countries were invited to undertake a 75-g oral glucose tolerance test before 20 weeks ' gestation . Those without GDM were r and omized to HE , PA , or HE+PA . Women received five face-to-face and four optional telephone coaching sessions , based on the principles of motivational interviewing . A gestational weight gain ( GWG ) < 5 kg was targeted . Coaches received st and ardized training and an intervention toolkit . Primary outcome measures were GWG , fasting glucose , and insulin sensitivity ( HOMA ) at 35–37 weeks . RESULTS Among the 150 trial participants , 32 % developed GDM  by 35–37 weeks and 20 % achieved GWG < 5 kg . HE women had less GWG ( −2.6 kg [ 95 % CI −4.9 , −0.2 ] ; P = 0.03 ) and lower fasting glucose ( −0.3 mmol/L [ −0.4 , −0.1 ] ; P = 0.01 ) than those in the PA group at 24–28 weeks . HOMA was comparable . No significant differences between HE+PA and the other groups were observed . CONCLUSIONS An antenatal HE intervention is associated with less GWG and lower fasting glucose compared with PA alone . These findings require a larger trial for confirmation but support the use of early HE interventions in obese pregnant women The aim of this study was to evaluate the association between fast food consumption and  gestational diabetes mellitus ( GDM ) among Tehranian women . This study was conducted over a 17-month period , on a r and om sample of pregnant women ( n = 1026 ) , aged 18–45 years , attending prenatal clinics in five hospitals affiliated with universities of medical sciences , located in different districts of Tehran , Iran .  Dietary data were collected during gestational age ≤6 weeks , using a 168-item valid and reliable food frequency question naire . Consumption of total fast foods including hamburgers , sausages , bologna ( beef ) , pizza and French fries was calculated . Between 24 and 28 weeks of gestation , all pregnant women underwent a scheduled 100 g 3 h oral glucose tolerance test . GDM was defined according to the American Diabetes Association definition . The mean age and pre-pregnancy body mass index BMI of participants were 26.7 ± 4.3 years and 25.4 ± 4.5 Kg/m2 , respectively . A total of 71 women developed GDM . After adjustment for confounders , the OR ( 95 % CI ) for GDM for total fast food consumption was 2.12 ( 1.12–5.43 ) and for French fries it was 2.18 ( 1.05–4.70 ) . No significant association was found  between hamburgers , sausages , bologna ( beef ) , pizza and GDM .  Fast food consumption in women of reproductive age was found to have undesirable effects in the prevalence of GDM Background Gestational diabetes mellitus ( GDM ) is an increasing problem world-wide . Lifestyle interventions and /or vitamin D supplementation might help prevent GDM in some women . Methods / design Pregnant women at risk of GDM ( BMI ≥29 ( kg/m2 ) ) from 9 European countries will be invited to participate and consent obtained before 19 + 6 weeks of gestation . After giving informed consent , women without GDM will be included ( based on IADPSG criteria : fasting glucose<5.1mmol ; 1 hour glucose < 10.0 mmol ; 2 hour glucose < 8.5 mmol ) and r and omized to one of the 8 intervention arms using a 2 × (2 × 2 ) factorial design : ( 1 ) healthy eating ( HE ) , 2 ) physical activity ( PA ) , 3 ) HE+PA , 4 ) control , 5 ) HE+PA+vitamin D , 6 ) HE+PA+placebo , 7 ) vitamin D alone , 8) placebo alone ) , pre-stratified for each site . In total , 880 women will be included with 110 women allocated to each arm . Between entry and 35 weeks of gestation , women allocated to a lifestyle intervention will receive 5 face-to-face , and 4 telephone coaching sessions , based on the principles of motivational interviewing . The lifestyle intervention includes a discussion about the risks of GDM , a weight gain  target < 5 kg and either 7 healthy eating ‘ messages ’ and /or 5 physical activity ‘ messages ’ depending on r and omization . Fidelity is monitored by the use of a personal digital assistance ( PDA ) system . Participants r and omized to the vitamin D intervention receive either 1600 IU vitamin D or placebo for daily intake until delivery . Data is collected at baseline measurement , at 24–28 weeks , 35–37 weeks of gestation and after delivery . Primary outcome measures are gestational weight gain , fasting glucose and insulin sensitivity , with a range of obstetric secondary outcome measures including birth weight . Discussion DALI is a unique Europe-wide r and omised controlled trial , which will gain insight into preventive measures against the development of GDM in overweight and obese women . Trial registration IS RCT Background Excessive gestational weight gain can result in poor maternal and child health outcomes . Estimates from single studies indicate the prevalence of excessive gestational weight gain in Australia could lie between 38 and 67 % . The risk of excessive weight gain can be reduced through healthy eating and exercise . We describe the rationale and methods of the Get Healthy in Pregnancy Service , a trial service which aims to support women in achieving appropriate gestational weight gain through an existing telephone-based health coaching service . Methods / Design This study aims to compare the effectiveness of a telephone-based health coaching program versus provision of information only in supporting pregnant women to achieve appropriate gestational weight gain . A pragmatic stratified clustered r and omised controlled trial will be conducted with 710 women who present to 5 hospitals for their first antenatal appointment during the recruitment period ( 6–8 months ) , have a pre-pregnancy body mass index ( BMI ) ≥ 18.50 ( healthy weight or above ) , are 18 years and over , singleton gestation , English speaking , have no pre-existing medical conditions that may limit their ability to exercise or require a restricted diet and are 18 weeks or less gestation . Hospitals will be r and omised into one of two intervention models : a ) information only ; or b ) information plus 10 telephone-based health coaching sessions with a university qualified coach . Both interventions will set a weight-range target with pregnant women . The women attending antenatal clinics at participating hospitals will be screened at their initial hospital appointment to assess their eligibility . Women recruited to the trial will have a number of measures recorded including anthropometrics ( self-reported height and weight ) and dietary and physical activity scores during and following pregnancy . These measurements will be collected at baseline ( prior to 18 weeks gestation ) , 36 weeks gestation and 12 months post-birth . Discussion This study responds to a need for an effective intervention that targets excessive gestational weight gain at a population level . This study investigates the potential for an innovative intervention combining two existing services ; a free state-wide telephone-based health coaching service and hospital-based antenatal care to support pregnant women to achieve healthy weight gain during pregnancy . The use of existing services provides the potential for immediate post- study implementation . While the impacts of telephone-based lifestyle programmes have been tested in a number of setting s , there are few studies which evaluate the effectiveness and acceptability of telephone support in achieving healthy gestational weight gain in association with routine antenatal care . Trial registration ACTRN12615000397516 ( Registration date : 26 June 2014 , retrospectively registered ) Abstract Background The Australian Carbohydrate Intolerance Study in Pregnant Women ( ACHOIS ) showed that treatment of pregnant women with mild gestational diabetes mellitus is beneficial for both women and their infants . It is still uncertain whether there are benefits of similar treatment for women with borderline gestational diabetes . This trial aims to assess whether dietary and lifestyle advice and treatment given to pregnant women who screen for borderline gestational diabetes reduces neonatal complications and maternal morbidities . Methods / design Design : Multicentre , r and omised controlled trial . Inclusion criteria : Women between 240 and 346 weeks gestation with a singleton pregnancy , a positive oral glucose challenge test ( venous plasma glucose ≥7.8 mmol/L ) and a normal oral 75 gram glucose tolerance test ( fasting venous plasma glucose < 5.5 mmol/L and a 2 hour glucose < 7.8 mmol/L ) with written , informed consent . Trial entry and r and omisation : Women with an abnormal oral glucose tolerance test ( fasting venous plasma glucose ≥5.5 mmol/L or 2 hour glucose ≥7.8 mmol/L ) will not be eligible and will be offered treatment for gestational diabetes , consistent with recommendations based on results of the ACHOIS trial . Eligible women will be r and omised into either the ‘ Routine Care Group ’ or the ‘ Intervention Group ’ . Study groups : Women in the ‘ Routine Care Group ’ will receive routine obstetric care reflecting current clinical practice in Australian hospitals . Women in the ‘ Intervention Group ’ will receive obstetric care , which will include dietary and lifestyle advice , monitoring of blood glucose and further medical treatment for hyperglycaemia as appropriate . Primary study outcome : Incidence of large for gestational age infants . Sample size : A sample size of 682 women will be sufficient to show a 50 % reduction in the risk of large for gestational age infants ( alpha 0.05 two-tailed , 80 % power , 4 % loss to follow up ) from 14 % to 7 % with dietary and lifestyle advice and treatment . Discussion A conclusive trial outcome will provide reliable evidence of relevance for the care of women with borderline glucose intolerance in pregnancy and their infants . Trial registration Australian New Zeal and Clinical Trials Registry - Background The purpose of this study is to assess use of a booklet by pregnant women to record and assist dietary and lifestyle changes ; to describe diet and exercise goals set during the initial lifestyle discussion s ; and to assess achievement of goals . Methods Participants were women with borderline gestational diabetes who received a printed pregnancy record booklet , as part of a r and omised trial , to record and set monthly goals for diet and exercise . Outcomes included women ’s use of the booklets and their achievement of dietary and exercise goals after 1 month . Results Fifty-six women returned their used pregnancy record booklets  and were included in this study . These women set a total of 197 dietary goals and 65 exercise goals . In the first month , over 80 % of dietary goals that targeted grains , dairy and overall diet were achieved , but only 20–30 % of goals about vegetables , and foods high in fat , sugar and /or salt were achieved . After 1 month , women had achieved 86.4 % of their exercise goals to maintain their current level of activity , but only 25.0 % exercise goals to increase walking during pregnancy . Conclusions Women who used pregnancy record booklets reported good achievement rates for goals related to grains , fruits , dairy and overall diet , but they were less likely to be successful in achieving goals to increase intake of vegetables , and limit foods that high in fat , sugar and /or salt . Maintaining an active lifestyle during pregnancy was feasible for women although increases in physical activity were less often achieved . Using a pregnancy record booklet may be helpful in assisting and encouraging behavioural changes , although further investigations of long-term effects and in different population s are warranted Background We conducted a nested r and omised trial to evaluate the effect of an educational DVD , providing information about healthy food choices and exercise during pregnancy , on diet and physical activity , among pregnant women who were overweight or obese . Methods We conducted a nested r and omised trial within the context of the LIMIT r and omised trial . Women were eligible with a singleton pregnancy between 10 and 20 weeks gestation , and body mass index at the time of their first antenatal appointment of ≥25 kg/m2 . All women who were r and omised to the Lifestyle Advice Group of the LIMIT trial  received a series of consultations with both research dieticians and research assistants , in addition to st and ard written dietary and exercise material s ( St and ard Material s Group ) . Women r and omised to the DVD Group received the same consultations and written material s , and additionally received an educational DVD ( DVD Group ) . The primary study outcome was the Healthy Eating Index . Other study outcomes included physical activity , and gestational weight gain . Women completed a qualitative evaluation of all the material s provided . Results 1,108 women in the LIMIT Lifestyle Advice Group participated in the nested trial , with 543 women r and omised to the DVD Group , and 565 women to the St and ard Material s Group . Women who received the DVD compared with those who did not , had a higher mean Healthy Eating Index at 36 weeks gestation ( 73.6 vs 72.3 ; adjusted mean difference 1.2 ; 95 % CI 0.2 to 2.3 ; p = 0.02 ) , but not at 28 weeks gestation ( 73.2 vs 73.5 ; adjusted mean difference −0.1 ; 95 % CI −1.1 to 0.9 ; p = 0.82 ) . There were no statistically significant differences in physical activity or total gestational weight gain . While most women evaluated the material s positively , frequency of utilisation was poor . Conclusions Ongoing attention to the delivery of information is required , particularly with the increased use and availability of digital and multi-media interactive technologies . Trial registration Australian and New Zeal and Clinical Trials Registry Background Recent studies suggest that excessive gestational weight gain ( GWG ) leads to adverse maternal and fetal outcomes including weight retention in the mother and an increased risk of childhood obesity in the offspring . The aim of the GeliS study is to examine the effect of a lifestyle intervention programme during pregnancy to avoid excessive GWG and , hence , to reduce pregnancy and obstetric complications as well as the risk of maternal and offspring obesity . Methods and design The GeliS study is a multicentre cluster-r and omized controlled trial . A total number of 2500 pregnant women ( singleton pregnancy ) with a pre-pregnancy BMI ≥ 18.5 kg/m2 and ≤ 40 kg/m2 will be recruited in practice s of gynaecologists and midwives in ten Bavarian regions . The intervention comprises three structured and individualised counselling sessions on a healthy diet , regular physical activity as well as weight monitoring during pregnancy and one session after delivery , respectively . The counselling sessions are attached to routine pre- and postnatal visits using st and ardised material s and procedures . In the control regions , general recommendations for a healthy lifestyle are given . An oral glucose tolerance test is offered to all participants .The primary outcome is the proportion of participants with excessive GWG . Secondary outcomes include pregnancy and obstetric complications such as frequency of gestational diabetes , preeclampsia and caesarean sections as well as weight retention in the mothers and BMI and other health variables in the offspring . A 5-year follow-up of both mothers and their infants is planned . Discussion The GeliS lifestyle intervention programme has been adapted to the existing routine health care system for pregnant women . If shown to be effective , it could be immediately implemented in routine care . Trial registration The study protocol is registered at the Clinical Trials.gov Protocol Registration System ( NCT01958307 ) Objective Evidence is lacking regarding effective weight control treatments in pregnancy for ethnic minority women with obesity . This study evaluated whether a technology-based , behavioral intervention could decrease the proportion of overweight or obese African American women who exceeded Institute of Medicine ( IOM ) guidelines for  gestational weight gain . Methods We conducted a 2-arm pilot r and omized clinical trial . Participants were 66 socioeconomically disadvantaged African American pregnant women ( 12.5 ± 3.7 weeks ’ gestation ; 36 % overweight , 64 % obese ) recruited from 2 outpatient obstetric practice s at Temple University between 2013 and 2014 . We r and omized participants to usual care ( n = 33 ) or a behavioral intervention ( n = 33 ) that promoted weight control in pregnancy . The intervention included : 1 ) empirically-supported behavior change goals ; 2 ) interactive self-monitoring text messages ; 3 ) biweekly health coach calls ; and 4 ) skills training and support through Facebook . Results The intervention reduced the proportion of women who exceeded IOM guidelines compared to usual care ( 37 % vs. 66 % , p = 0.033 ) . Intervention participants gained less weight during pregnancy ( 8.7 vs. 12.3 kg , adjusted mean difference −3.1 kg , 95 % CI −6.2 , −0.1 ) . No group differences in neonatal or obstetric outcomes were found . Conclusions The intervention result ed in lower prevalence of excessive gestational weight gain 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 Background The proportion of women entering pregnancy overweight or obese has been rising and , in turn , is associated with adverse maternal and fetal outcomes . Gestational weight gain ( GWG ) exceeding Institute of Medicine ( IOM ) guidelines further increases health risks and has been independently associated with postpartum weight retention . Hispanic women are disproportionately affected by overweight and obesity , but have had limited access to interventions that promote healthy lifestyles due to cultural , socioeconomic , and language barriers . Therefore , the overall goal of this r and omized controlled trial is to test the efficacy of a culturally and linguistically modified , individually-tailored lifestyle intervention to reduce excess GWG , increase postpartum weight loss , and improve maternal metabolic status among overweight/obese Hispanic women . Methods / Design Overweight/obese Hispanic women are recruited in early pregnancy and r and omly assigned to a Lifestyle Intervention ( n = 150 ) or a Comparison Health and Wellness ( control ) intervention ( n = 150 ) . Multimodal contacts ( i.e. , in-person , telephone counseling , and mailed print-based material s ) are used to deliver the intervention from early pregnancy ( 12 weeks gestation ) to 6 months postpartum , with follow-up to 1 year postpartum . Targets of the intervention are to achieve IOM Guidelines for GWG and postpartum weight loss ; American Congress of Obstetrician and Gynecologist guidelines for physical activity ; and American Diabetes Association guidelines for diet . The intervention draws from Social Cognitive Theory and the Transtheoretical Model and includes strategies to address the specific social , cultural , and economic challenges faced by low-income Hispanic women . Assessment s are conducted at baseline ( ~10 weeks gestation ) , mid pregnancy ( 24–28 weeks gestation ) , late pregnancy ( 32–34 weeks gestation ) and postpartum at 6-weeks , 6-months , and 12-months by bicultural and bilingual personnel blinded to the intervention arm . Efficacy is assessed via GWG , postpartum weight loss , and biomarkers of glycemic control , insulin resistance , and cardiovascular disease risk factors . Changes in physical activity and diet are measured via 7-day accelerometer data and 24-h dietary recalls at each assessment time period . Discussion Hispanic women are the fastest growing minority group in the U.S. and are disproportionately affected by overweight and obesity . This r and omised trial uses a high-reach , low-cost strategy that can readily be translated into clinical practice in underserved and minority population s . Trial registration NCT01868230 May 29 , This study examined psychosocial and sociodemographic factors associated with pregnant women ’s use of Web-based tools to set and monitor personal goals for healthy diet and physical activity . These tools were made available to women participating in a r and omized trial testing a Web-based intervention to promote appropriate gestational weight gain . We used data from a baseline survey of pregnant women assigned to the intervention group and log data on women ’s use of various intervention features ( N = 873 ) . Women who believed that appropriate gestational weight gain would lead to healthy outcomes for their child were more likely to engage in online goal - setting and self-monitoring . Less positive outcome expectancy beliefs about the relationship between their own weight and baby ’s health partially explains why some at risk sub population s ( e.g. , African-American women ) were less likely to utilize online self-regulatory tools . This study specifies key psychosocial and motivational factors that guide the construction and monitoring of goals among pregnant women . These findings offer guidance for the design of interventions to promote self-regulatory techniques by identifying groups for whom those features are most likely to be useful , as well as psychological determinants of their use Background The objectives of this study were to assess the efficacy of lifestyle intervention on gestational weight gain in pregnant women with normal and above normal body mass index ( BMI ) in a r and omized controlled trial . Methods A total of 116 pregnant women ( < 20 weeks of pregnancy ) without diabetes were enrolled and 113 pregnant women completed the program . Participants were r and omized into intervention and control groups . Women in the intervention group received weekly trainer-led group exercise sessions , instructed home exercise for 3 - 5-times/week during 20 - 36 weeks of gestation , and dietary counseling twice during pregnancy . Participants in the control group did not receive the intervention . All participants completed a physical activity question naire and a 3-day food record at enrolment and 2 months after enrolment . Results The participants in the intervention group with normal pre-pregnancy BMI ( ≤24.9 kg/M2 , n = 30 ) had lower gestational weight gain ( GWG ) , offspring birth weight and excessive gestational weight gain ( EGWG ) on pregnancy weight gain compared to the control group ( n = 27 , p < 0.05 ) . Those weight related-changes were not detected between the intervention ( n = 27 ) and control group ( n = 29 ) in the above normal pre-pregnancy BMI participants . Intervention reduced total calorie , total fat , saturated fat and cholesterol intake were detected in women with normal or above normal pre-pregnancy BMI compared to the control group ( p < 0.05 or 0.01 ) . Increased physical activity and reduced carbohydrate intake were detected in women with normal ( p < 0.05 ) , but not above normal , pre-pregnancy BMI at 2 months after the onset of the intervention compared to the control group . Conclusion The results of the present study demonstrated that the lifestyle intervention program decreased EGWG , GWG , offspring birth weight in pregnant women with normal , but not above normal , pre-pregnancy BMI , which was associated with increased physical activity and decreased carbohydrate intake . Trial registration Aims The aim was to evaluate the cost-effectiveness of primary prevention of gestational diabetes mellitus ( GDM ) through intensified counselling on physical activity , diet , and appropriate weight gain among the risk group . Material s and Methods The cost-effectiveness analysis was based on data from a cluster-r and omised controlled GDM prevention trial carried out in primary health-care maternity clinics in Finl and . Women ( n = 399 ) with at least one risk factor for GDM were included .  The incremental cost-effectiveness ratio ( ICER ) was calculated in terms of birth weight , 15D , and perceived health as measured with a visual analogue scale ( VAS ) . A bootstrap technique for cluster-r and omised sample s was used to estimate uncertainty around a cost-effectiveness acceptability curve . Results The mean total cost in the intervention group was € 7,763 ( st and ard deviation ( SD ) : € 4,511 ) and in the usual-care group was € 6,994 ( SD : € 4,326 , p = 0.14 ) . The mean intervention cost was € 141 . The difference for costs in the birth-weight group was € 753 ( 95 % CI : −250 to 1,818 ) and in effects for birth weight was 115 g ( 95 % CI : 15 to 222 ) . The ICER for birth weight was almost € 7 , with 86.7 % of bootstrap pairs located in the north-east quadrant , indicating that the intervention was more effective and more expensive in birth weight terms than the usual care was . The data show an 86.7 % probability that each gram of birth weight avoided requires an additional cost of € 7 . Conclusions Intervention was effective for birth weight but was not cost-effective for birth weight , 15D , or VAS when compared to the usual care . Trial Registration IS RCT N 33885819 Background The purpose of the study is to examine the effects and feasibility of individual physical activity ( PA ) counseling in maternity and child health clinics in Finl and . Methods Three clinics including both maternity and child health care signed up for the experimental ( EXP ) and three for the control group ( CON ) . The participants were 132 pregnant and 92 postpartum primiparas . The nurses in EXP integrated a primary and four booster PA counseling sessions into routine visits . An option for supervised group exercise was offered . In CON former practice s , usually including brief PA advice , were continued .  Leisure-time PA ( LTPA ) prior to pregnancy was elicited by question naire and followed 16–18 and 36–37 weeks ' gestation in maternity clinics and 5 and 10 months postpartum in child health clinics . Feasibility included safety , participant responsiveness , realization of counseling and applicability . Results According to analysis of covariance adjusted for baseline LTPA and possible confounders , no relative between-group differences in LTPA were found at the first follow-up in either maternity or child health clinics . At the last follow-up in maternity clinics the weekly number of at least moderate-intensity LTPA days was 43 % ( 95 % CI : 9 , 87 ) higher and the weekly duration of at least moderate-intensity LTPA 154 % ( 95 % CI : 16 , 455 ) higher in EXP compared with CON . Counseling proved feasible in both maternity and child health clinics . Conclusion Counseling  encouraged pregnant women to sustain their moderate-intensity LTPA and was feasible in routine practice s. No effects were observed if counseling was initiated postpartum . Trial registration Current Controlled Trials IS RCT Objectives : R and omised controlled trials are required to address causality in the reported associations between maternal influences and offspring adiposity . The aim of this study was to determine whether an antenatal lifestyle intervention , associated with improvements in maternal diet and reduced gestational weight gain ( GWG ) in obese pregnant women leads to a reduction in infant adiposity and sustained improvements in maternal lifestyle behaviours at 6 months postpartum . Subjects and methods : We conducted a planned postnatal follow-up of a r and omised controlled trial ( UK Pregnancies Better Eating and Activity Trial ( UPBEAT ) ) of a complex behavioural intervention targeting maternal diet ( glycaemic load ( GL ) and saturated fat intake ) and physical activity in 1555 obese pregnant women . The main outcome measure was infant adiposity , assessed by subscapular and triceps skinfold thicknesses . Maternal diet and physical activity , indices of the familial lifestyle environment , were assessed by question naire . Results : A total of 698 ( 45.9 % ) infants ( 342 intervention and 356 st and ard antenatal care ) were followed up at a mean age of 5.92 months . There was no difference in triceps skinfold thickness z-scores between the intervention vs st and ard care arms ( difference −0.14 s.d . , 95 % confidence interval −0.38 to 0.10 , P=0.246 ) , but subscapular skinfold thickness z-score was 0.26 s.d . ( −0.49 to −0.02 ; P=0.03 ) lower in the intervention arm . Maternal dietary GL ( −35.34 ; −48.0 to −22.67 ; P<0.001 ) and saturated fat intake ( −1.93 % energy ; −2.64 to −1.22 ; P<0.001 ) were reduced in the intervention arm at 6 months postpartum . Causal mediation analysis suggested that lower infant subscapular skinfold thickness was partially mediated by changes in antenatal maternal diet and GWG rather than postnatal diet . Conclusions : This study provides evidence from follow-up of a r and omised controlled trial that a maternal behavioural intervention in obese pregnant women has the potential to reduce infant adiposity and to produce a sustained improvement in maternal diet at 6 months postpartum AIMS To pilot the feasibility of a prenatal lifestyle intervention to modify physical activity and diet among pregnant overweight and obese Hispanic women , with the aim of reducing risk factors for gestational diabetes mellitus . METHODS Women were r and omized either to a  lifestyle intervention ( n = 33 , 48.5 % ) , consisting of a culturally and linguistically modified , motivationally targeted , individually tailored 6-month prenatal programme , or to st and ard care  ( n = 35 , 51.5 % ) . Bilingual and bicultural health educators encouraged women to achieve guidelines for physical activity , decrease saturated fat and increase dietary fibre . Outcomes included gestational weight gain , infant birth weight and biomarkers associated with insulin resistance . RESULTS Patient retention up to delivery was 97 % in both study groups . The lifestyle intervention attenuated the pregnancy-associated decline in moderate-intensity physical activity , but differences between groups were not significant ( mean ± se -23.4 ± 16.6 vs -27.0 ± 16.2 metabolic equivalent of task h/week ; P = 0.88 ) . Vigorous-intensity activity increased during the course of pregnancy in the lifestyle intervention group ( mean ± se 1.6 ± 0.8 metabolic equivalent of task h/week ) and declined in the st and ard care group ( -0.8 ± 0.8 metabolic equivalent of task h/week ; P = 0.04 ) . The lifestyle intervention group also had slightly lower gestational weight gain and infant birth weights compared with the st and ard care group ; however , these differences were not statistically significant . There were no statistically significant differences in biomarkers of insulin resistance between groups . CONCLUSIONS Findings suggest that a motivationally matched lifestyle intervention is feasible and may help attenuate pregnancy-related decreases in vigorous physical activity in a population of overweight and obese Hispanic women . The intervention protocol can readily be translated into clinical practice in underserved and minority population BACKGROUND Type 2 diabetes mellitus is increasingly common , primarily because of increases in the prevalence of a sedentary lifestyle and obesity . Whether type 2 diabetes can be prevented by interventions that affect the lifestyles of subjects at high risk for the disease is not known . METHODS We r and omly assigned 522 middle-aged , overweight subjects ( 172 men and 350 women ; mean age , 55 years ; mean body-mass index [ weight in kilograms divided by the square of the height in meters ] , 31 ) with impaired glucose tolerance to either the intervention group or the control group . Each subject in the intervention group received individualized counseling aim ed at reducing weight , total intake of fat , and intake of saturated fat and increasing intake of fiber and physical activity . An oral glucose-tolerance test was performed annually ; the diagnosis of diabetes was confirmed by a second test . The mean duration of follow-up was 3.2 years . RESULTS The mean ( + /-SD ) amount of weight lost between base line and the end of year 1 was 4.2+/-5.1 kg in the intervention group and 0.8+/-3.7 kg in the control group ; the net loss by the end of year 2 was 3.5+/-5.5 kg in the intervention group and 0.8+/-4.4 kg in the control group ( P<0.001 for both comparisons between the groups ) . The cumulative incidence of diabetes after four years was 11 percent ( 95 percent confidence interval , 6 to 15 percent ) in the intervention group and 23 percent ( 95 percent confidence interval , 17 to 29 percent ) in the control group . During the trial , the risk of diabetes was reduced by 58 percent ( P<0.001 ) in the intervention group . The reduction in the incidence of diabetes was directly associated with changes in lifestyle . CONCLUSIONS Type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects 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 BACKGROUND : The Institute of Medicine ( IOM ) recommends that normal‐weight women ( BMI ( body mass index ) of 19.8–26.0 ) gain 25–35 lb ( 11.4–15.9 kg ) during pregnancy , and that overweight women ( BMI of 26.1–29.0 ) gain 15–25 lbs ( 6.8–11.4 kg ) . A significant number of normal‐weight women and an even greater proportion of overweight women exceed these guidelines , which increases postpartum weight retention and may contribute to the development of obesity . OBJECTIVE : To determine whether a stepped care , behavioral intervention will decrease the percentage of women who gain more than the IOM recommendation . DESIGN : R and omized controlled trial comparing a stepped-care behavioral intervention with usual care .  Women ( n=120 ) who had a BMI > 19.8 , age>18 and < 20 weeks gestation were recruited from a hospital-based clinic serving low-income women and r and omized by race and BMI category to the intervention or control group . The intervention group received education about weight gain , healthy eating , and exercise and individual graphs of their weight gain . Those exceeding weight gain goals were given more intensive intervention . Women were followed through pregnancy to their first postpartum clinic visit . The main outcome measure was weight gain during pregnancy categorized as above the IOM recommendations vs below or within the IOM recommendations . RESULTS : The intervention significantly decreased the percentage of normal-weight women who exceeded the IOM recommendations ( 33 vs 58 % , P<0.05 ) . There was a non-significant ( P=0.09 ) effect in the opposite direction among overweight women ( 59 % of intervention and 32 % of control gained more than recommended ) . Postpartum weight retention was strongly related to weight gain during pregnancy ( r=0.89 ) . CONCLUSIONS : The intervention reduced excessive weight gain during pregnancy among normal weight women 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 Background . Pregnancy is an opportune time to initiate diabetes prevention strategies for minority and underserved women , using culturally tailored interventions delivered by community health workers . A community-partnered r and omized controlled trial ( RCT ) with pregnant Latino women result ed in significantly improved vegetable , fiber , added sugar , and total fat consumption compared to a minimal intervention group . However , study ing RCT intervention effects alone does not explain the mechanisms by which the intervention was successful or help identify which participants may have benefitted most . Purpose . To improve the development and targeting of future community health worker interventions for high-risk pregnant women , we examined baseline characteristics ( moderators ) and potential mechanisms ( mediators ) associated with these dietary changes . Method . Secondary analysis of data for 220 Latina RCT participants was conducted . A linear regression with effects for intervention group , moderator , and interaction between intervention group and moderator was used to test each hypothesized moderator of dietary changes . Sobel – Goodman mediation test was used to assess mediating effects on dietary outcomes . Results . Results varied by dietary outcome . Improvements in vegetable consumption were greatest for women who reported high spousal support at baseline . Women younger than age 30 were more likely to reduce added sugar consumption than older women . Participants who reported higher baseline perceived control were more likely to reduce fat consumption . No examined mediators were significantly associated with intervention effects . Conclusion . Future interventions with pregnant Latinas may benefit from tailoring dietary goals to consider age , level of spousal support , and perceived control to eat healthy Background : Abnormal weight gain during pregnancy increases the adverse health outcomes during the pregnancy , delivery , and the postpartum period . Most of the pregnant women develop weight gain more than the recommended limits ; therefore , interventions to manage such disproportionate weight gain are needed . In this paper , the design of the maternal centered life-style intervention study is described , which focuses on controlling weight gaining during pregnancy for all body mass index ( BMI ) groups . Material s and Methods : In our r and omized field trial , 160 pregnant women with 6 - 10 weeks of gestational age who visit one of the participating Isfahan four urban public-health centers and 4 private obstetric offices are included . The maternal centered life-style intervention carried out by trained midwives is st and ardized in a protocol . All the participants are visited at 6 - 10 , 11 - 15 , 16 - 20 , 21 - 25 , 26 - 30 , 31 - 34 , 35 - 37 , 38 , 39 , and 40 weeks of pregnancy . The women who are r and omized in the intervention group receive maternal centered educational package of prenatal care for the pregnant woman and a log book in the first visit . Counselors accompany the pregnant women to maintain or develop  a healthy life-style . Data collection will perform monthly measuring body weight , BMI . Conclusion : Because , we do n’t have structured protocol for weight management during pregnancy especially , in private sectors if the maternal centered life-style intervention proves to be effective , it will be suggested to merge this package to routine care . Therewith by empowering women to manage their weight the public-health burden can be reduced . Beside that private obstetricians also have structured protocol for their client management 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 OBJECTIVE The Lifestyle Interventions for Expectant Moms ( LIFE-Moms ) Consortium is design ed to determine , in pregnant women with overweight or obesity , whether various behavioral and lifestyle interventions reduce excessive  gestational weight gain ( GWG ) and subsequent adverse maternal and neonatal outcomes and obesity in offspring . The design and planning process of the LIFE-Moms Consortium is described . METHODS The LIFE-Moms Consortium is a collaboration among seven clinical centers , a Research Coordinating Unit , and the NIH design ed to support each clinical center 's conduct of a separate trial of a unique intervention . Specific common measures , procedures , and eligibility criteria are consistent across the seven trials allowing data to be combined in exploratory analyses and /or compared readily . RESULTS Numerous committees and working groups were created to define common measures and outcomes during pregnancy and through 1 year postpartum , develop Consortium policies , and oversee progress of the trials . The primary outcome for the Consortium is excessive GWG . Secondary outcomes include maternal , neonatal , and infant anthropometric measures , physical activity , sleep , and complications of pregnancy and delivery . CONCLUSIONS A multi-center consortium of independent , lifestyle interventions with common measures and outcomes may enhance the ability to identify promising interventions for improving outcomes in pregnant women and their offspring The aim of the study was to evaluate the role of physical activity before and during pregnancy on health-related quality of life ( HRQoL ) . Data from the cluster-r and omised gestational diabetes mellitus primary prevention trial conducted in maternity clinics were utilised in a secondary analysis . The cases considered were pregnant women who reported engaging in at least 150 min of moderate-intensity leisure-time physical activity per week ( active women ) ( N = 80 ) , and the controls were women below these recommendations ( less active ) ( N = 258 ) . All participants had at least one risk factor for gestational diabetes mellitus . Their HRQoL was evaluated via the vali date d generic instrument 15D , with HRQoL at the end of pregnancy examined in relation to changes in physical activity during pregnancy . Logistic regression models addressed age , parity , education , and pre-pregnancy body mass index . At the end of pregnancy , the expected HRQoL was higher ( tobit regression coefficient 0.022 , 95 % CI 0.003–0.042 ) among active women than less active women . Active women also had greater mobility ( OR 1.98 , 95 % CI 1.04–3.78 ) , ability to h and le their usual activities ( OR 2.22 , 95 % CI 1.29–3.81 ) , and vitality ( OR 2.08 , 95 % CI 1.22–3.54 ) than did less active women . Active women reported higher- quality sleep ( OR 2.11 , 95 % CI 1.03–4.30 ) throughout pregnancy as compared to less active women . Meeting of the physical activity guidelines before pregnancy was associated with better overall HRQoL and components thereof related to physical activity 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 OBJECTIVE To examine the potential effect of low-risk pregnancy on women 's recreational activity patterns and to explore pregnant women 's beliefs and information sources regarding physical exercise participation . DESIGN Preliminary , prospect i ve survey SETTING Participants ' homes in the East Midl and s , UK . PARTICIPANTS Fifty-seven nulliparous , pregnant women . MEASUREMENTS Levels of  maternal physical activity participation were assessed by semi-structured interview at 16 , 25 , 34 and 38 weeks gestation . The modified Baecke question naire provided a measure of women 's habitual sport and leisure activities in the 12 months prior to pregnancy . A 10-item scale assessed maternal beliefs regarding the importance of physical activity in pregnancy . The fetal health locus of control scale measured the extent to which women believed their own behaviour , the behaviour of others and /or chance would influence fetal health . Open-ended questions assessed women 's information sources . FINDINGS Fourteen of the 36 ( 39 % ) women who reported participating in some form of weekly exercise before pregnancy did not report pursuing any similar activities during pregnancy .  Rest and relaxation  were perceived as being significantly more important during pregnancy than was regular exercise or the maintenance of an active lifestyle . Fifty-five respondents ( 96 % ) indicated that they had received advice about physical activity at least once during pregnancy . At 16 weeks gestation , women obtained most of their information from books and magazines . Between 25 and 38 weeks gestation , most advice came from family and friends . Participants who reported receiving this advice were significantly older , more educated and of a higher activity level pre-pregnancy . KEY CONCLUSIONS Levels of maternal exercise  may decline during pregnancy both as a result of the physical changes of pregnancy and from a combination of social and psychological factors . Present health education may be failing to correct inaccurate perceptions of the risks associated with physical exercise in pregnancy . IMPLICATION S FOR PRACTICE Improving the quantity and quality of information related to physical exercise has the potential to correct inaccurate perceptions and confer several benefits on maternal and fetal health . Effective intervention strategies should focus not only on the pregnant woman but also extend to her family , friends and exercise provider OBJECTIVES The objectives of this study were to evaluate the efficacy of a health coaching ( HC ) intervention design ed to prevent  excessive gestational weight gain ( GWG )  , and promote positive psychosocial and motivational outcomes in comparison with an Education Alone ( EA ) group . DESIGN R and omized-controlled trial . METHODS Two hundred and sixty-one women who were < 18 weeks pregnant consented to take part . Those allocated to the HC group received a tailored HC intervention delivered by a Health Coach , whilst those in the EA group attended two education sessions . Women completed measures , including motivation , psychosocial variables , sleep quality , and knowledge , beliefs and expectations concerning GWG , at 15 weeks of gestation ( Time 1 ) and 33 weeks of gestation ( Time 2 ) . Post-birth data were also collected at 2 months post-partum ( Time 3 ) . RESULTS There was no intervention effect in relation to weight gained during pregnancy , rate of excessive GWG or birth outcomes . The only differences between HC and EA women were higher readiness ( b = 0.29 , 95 % CIs = 0.03 - 0.55 , p < .05 ) and the importance to achieve a healthy GWG ( b = 0.27 , 95 % CIs = 0.02 - 0.52 , p < .05 ) , improved sleep quality ( b = -0.22 , 95 % CIs = -0.44 to -0.03 , p < .05 ) , and increased knowledge for an appropriate amount of GWG that would be best for their baby 's health ( b = -1.75 , 95 % CI = -3.26 to -0.24 , p < .05 ) reported by the HC at Time 2 . CONCLUSIONS Whilst the HC intervention was not successful in preventing excessive GWG , several implication s for the design of future GWG interventions were identified , including the burden of the intervention commitment and the use of weight monitoring . STATEMENT OF CONTRIBUTION What is already known on the subject ? Design ing interventions to address gestational weight gain ( GWG ) continues to be a challenge . To date , health behaviour change factors have not been the focus of GWG interventions . What does this study add ? Our health coaching ( HC ) intervention did not reduce GWG more so than education alone ( EA ) . There was an intervention effect on readiness and importance to achieve healthy GWG . Yet there were no group differences regarding confidence to achieve healthy GWG post-intervention OBJECTIVE To test the hypothesis that untreated partners of pregnant women receiving a prenatal lifestyle intervention ( vs. st and ard care ) would lose more weight during pregnancy and postpartum . METHODS Fit for Delivery was a study of 401 pregnant women with overweight/obesity ( OW/OB ) and normal weight ( NW ) r and omized to prenatal lifestyle intervention or st and ard care .  Mother 's self-report of partners ' weight was obtained at study entry ( < 16 weeks gestation ) , 30 weeks gestation , and 6 and 12 months postpartum . RESULTS At study entry , 157 of 200 ( 78 % ) of intervention mothers and 144 of 201 ( 72 % ) of st and ard care mothers reported having a partner . In intent-to-treat analyses , there was no significant treatment × time effects on partner weight ( P = 0.67 ) . In secondary analyses , partners of OW/OB intervention women lost weight from study entry to 6 and 12 months postpartum ( -0.5 ± 9.5 kg , -1.0 ± 9.3 kg ; P < 0.05 ) , while partners of st and ard care women gained weight during the same time frame ( + 2.5 ± 6.7 kg , + 2.9 ± 7.4 kg ; P < 0.05 ) ; adjusting for partner study entry BMI removed these effects . CONCLUSIONS Lifestyle intervention delivered to pregnant women did not significantly reduce weight of untreated partners . Future research is needed to test prenatal interventions that engage partners and use objective measures of weight BACKGROUND Intensive lifestyle interventions can reduce the incidence of  type 2 diabetes in people with impaired glucose tolerance , but how long these benefits extend beyond the period of active intervention , and whether such interventions reduce the risk of cardiovascular disease ( CVD ) and mortality , is unclear . We aim ed to assess whether intensive lifestyle interventions have a long-term effect on the risk of diabetes , diabetes-related macrovascular and microvascular complications , and mortality . METHODS In 1986 , 577 adults with impaired glucose tolerance from 33 clinics in China were r and omly assigned to either the  control group or to one of three lifestyle intervention groups ( diet , exercise , or diet plus exercise ) . Active intervention took place over 6 years until 1992 . In 2006 , study participants were followed-up to assess the long-term effect of the interventions . The primary outcomes were diabetes incidence , CVD incidence and mortality , and all-cause mortality . FINDINGS Compared with control participants , those in the combined lifestyle intervention groups had a 51 % lower incidence of diabetes ( hazard rate ratio [ HRR ] 0.49 ; 95 % CI 0.33 - 0.73 ) during the active intervention period and a 43 % lower incidence ( 0.57 ; 0.41 - 0.81 ) over the 20 year period , controlled for age and clustering by clinic . The average annual incidence of diabetes was 7 % for intervention participants versus 11 % in control participants , with 20-year cumulative incidence of 80 % in the intervention groups and 93 % in the control group . Participants in the intervention group spent an average of 3.6 fewer years with diabetes than those in the control group . There was no significant difference between the intervention and control groups in the rate of first CVD events ( HRR 0.98 ; 95 % CI 0.71 - 1.37 ) , CVD mortality ( 0.83 ; 0.48 - 1.40 ) , and all-cause mortality ( 0.96 ; 0.65 - 1.41 ) , but our study had limited statistical power to detect differences for these outcomes . INTERPRETATION Group-based lifestyle interventions over 6 years can prevent or delay diabetes for up to 14 years after the active intervention . However , whether lifestyle intervention also leads to reduced CVD and mortality remains unclear OBJECTIVE To assess whether gestational diabetes mellitus ( GDM ) can be prevented by a moderate lifestyle intervention in pregnant women who are at high risk for the disease . RESEARCH DESIGN AND METHODS Two hundred ninety-three women with a history of GDM and /or a prepregnancy BMI of ≥30 kg/m2 were enrolled in the study at < 20 weeks of gestation and were r and omly allocated to the intervention group ( n = 155 ) or the control group ( n = 138 ) . Each subject in the intervention group received individualized counseling on diet , physical activity , and weight control from trained study nurses , and had one group meeting with a dietitian . The control group received st and ard antenatal care . The diagnosis of GDM was based on a 75-g , 2-h oral glucose tolerance test at 24–28 weeks of gestation . RESULTS A total of 269 women were included in the analyses .  The incidence of GDM was 13.9 % in the intervention group and 21.6 % in the control group ( [ 95 % CI 0.40–0.98 % ] ; P = 0.044 , after adjustment for age , prepregnancy BMI , previous GDM status , and the number of weeks of gestation ) . Gestational weight gain was lower in the intervention group ( −0.58 kg [ 95 % CI −1.12 to −0.04 kg ] ; adjusted P = 0.037 ) . Women in the intervention group increased their leisure time physical activity more and improved their dietary quality compared with women in the control group . CONCLUSIONS A moderate individualized lifestyle intervention reduced the incidence of GDM by 39 % in high-risk pregnant women . These findings may have major health consequences for both the mother and the child BACKGROUND Fit for Delivery ( FFD ) is a r and omized , controlled trial of a lifestyle intervention design ed to limit weight gain and increase physical activity in pregnancy . A question naire for non- participants was included in the design of the study . METHODS Nulliparous women residing in southern Norway were invited to participate in FFD if they had a singleton pregnancy at ⩽20weeks gestation , age ⩾18years and body mass index ( BMI ) of ⩾19kg/m(2 ) . Women who declined participation were asked to complete an anonymous question naire with 7 questions . They were asked reason for non-participation ( 8 choices ) , age , height , pre-pregnancy weight , smoking status , educational level and frequency of physical activity . Study participants ( n=606 ) completed a more comprehensive question naire before r and omization . Responses were compared using independent- sample s t-test and chi-square test for continuous and categorical data , respectively . RESULTS Non- participants who completed the non-response question naire ( n=60 ) most often cited satisfaction with their own nutrition and fitness plan ( 50 % ) and being too busy to exercise several days a week ( 43 % ) . Compared with participants , non- participants were younger ( mean difference 1.48 years , CI 0.51 - 2.65 ( p=0.013 ) ) , more often smokers ( 12.5 % vs. 4 % , p=0.014 ) , and fewer had ⩾4years of higher education ( 9.4 % vs. 35.6 % , p<0.001 ) . There were no significant differences between groups in weight , height , BMI or physical activity level . CONCLUSION There is a statistically significant difference in age , smoking and educational status between FFD participants and non- participants . BMI and activity level do not differ between groups . These finding may help us in developing future interventions and trials Self‐weighing is important for weight management in general population s ; however its role in optimising gestational weight gain is less clear . Our r and omised trial in early pregnancy found regular self‐weighing when combined with a self‐management intervention  , optimised weight gain at 28 weeks gestation ( 5.66 ± 2.6 kg vs 7.03 ± 3.56 kg , P = 0.02 ) and reduced postpartum weight retention ( −0.57 ± 3.94 kg vs 1.48 ± 5.49 kg , P < 0.05 ) compared with control participants . Results highlight the importance of self‐monitoring strategies during pregnancy BACKGROUND Type 2 diabetes affects approximately 8 percent of adults in the United States . Some risk factors -- elevated plasma glucose concentrations in the fasting state and after an oral glucose load , overweight , and a sedentary lifestyle -- are potentially reversible . We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes . METHODS We r and omly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo , metformin ( 850 mg twice daily ) , or a lifestyle-modification program  with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week . The mean age of the participants was 51 years , and the mean body-mass index ( the weight in kilograms divided by the square of the height in meters ) was 34.0 ; 68 percent were women , and 45 percent were members of minority groups . RESULTS The average follow-up was 2.8 years . The incidence of diabetes was 11.0 , 7.8 , and 4.8 cases per 100 person-years in the placebo , metformin , and lifestyle groups , respectively . The lifestyle intervention reduced the incidence by 58 percent ( 95 percent confidence interval , 48 to 66 percent ) and metformin by 31 percent ( 95 percent confidence interval , 17 to 43 percent ) , as compared with placebo ; the lifestyle intervention was significantly more effective than metformin . To prevent one case of diabetes during a period of three years , 6.9 persons would have to participate in the lifestyle-intervention program , and 13.9 would have to receive metformin . CONCLUSIONS Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk . The lifestyle intervention was more effective than metformin 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 A mother 's diet during pregnancy has the potential to influence both her own and her child 's short- and long-term health . This paper reports the effects of a r and omized controlled diet intervention during pregnancy on dietary behavior post-intervention as reported in late pregnancy . The diet intervention was part of a lifestyle intervention targeting both diet and physical activity behaviors among nulliparous women participating in the r and omized controlled Norwegian Fit for Delivery study ( NFFD ) . Eligible women were enrolled in early pregnancy from eight healthcare clinics in southern Norway between 2009 and 2013 . The diet intervention was based on 10 dietary recommendations that were conveyed during two counseling sessions by phone and in a pamphlet describing the recommendations and their simplified rationale . A diet score was constructed from a 43-item food frequency question naire ( FFQ ) and used to assess intervention effect on dietary behavior ( score range 0 - 10 ) . Between-group dietary differences post-intervention were estimated with analysis of covariance , with adjustment for baseline diet . A total of 508 women completed the FFQ both at baseline and post-intervention . There were no between-group differences in diet score and subscales at baseline . Post-intervention , the intervention group had higher overall diet score ( control : 4.61 , intervention : 5.04 , P=0.013 ) and favorable dietary behavior in seven of the 10 dietary domains : ' consumption of water relative to total beverage consumption ' ( P=0.002 ) , ' having vegetables with dinner ' ( P=0.027 ) , ' choosing fruits and vegetables for between-meal snacks ' ( P=0.023 ) , ' buying small portion sizes of unhealthy foods ' ( P=0.010 ) , ' limiting sugar intake ' ( P=0.005 ) , ' avoiding eating beyond satiety ' ( P=0.009 ) and ' reading food labels ' ( P=0.011 ) . The NFFD diet intervention improved dietary behavior . Potential long-term clinical influence in mother and child will be investigated in further studies AIM This r and omized controlled trial was carried out to investigate the effect of mindfulness eating and yoga exercise on blood sugar levels among pregnant Thai women with GDM . BACKGROUND Interventions promoting achievement of good glycemic control result in desired pregnancy outcomes . Little is known about the health benefits of mindfulness eating and yoga exercise on blood sugar levels among pregnant with GDM . METHODS A r and omized controlled trial was carried out . Main outcome measures were capillary fasting plasma glucose , 2-h postpr and ial blood glucose , and hemoglobin A1c . RESULTS The intervention group showed significantly reduced fasting plasma glucose , 2-h postpr and ial blood glucose , and glycosylated hemoglobin ( HbA1c ) in the intervention group ( p<0.05 ) . CONCLUSIONS Mindfulness eating and yoga exercise had health benefits on glycemic control in pregnant women with GDM . It should be recommended in clinical and community health services Aims /hypothesisThe aim of this study was to assess the interaction between melatonin receptor 1B gene ( MTNR1B ) rs10830963 polymorphism and lifestyle intervention during pregnancy on occurrence of  gestational diabetes mellitus ( GDM ) in high-risk women . Methods This is a secondary analysis of the r and omised controlled gestational diabetes prevention trial ‘ RADIEL ’ , conducted between 2008 and 2014 in four maternity hospitals in southern Finl and . A total of 226 women with a history of GDM and /or a pre-pregnancy BMI ≥ 30 kg/m2 were enrolled at < 20 weeks of gestation ( mean 13 weeks ) and r and omised into an intervention group receiving counselling on diet , physical activity and weight control and a control group receiving st and ard antenatal care . The main outcome was incidence of GDM , defined as one or more pathological glucose values in a st and ard 75 g 2-h OGTT . The MTNR1B rs10830963 was genotyped for further analyses . Results No significant differences were found in the genotype distribution between the intervention and the control group . A significant interaction was observed between the rs10830963 genotypes and the lifestyle intervention on age-adjusted occurrence of gestational diabetes ( p = 0.038 ) . Among women homozygous for the C allele of rs10830963 , the OR for GDM was significantly lower in the intervention group than in the control group ( OR 0.16 [ 95 % CI 0.03 , 0.85 ] , p = 0.014 ) . This difference was not seen in women heterozygous ( OR 0.88 [ 95 % CI 0.32 , 2.41 ] , p = 0.798 ) or homozygous ( OR 2.25 [ 95 % CI 0.34 , 14.69 ] , p = 0.384 ) for the risk allele G. Conclusions /interpretationIn women at high risk of GDM , only those not carrying the risk allele G benefited from the lifestyle intervention . Our results indicate that certain genetic risk variants may modify the effectiveness of  lifestyle interventions . This may provide important information when planning GDM prevention studies in the future OBJECTIVE The purpose of this study was to test the null hypothesis that the volume of exercise at different times during pregnancy has no effect on fetoplacental growth . STUDY DESIGN Seventy-five women who exercised regularly were evaluated before pregnancy and r and omly assigned at 8 weeks ' gestation to one of 3 exercise regimens for the remainder of pregnancy . Primary outcome variables included placental growth rate , birth weight , and placental volume at term . RESULTS The offspring of the women who were r and omly assigned to a high volume of exercise in mid and late pregnancy were significantly lighter ( 3.39 kg vs 3.81 kg ) and thinner ( 8.3 % fat vs 12.1 % fat ) than those offspring born of women who were r and omly assigned to reduce their exercise volume after the 20th week . Maternal weight gain , fresh placental volumes , and histomorphometric indices of placental function were greater in the high-low group . CONCLUSION These data indicate that a high volume of moderate-intensity , weight-bearing exercise in mid and late pregnancy symmetrically reduces fetoplacental growth , whereas a reduction in exercise volume enhances fetoplacental growth with a proportionally greater increase in fat mass than in lean body mass OBJECTIVE Maternal adiposity confers an increased risk of GDM in pregnancy . A low glycemic index ( GI ) dietary intervention has been found to improve glucose homeostasis and reduce gestational weight gain .  Mobile Health ( mHealth ) Technology-assisted interventions are becoming commonplace as an aid to treating many chronic diseases . The aim of this study is to assess the impact of a ' healthy lifestyle package ' with mHealth smart phone technology as support compared with usual care on the incidence of GDM in an overweight and obese pregnant population . METHODS We propose a r and omized controlled trial of an mHealth assisted healthy lifestyle intervention package versus st and ard obstetric care in pregnant women with a BMI ≥25kg/m(2)-39.9kg/m(2 ) . Patients are r and omized to control or intervention group in a 1:1 ratio . The intervention arm healthy lifestyle package includes a motivational counseling session to encourage behavior change , involving targeted , low GI nutritional advice and daily physical activity prescription delivered before 18weeks gestation , as well as a smart phone app to provide ongoing healthy lifestyle advice and support throughout pregnancy . The primary outcome is the incidence of GDM at 29weeks ' gestation and power analysis indicates that 253 women are required in each group to detect a difference . CONCLUSION This will be the first clinical trial to evaluate the effectiveness of a smart phone technology-assisted targeted healthy lifestyle intervention , which is grounded in behavior change theories and techniques , to support antenatal management of an overweight and obese pregnant population in preventing GDM 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 AIMS To investigate whether maternal body size pre-pregnancy , gestational diabetes and weight gain are independently associated with subsequent insulin resistance in children ; and to examine the potential mediating role of child 's body size in any associations . METHODS At 9 - 10 years , 443 children took part in a follow-up of a prospect i ve cohort . Of those , 163 children elected to provide a fasting blood sample  and child insulin resistance was estimated by homeostasis model assessment . Generalized linear models with log link function and Gaussian family were used to assess associations with antenatal exposures . Potential confounders were considered as well as the role of the child 's size . RESULTS Prior to pregnancy , 23 % of mothers were overweight and another 17 % obese . All women were screened for gestational diabetes , with 6 % diagnosed . On average , women gained an estimated 14 kg during pregnancy . Gestational diabetes was positively associated with child insulin resistance . In addition , maternal pre-pregnancy body mass index ( BMI ) was associated with child insulin resistance in a non-linear manner : a positive , progressive association was observed until BMI of 30 kg/m² was reached , but not thereafter . Estimated gestational weight gain was not associated with child insulin resistance . These findings were not accounted for by size of the child at birth or at 9 - 10 years . CONCLUSIONS Maternal body size prior to pregnancy is positively associated with increases in child insulin resistance , at least until the ' obese ' category is reached . This is independent of gestational diabetes and not mediated by body size of the child , suggesting genetic and /or developmental programming origins The benefits of exercise and behavioural recommendations in gestational diabetes mellitus ( GDM ) are controversial . In a r and omized trial with a 2 × 2 factorial design , we examined the effect of exercise and behavioural recommendations on metabolic variables , and maternal/neonatal outcomes in 200 GDM patients . All women were given the same diet : group D received dietary recommendations only ; group E was advised to briskly walk 20‐min/day ; group B received behavioural dietary recommendations ; group BE was prescribed the same as B + E.  Dietary habits improved in all groups . In a multivariable regression model , fasting glucose did not change . Exercise , but not behavioural recommendations , was associated with the reduction of postpr and ial glucose ( p < 0001 ) , glycated haemoglobin ( HbA1c ; p < 0.001 ) , triglycerides ( p = 0.02 ) and C‐reactive protein ( CRP ; p < 0.001 ) and reduced any maternal/neonatal complications ( OR = 0.50 ; 95%CI=0.28–0.89;p = 0.02 ) . In GDM patients  a simple exercise programme reduced maternal postpr and ial glucose , HbA1c , CRP , triglycerides and any maternal/neonatal complications , but not fasting glucose values BACKGROUND It is uncertain whether treatment of mild gestational diabetes mellitus improves pregnancy outcomes . METHODS Women who were in the 24th to 31st week of gestation and who met the criteria for mild gestational diabetes mellitus ( i.e. , an abnormal result on an oral glucose-tolerance test but a fasting glucose level below 95 mg per deciliter [ 5.3 mmol per liter ] ) were r and omly assigned to usual prenatal care ( control group ) or dietary intervention , self-monitoring of blood glucose , and insulin therapy , if necessary ( treatment group ) . The primary outcome was a composite of stillbirth or perinatal death and neonatal complications , including hyperbilirubinemia , hypoglycemia , hyperinsulinemia , and birth trauma . RESULTS A total of 958 women were r and omly assigned to a study group--485 to the treatment group and 473 to the control group . We observed no significant difference between groups in the frequency of the composite outcome ( 32.4 % and 37.0 % in the treatment and control groups , respectively ; P=0.14 ) . There were no perinatal deaths . However , there were significant reductions with treatment as compared with usual care in several prespecified secondary outcomes , including mean birth weight ( 3302 vs. 3408 g ) , neonatal fat mass ( 427 vs. 464 g ) , the frequency of large-for-gestational-age infants ( 7.1 % vs. 14.5 % ) , birth weight greater than 4000 g ( 5.9 % vs. 14.3 % ) , shoulder dystocia ( 1.5 % vs. 4.0 % ) , and cesarean delivery ( 26.9 % vs. 33.8 % ) . Treatment of gestational diabetes mellitus , as compared with usual care , was also associated with reduced rates of preeclampsia and gestational hypertension ( combined rates for the two conditions , 8.6 % vs. 13.6 % ; P=0.01 ) . CONCLUSIONS Although treatment of mild gestational diabetes mellitus did not significantly reduce the frequency of a composite outcome that included stillbirth or perinatal death and several neonatal complications , it did reduce the risks of fetal overgrowth , shoulder dystocia , cesarean delivery , and hypertensive disorders . ( Clinical Trials.gov number , NCT00069576 . This study aims to determine whether the prescription of a detailed lifestyle programme in overweight/obese pregnant women influences the occurrence of gestational diabetes ( GDM ) , and if this kind of prescription increases the adherence to a healthier lifestyle in comparison to st and ard care . The study was design ed as a r and omized controlled trial , with open allocation , enrolling women at 9 - 12 weeks of pregnancy with a BMI ≥ 25 kg/m2 . The women assigned to the Intervention group ( I = 96 ) received a hypocaloric , low-glycaemic , low-saturated fat diet and physical activity recommendations . Those assigned to the St and ard Care group ( SC = 95 ) received lifestyle advices regarding healthy nutrition and exercise . Follow-up was planned at the 16th , 20th , 28th and 36th weeks . A total of 131 women completed the study ( I = 69 , SC = 62 ) . The diet adherence was higher in the I ( 57.9 % ) than in the SC ( 38.7 % ) group . GDM occurred less frequently in the I ( 18.8 % ) than in the SC ( 37.1 % , P = 0.019 ) group . The adherent women from either groups showed a lower GDM rate ( 12.5 % vs. 41.8 % , P < 0.001 ) . After correcting for confounders , the GDM rate was explained by allocation into the I group ( P = 0.034 ) and a lower BMI category ( P = 0.039 ) . The rates of hypertension , preterm birth , induction of labour , large for gestational age babies and birthweight > 4000 g were significantly lower in I group . The incidence of small for gestational age babies was not different . These findings demonstrate that the adherence to a personalized , hypocaloric , low-glycaemic , low-saturated fat diet started early in pregnancy prevents GDM occurrence , in women with BMI ≥ 25 kg/m2 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 Abstract Objectives : To determine whether changes in lifestyle in women with BMI > 25 could decrease gestational weight gain and unfavorable pregnancy outcomes . Methods : Women with BMI > 25 were r and omized at 1st trimester to no intervention or a Therapeutic Lifestyle Changes ( TLC ) Program including diet  ( overweight : 1700 kcal/day , obese : 1800 kcal/day ) and mild physical activity ( 30 min/day , 3 times/week ) . At baseline and at the 36th week women filled-in a Food Frequency Question naire . Outcomes : gestational weight gain , gestational diabetes mellitus , gestational hypertension , preterm delivery . Data stratified by BMI categories . Results : Socio-demographic features were similar between groups ( TLC : 33 cases , Controls : 28 cases ) . At term , gestational weight gain in obese women r and omized to TLC group was lower ( 6.7 ± 4.3 kg ) versus controls ( 10.1 ± 5.6 kg , p = 0.047 ) . Gestational diabetes mellitus , gestational hypertension and preterm delivery were also significantly lower . TLC was an independent factor in preventing gestational weight gain , gestational diabetes mellitus , gestational hypertension . Significant changes in eating habits occurred in the TLC group , which increased the number of snacks , the intake of fruits – vegetables and decreased the consumption of sugar . Conclusions : A caloric restriction associated to changes in eating behavior and constant physical activity , is able to reduce gestational weight gain and related pregnancy complications in obese women 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 associated with a wide range of adverse health consequences for women and their infants in the short and long term .
With an increasing prevalence of GDM worldwide , there is an urgent need to assess strategies for GDM prevention , such as combined diet and exercise interventions .
This is an up date of a Cochrane review that was first published in 2015 .
OBJECTIVES To assess the effects of diet interventions in combination with exercise interventions for pregnant women for preventing GDM , and associated adverse health consequences for the mother and her infant/child .