Low glycaemic index diet in pregnancy to prevent macrosomia (ROLO study): randomised control 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 myo-Inositol Supplementation and Onset of Gestational Diabetes Mellitus in Pregnant Women With a Family History of Type 2 Diabetes Mild gestational diabetes in pregnancy and the adipoinsular axis in babies born to mothers in the ACHOIS randomised controlled trial Lifestyle intervention on diet and exercise reduced excessive gestational weight gain in pregnant women under a randomised controlled trial Increased Maternal Plasma Leptin in Early Pregnancy and Risk of Gestational Diabetes Mellitus Perinatal outcomes in nutritionally monitored obese pregnant women: a randomized clinical trial. Impact of maternal probiotic-supplemented dietary counselling on pregnancy outcome and prenatal and postnatal growth: a double-blind, placebo-controlled study. Dairy Products and Prevention of Type 2 Diabetes: Implications for Research and Practice Effect of intensive counselling on the quality of dietary fats in pregnant women at high risk of gestational diabetes mellitus. Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: a randomized controlled trial. Randomized controlled trial to prevent excessive weight gain in pregnant women Insulin sensitivity in third trimester pregnancy. A randomized study of dietary effects Reducing excessive weight gain in pregnancy: a randomised controlled trial. Effects of lifestyle intervention in obese pregnant women on gestational weight gain and mental health: a randomized controlled trial The Treatment of Obese Pregnant Women (TOP) study: a randomized controlled trial of the effect of physical activity intervention assessed by pedometer with or without dietary intervention in obese pregnant women. 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
Objective To determine if a low glycaemic index diet in pregnancy could reduce the incidence of macrosomia in an at risk group . Design R and omised controlled trial . Setting Maternity hospital in Dublin , Irel and . Participants 800 women without diabetes , all in their second pregnancy between January 2007 to January 2011 , having previously delivered an infant weighing greater than 4 kg . Intervention Women were r and omised to receive no dietary intervention or start on a low glycaemic index diet from early pregnancy . Main outcomes The primary outcome measure was difference in birth weight . The secondary outcome measure was difference in gestational weight gain . Results No significant difference was seen between the two groups in absolute birth weight , birthweight centile , or ponderal index . Significantly less gestational weight gain occurred in women in the intervention arm ( 12.2 v 13.7 kg ; mean difference −1.3 , 95 % confidence interval −2.4 to −0.2 ; P=0.01 ) . The rate of glucose intolerance was also lower in the intervention arm : 21 % ( 67/320 ) compared with 28 % ( 100/352 ) of controls had a fasting glucose of 5.1 mmol/L or greater or a 1 hour glucose challenge test result of greater than 7.8 mmol/L ( P=0.02 ) . Conclusion A low glycaemic index diet in pregnancy did not reduce the incidence of large for gestational age  infants in a group at risk of fetal macrosomia . It did , however , have a significant positive effect on gestational weight gain and maternal glucose intolerance . Trial registration Current Controlled Trials IS RCT N54392969 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 ) OBJECTIVE To check the hypothesis that myo-inositol supplementation may reduce gestational diabetes mellitus ( GDM ) onset in pregnant women with a family history of type 2 diabetes . RESEARCH DESIGN AND METHODS A 2-year , prospect i ve , r and omized , open-label , placebo-controlled study was carried out in pregnant out patients with a parent with type 2 diabetes who were treated from the end of the first trimester with 2 g myo-inositol plus 200 µg folic acid twice a day ( n = 110 ) and in the placebo group ( n = 110 ) , who were only treated with 200 µg folic acid twice a day . The main outcome measure was the incidence of GDM in both groups . Secondary outcome measures were as follows : the incidence of fetal macrosomia ( > 4,000 g ) , gestational hypertension , preterm delivery , caesarean section , shoulder dystocia , neonatal hypoglycemia , and neonatal distress respiratory syndrome . GDM diagnosis was performed according to the International Association of the Diabetes and Pregnancy Study Groups ( IADPSG ) recommendations . RESULTS Incidence of GDM was significantly reduced in the myo-inositol group compared with the placebo group : 6 vs. 15.3 % , respectively ( P = 0.04 ) . In the myo-inositol group , a reduction of GDM risk occurrence was highlighted ( odds ratio 0.35 ) . A statistically significant reduction of fetal macrosomia in the myo-inositol group was also highlighted together with a significant reduction in mean fetal weight at delivery . In the other secondary outcome measures , there were no differences between groups . CONCLUSIONS myo-Inositol supplementation in pregnant women with a family history of type 2 diabetes may reduce GDM incidence and the delivery of macrosomia fetuses Background Mild gestational diabetes is a common complication of pregnancy , affecting up to 9 % of pregnant women . Treatment of mild GDM is known to reduce adverse perinatal outcomes such as macrosomia and associated birth injuries , such as shoulder dystocia , bone fractures and nerve palsies . This study aim ed to compare the plasma glucose concentrations and serum insulin , leptin and adiponectin in cord blood of babies of women ( a ) without gestational diabetes mellitus ( GDM ) , ( b ) with mild GDM under routine care , or ( c ) mild GDM with treatment . Methods 95 women with mild GDM on oral glucose tolerance testing ( OGTT ) at one tertiary level maternity hospital who had been recruited to the ACHOIS trial at one of the collaborating hospitals and r and omised to either Treatment ( n = 46 ) or Routine Care ( n = 49 ) and Control women with a normal OGTT ( n = 133 ) were included in the study . Women with mild GDM ( treatment or routine care group ) and OGTT normal women received routine pregnancy care . In addition , women with treated mild GDM received dietary advice , blood glucose monitoring and insulin if necessary . The primary outcome measures were cord blood concentrations of glucose , insulin , adiponectin and leptin . Results Cord plasma glucose was higher in women receiving routine care compared with control , but was normalized by treatment for mild GDM ( p = 0.01 ) . Cord serum insulin and insulin to glucose ratio were similar between the three groups . Leptin concentration in cord serum was lower in GDM treated women compared with routine care ( p = 0.02 ) and not different to control ( p = 0.11 ) . Adiponectin was lower in both mild GDM groups compared with control ( Treatment p = 0.02 and Routine Care p = 0.07 ) , while the adiponectin to leptin ratio was lower for women receiving routine care compared with treatment ( p = 0.08 ) and control ( p = 0.05 ) . Conclusion Treatment of women with mild GDM using diet , blood glucose monitoring and insulin if necessary , influences the altered fetal adipoinsular axis characteristic of mild GDM in pregnancy 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 OBJECTIVE : Emerging evidence suggests that leptin , an adipocyte-derived hormone , may have independent direct effects on both insulin secretion and action , in addition to its well documented effects on appetite and energy expenditure . Some , but not all , previously published studies suggest that maternal leptin concentrations may be increased in pregnancies complicated by gestational diabetes mellitus ( GDM ) . We examined the association between plasma leptin concentration and GDM risk . METHODS : Women were recruited before 16 weeks of gestation and were followed up until delivery .  Maternal plasma leptin concentrations  ( collected at 13 weeks of gestation ) were measured by using immunoassay . We used generalized linear models to estimate relative risks and 95 % confidence intervals . RESULTS : GDM developed in 5.7 % of the cohort ( 47 of 823 ) . Elevated leptin concentrations were positively associated with GDM risk ( P for trend < .001 ) . After adjusting for maternal prepregnancy adiposity and other confounders , women with leptin concentrations of 31.0 ng/mL or higher experienced a 4.7-fold increased risk of GDM ( 95 % confidence interval 1.2 , 18.0 ) as compared with women who had concentrations of 14.3 ng/mL or lower . We noted a strong linear component of trend in risk of GDM with increasing maternal plasma leptin concentration . Each 10-ng/mL increase in the leptin concentration was associated with a 20 % increase in GDM risk ( relative risk 1.2 ; 95 % confidence interval 1.0 , 1.3 ) . CONCLUSIONS : Hyperleptinemia , independent of maternal adiposity , in early pregnancy appears to be predictive of an increased risk of GDM later in pregnancy . Additional larger prospect i ve cohort studies are needed to confirm and more precisely assess the etiologic importance of hyperleptinemia in pregnancy . LEVEL OF EVIDENCE : BACKGROUND Although obesity in pregnancy continues to be associated with ongoing health problems , many clinicians have been reluctant to place nondiabetic , obese , pregnant women on a monitored , calorie-appropriate nutritional regimen for fear of fetal growth restriction , low birth weight , or starvation ketosis . METHODS A total of 257 patients were enrolled in the r and omized study , with a loss-to-follow-up rate of 9.73 % . Patients were assigned r and omly to either the control ( unmonitored ) group ( n=116 ) , consisting of conventional prenatal dietary management , or to the study ( monitored ) group ( n=116 ) , which was prescribed a balanced nutritional regimen and were asked to record in a diary all of the foods eaten during each day .  Women were eligible for the study if they were pregnant with a single fetus between 12 and 28 weeks of gestation and had a prepregnancy body mass index of more than 30 kg/m2 . The primary outcome was to compare perinatal outcomes in the control vs the study groups . The secondary measure was to compare outcomes in adherent and nonadherent patients in the study group . RESULTS Omnibus MANOVA showed statistically significant differences between the study and control groups regarding 3 variables : ( 1 ) gestational hypertension , p < .46 ; ( 2 ) mother 's last weight before delivery , p < .001 ; and ( 3 ) mother 's 6-week postpartum weight , p < .001 . Patients gaining 15 pounds or more during their pregnancy showed statistically significant differences between the groups for 8 variables . CONCLUSION Obese pregnant women may be placed on a healthy , well-balanced , monitored nutritional program during their antepartum course without adverse perinatal outcomes The perinatal nutritional environment impacts upon the health and well-being of mother and child also in the long term . The aim of the present study was to determine the safety and efficacy of perinatal probiotic-supplemented dietary counselling by evaluating pregnancy outcome and fetal and infant growth during the 24 months ' follow-up . Altogether , 256 women were r and omised at their first trimester of pregnancy into a control and a dietary intervention group . The intervention group received intensive dietary counselling provided by a nutritionist and were further r and omised , double-blind to receive probiotics ( Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb12 ; diet/probiotics ) or placebo ( diet/placebo ) . Firstly , probiotic intervention reduced the frequency of gestational diabetes mellitus ( GDM ) ; 13 % ( diet/probiotics ) v. 36 % ( diet/placebo ) and 34 % ( control ) ; P = 0.003 . Secondly , the safety of this approach was attested by normal duration of pregnancies with no adverse events in mothers or children . No significant differences in prenatal or postnatal growth rates among the study groups were detected . Thirdly , distinctive effects of the two interventions were detected ; probiotic intervention reduced the risk of GDM and dietary intervention diminished the risk of larger birth size in affected cases ; P = 0.035 for birth weight and P = 0.028 for birth length . The results of the present study show that probiotic-supplemented perinatal dietary counselling could be a safe and cost-effective tool in addressing the metabolic epidemic . In view of the fact that birth size is a risk marker for later obesity , the present results are of significance for public health in demonstrating that this risk is modifiable A growing body of scientific evidence has linked dairy intake to a reduced  type 2 diabetes ( T2D ) risk . Using an evidence -based approach , we review ed the most recent and strongest evidence on the relationship between dairy intake and the risk of T2D . Evidence indicates that dairy intake is significantly associated with a reduced T2D risk , and likely in a dose-response manner . The association between low-fat dairy and T2D risk reduction appears consistent . A beneficial impact is suggested for regular-fat dairy . The role of specific dairy products needs to be clarified . Potential underlying mechanisms include the role of dairy products in obesity and metabolic syndrome , as well as several dairy components , such as calcium , vitamin D , dairy fat , and specifically trans-palmitoleic acid . To conclude , there is strong , consistent , and accumulating evidence that dairy intake reduces the risk of T2D . More research is needed to better underst and the role of regular-fat and specific dairy products . Well- design ed r and omized controlled trials and mechanistic studies are needed to support these findings . Efforts to translate this evidence into clinical practice and public health guidance are needed As part of a feasibility study to prevent gestational diabetes mellitus ( GDM ) , we evaluated the effect of an intensive dietary therapy on quality of diet , weight gain and birth weight in women at high risk of GDM . Women with risk factors for GDM ( n 54 ) were r and omly assigned from April 2005 to May 2006 to a  lifestyle intervention group ( n 27 ) including dietary advice six times during pregnancy or to a close follow-up group ( n 27 ) in a community-based setting in Finl and . Dietary intake was recorded three times during pregnancy using 4 d food records . The main outcome was the incidence of GDM . The secondary outcomes were the changes in nutrient intake , weight gain and birth weight . Overall , seventeen ( 65 % ) women in the intervention group and eighteen ( 69 % ) women in the close follow-up group returned all three food records . PUFA intake increased ( P = 0·008 ) during pregnancy in the intervention as compared to the close follow-up group . There were no clear differences in the changes of saturated fat or fibre intake between the groups . Intensive dietary education result ed in a somewhat lower weight gain during pregnancy ( P = 0·062 ) and higher birth weights of the infants ( P = 0·047 ) without an effect on macrosomia as compared to the close follow-up group . Individualised counselling by a clinical nutritionist as part of a lifestyle intervention improved the quality of dietary fat intake in pregnant women at high risk of GDM BACKGROUND Maternal obesity and excessive gestational weight gain ( GWG ) are major short- and long-term risk factors for maternal and fetal complications . OBJECTIVE The objective was to study whether a lifestyle intervention based on a brochure or on active education can improve dietary habits , increase physical activity ( PA ) , and reduce GWG in obese pregnant women . DESIGN In this r and omized controlled trial , 195 white , obese pregnant women [ age : 29 + or - 4 y ; body mass index ( in kg/m(2 ) ) ; 33.6 + or - 4.2 ] were r and omly assigned into 3 groups : a group that received nutritional advice from a brochure , a group that received the brochure and lifestyle education by a nutritionist , and a control group . Nutritional habits  were evaluated every trimester through 7-d food records . PA was evaluated with the Baecke question naire . RESULTS Energy intake did not change during pregnancy and was comparable in all groups . Fat intake , specifically saturated fat intake , decreased and protein intake increased from the first to the third trimester in the passive and active groups compared with an opposite change in the control group . Calcium intake and vegetable consumption increased during pregnancy in all groups . PA decreased in all groups , especially in the third trimester . No significant differences in GWG and obstetrical or neonatal outcome could be observed between the groups . CONCLUSIONS Both lifestyle interventions improved the nutritional habits of obese women during pregnancy . Neither PA nor GWG was affected 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 Summary . The metabolic effects of three diets were investigated in a r and omized study in 15 non‐pregnant women and 14 pregnant women in the third trimester ; all the women were of normal weight . After 2‐week periods of habituation to each diet , metabolic profiles were performed on st and ardized intakes . Diet 1 contained 40 % of energy as carbohydrate and 10 g dietary fibre representing typical Western intakes . Diet 2 contained 40 % energy as carbohydrate and 52 g dietary fibre and diet 3 contained 60 % of energy as carbohydrate and 84 g dietary fibre , representing typical developing world intakes . No deterioration in glucose homeostasis in pregnancy was seen on any of the three diets in contrast to previous work . On diet 1 there was a loss of insulin sensitivity in pregnancy , but not on diets 2 and 3 . The loss of insulin sensitivity which is typical of Western women in the third trimester of pregnancy and is considered to be physiological , may be a diet‐induced artefact OBJECTIVE To determine if regular weight measurement throughout pregnancy can reduce excessive gestational weight gain . DESIGN A r and omised controlled trial . SETTING A tertiary obstetric hospital in Melbourne , between July 2007 and May 2008 . PARTICIPANTS 236 pregnant women recruited at < or = 14 weeks ' gestation . INTERVENTION Women allocated to the intervention group were given a personalised weight measurement card , advised of their optimal gestational weight gain ( based on their body mass index at the time of recruitment and the United States Institute of Medicine guidelines ) , and instructed to record their weight at 16 , 20 , 24 , 28 , 30 , 32 and 34 weeks ' gestation . The control group were weighed at recruitment , but were not given instructions about regular weight measurement . All participants were blinded to the purpose of the study . MAIN OUTCOME MEASURE Weight gain from recruitment to follow-up at 36 weeks ' gestation . RESULTS In the study population , there was a trend to less weight gain in the intervention group . The women in the intervention group experienced a mean ( SD ) per-week weight gain of 0.44 ( 0.173 ) kg compared with those in the control group , who gained 0.46 ( 0.156 ) kg/week ( mean difference , 0.02 kg/week ; 95 % CI , - 0.02 to 0.07 kg/week ) . The intervention significantly reduced gestational weight gain in the group of women who were overweight but not obese at recruitment : those in the intervention group ( 20 women ) gained a mean ( SD ) of 0.42 ( 0.153 ) kg/week and the control group ( 18 women ) gained 0.54 ( 0.123 ) kg/week ( mean difference , 0.12 kg/week ; 95 % CI , 0.03 to 0.22 kg/week ; P = 0.01 ) . CONCLUSION Regular weight measurement in pregnancy was not found to be effective in reducing weight gain , except among women who were overweight but not obese before pregnancy . TRIAL REGISTRATION Australian Clinical Trials Registry ACTRN12607000272493 Objective : Lifestyle intervention could help obese pregnant women to limit their weight gain during pregnancy and improve their psychological comfort , but has not yet been evaluated in r and omized controlled trials . We evaluated whether a targeted antenatal lifestyle intervention programme for obese pregnant women  influences gestational weight gain ( GWG ) and levels of anxiety or depressed mood . Design and subjects : This study used a longitudinal interventional design . Of the 235 eligible obese pregnant women , 205 ( mean age ( years ) : 29±4.5 ; body mass index ( BMI , kg m−2 ) : 34.7±4.6 ) were r and omized to a  control  group , a brochure group receiving written information on healthy lifestyle and an experimental group receiving an additional four antenatal lifestyle intervention sessions by a midwife trained in motivational lifestyle intervention . Anxiety ( State and Trait Anxiety Inventory ) and feelings of depression ( Edinburgh Depression Scale ) were measured during the first , second and third trimesters of pregnancy . Socio-demographical , behavioural , psychological and medical variables were used for controlling and correcting outcome variables . Results : We found a significant reduction of GWG in the brochure ( 9.5 kg ) and lifestyle intervention ( 10.6 kg ) group compared with normal care group ( 13.5 kg ) ( P=0.007 ) . Furthermore , levels of anxiety significantly decreased in the lifestyle intervention group and increased in the normal care group during pregnancy ( P=0.02 ) ; no differences were demonstrated in the brochure group . Pre-pregnancy BMI was positively related to levels of anxiety . Obese pregnant women who stopped smoking recently showed a significant higher GWG ( β=3.04 ; P=0.01 ) ; those with concurrent gestational diabetes mellitus ( GDM ) ( β=3.54 ; P=0.03 ) and those who consumed alcohol on a regular base ( β=3.69 ; P=0.04 ) showed significant higher levels of state anxiety . No differences in depressed mood or obstetrical/neonatal outcomes were observed between the three groups . Conclusions : A targeted lifestyle intervention programme based on the principles of motivational interviewing reduces GWG and levels of anxiety in obese pregnant women OBJECTIVE The objective of the study was to assess physical activity intervention assessed by a pedometer with or without dietary intervention on gestational weight gain ( GWG ) in obese pregnant women by comparing with a control group . STUDY DESIGN This study was a r and omized controlled trial of 425 obese pregnant women comparing 3 groups : ( 1 ) PA plus D , physical activity and dietary intervention ( n = 142 ) ; ( 2 ) PA , physical activity intervention ( n = 142 ) ; and ( 3 ) C , a control group receiving st and ard care ( n = 141 ) . All participants routinely in gestational weeks 11 - 14 had an initial dietary counseling session and were advised to limit GWG to less than 5 kg . Physical activity intervention included encouragement to increase physical activity , aim ing at a daily step count of 11,000 , monitored by pedometer assessment on 7 consecutive days every 4 weeks . Dietary intervention included follow-up on a hypocaloric Mediterranean-style diet . Instruction was given by a dietician every 2 weeks . The primary outcome measure was GWG , and the secondary outcome measures were complications of pregnancy and delivery and neonatal outcome . RESULTS The study was completed by 389 patients ( 92 % ) .  Median values of GWG ( ranges ) were lower in each of the intervention groups ( PA plus D , 8.6 [ -9.6 to 34.1 ] kg , and group PA , 9.4 [ -3.4 to 28.2 ] kg ) compared with the control group ( 10.9 [ -4.4 to 28.7 ] kg [ PA+D vs C ] ; P = .01 ; PA vs C ; P = .042 ) . No significant difference was found between the 2 intervention groups . In a multivariate analysis , physical activity intervention decreased GWG by a mean of 1.38 kg ( P = .040 ) . The Institute of Medicine 's recommendations for GWG were more frequently followed in the intervention groups . CONCLUSION Physical activity intervention assessed by pedometer with or without dietary follow-up reduced GWG compared with controls in obese pregnant women 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
INTRODUCTION The rise in gestational diabetes ( GDM ) , defined as first onset or diagnosis of diabetes in pregnancy , is a global problem .
GDM is often associated with unhealthy diet and is a major contributor to adverse outcomes maternal and fetal outcomes .
Manipulation of nutrition has the potential to prevent GDM .