Diet and IVF pilot study: Short‐term weight loss improves pregnancy rates in overweight/obese women undertaking IVF Probiotics and dietary counselling contribute to glucose regulation during and after pregnancy: a randomised controlled trial. Low glycaemic index diet in pregnancy to prevent macrosomia (ROLO study): randomised control trial Effects of Lactobacillus acidophilus NCFM on insulin sensitivity and the systemic inflammatory response in human subjects. Effect of exercise intensity and duration on capillary glucose responses in pregnant women at low and high risk for gestational diabetes. Effect of the consumption of a new symbiotic shake on glycemia and cholesterol levels in elderly people with type 2 diabetes mellitus Optimizing healthy gestational weight gain in women at high risk of gestational diabetes: a randomized controlled trial. myo-Inositol Supplementation and Onset of Gestational Diabetes Mellitus in Pregnant Women With a Family History of Type 2 Diabetes The LIFESTYLE study: costs and effects of a structured lifestyle program in overweight and obese subfertile women to reduce the need for fertility treatment and improve reproductive outcome. A randomised controlled trial Exercise during pregnancy improves maternal glucose screen at 24–28 weeks: a randomised controlled trial SPRING: an RCT study of probiotics in the prevention of gestational diabetes mellitus in overweight and obese women DALI: Vitamin D and lifestyle intervention for gestational diabetes mellitus (GDM) prevention: an European multicentre, randomised trial – study protocol Impact of maternal probiotic-supplemented dietary counselling on pregnancy outcome and prenatal and postnatal growth: a double-blind, placebo-controlled study. Effect of daily consumption of probiotic yoghurt on insulin resistance in pregnant women: a randomized controlled trial Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: a randomized controlled trial. Probiotic yogurt improves antioxidant status in type 2 diabetic patients. Prepregnancy body mass index, gestational weight gain, and the likelihood of major depressive disorder during pregnancy. Weight loss results in significant improvement in pregnancy and ovulation rates in anovulatory obese women. Exercise during pregnancy and gestational diabetes-related adverse effects: a randomised controlled trial Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Perceived Exertion in Physical Activity and Risk of Gestational Diabetes Mellitus No effect of the FitFor2 exercise programme on blood glucose, insulin sensitivity, and birthweight in pregnant women who were overweight and at risk for gestational diabetes: results of a randomised controlled trial Exercise in pregnancy: effect on fitness and obstetric outcomes-a randomized trial. Effects of lifestyle intervention in obese pregnant women on gestational weight gain and mental health: a randomized controlled trial Comprehensive intensive therapy for Chinese gestational diabetes benefits both newborns and mothers. Primary Prevention of Gestational Diabetes Mellitus and Large-for-Gestational-Age Newborns by Lifestyle Counseling: A Cluster-Randomized Controlled Trial ATLANTIC DIP: The Impact of Obesity on Pregnancy Outcome in Glucose-Tolerant Women Gestational weight gain in overweight and obese women enrolled in a healthy lifestyle and eating habits program
Obesity worsens and modest weight loss improves female fertility . Overweight women were r and omised to lifestyle or st and ard treatment pre‐in vitro fertilisation with treatment cessation at embryo transfer . There was a greater reduction in weight ( P < 0.001 ) for lifestyle treatment ( −3.8 ± 3.0 kg , P < 0.001 ) compared with no changes for st and ard treatment ( −0.5 ± 1.2 kg , P = 0.092 ) . Both the intervention ( −5.3 ± 4.6 cm ) and control ( −3.5 ± 3.5 cm ) group had reductions in waist circumference ( P < 0.001 ) with no differences between the two groups ( P = 0.215 ) . The overall pregnancy rate was 53 % ( 20/38 ) for the intervention and control group combined Balanced glucose metabolism ensures optimal fetal growth with long-term health implication s conferred on both mother and child . We examined whether supplementation of probiotics with dietary counselling affects glucose metabolism in normoglycaemic pregnant women . At the first trimester of pregnancy 256 women were r and omised to receive nutrition counselling to modify dietary intake according to current recommendations or as controls ; the dietary intervention group was further r and omised to receive probiotics ( Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb12 ; diet/probiotics ) or placebo ( diet/placebo ) in a double-blind manner , whilst the control group received placebo ( control/placebo ) . Blood glucose concentrations were lowest in the diet/probiotics group during pregnancy ( baseline-adjusted means 4.45 , 4.60 and 4.56 mmol/l in diet/probiotics , diet/placebo and control/placebo , respectively ; P = 0.025 ) and over the 12 months ' postpartum period ( baseline-adjusted means 4.87 , 5.01 and 5.02 mmol/l ; P = 0.025 ) . Better glucose tolerance in the diet/probiotics group was confirmed by a reduced risk of elevated glucose concentration compared with the control/placebo group ( OR 0.31 ( 95 % CI 0.12 , 0.78 ) ; P = 0.013 ) as well as by the lowest insulin concentration ( adjusted means 7.55 , 9.32 and 9.27 mU/l ; P = 0.032 ) and homeostasis model assessment ( adjusted means 1.49 , 1.90 and 1.88 ; P = 0.028 ) and the highest quantitative insulin sensitivity check index ( adjusted means 0.37 , 0.35 and 0.35 ; P = 0.028 ) during the last trimester of pregnancy . The effects observed extended over the 12-month postpartum period . The present study demonstrated that improved blood glucose control can be achieved by dietary counselling with probiotics even in a normoglycaemic population and thus may provide potential novel means for the prophylactic and therapeutic management of glucose disorders Objective To determine if a low glycaemic index diet in pregnancy could reduce the incidence of macrosomia in an at risk group . Design R and omised controlled trial . Setting Maternity hospital in Dublin , Irel and . Participants 800 women without diabetes , all in their second pregnancy between January 2007 to January 2011 , having previously delivered an infant weighing greater than 4 kg . Intervention Women were r and omised to receive no dietary intervention or start on a low glycaemic index diet from early pregnancy . Main outcomes The primary outcome measure was difference in birth weight . The secondary outcome measure was difference in gestational weight gain . Results No significant difference was seen between the two groups in absolute birth weight , birthweight centile , or ponderal index . Significantly less gestational weight gain occurred in women in the intervention arm ( 12.2 v 13.7 kg ; mean difference −1.3 , 95 % confidence interval −2.4 to −0.2 ; P=0.01 ) . The rate of glucose intolerance was also lower in the intervention arm : 21 % ( 67/320 ) compared with 28 % ( 100/352 ) of controls had a fasting glucose of 5.1 mmol/L or greater or a 1 hour glucose challenge test result of greater than 7.8 mmol/L ( P=0.02 ) . Conclusion A low glycaemic index diet in pregnancy did not reduce the incidence of large for gestational age  infants in a group at risk of fetal macrosomia . It did , however , have a significant positive effect on gestational weight gain and maternal glucose intolerance . Trial registration Current Controlled Trials IS RCT N54392969 According to animal studies , intake of probiotic bacteria may improve glucose homeostasis . We hypothesised that probiotic bacteria improve insulin sensitivity by attenuating systemic inflammation . Therefore , the effects of oral supplementation with the probiotic bacterium Lactobacillus acidophilus NCFM on insulin sensitivity and the inflammatory response were investigated in subjects with normal or impaired insulin sensitivity . In a double-blinded , r and omised fashion , forty-five males with type 2 diabetes , impaired or normal glucose tolerance were enrolled and allocated to a 4-week treatment course with either L. acidophilus NCFM or placebo . L. acidophilus was detected in stool sample s by denaturating gradient gel electrophoresis and real-time PCR . Separated by the 4-week intervention period , two hyperinsulinaemic-euglycaemic clamps were performed to estimate insulin sensitivity . Furthermore , the systemic inflammatory response was evaluated by subjecting the participants to Escherichia coli lipopolysaccharide injection ( 0·3 ng/kg ) before and after the treatment course . L. acidophilus NCFM was detected in 75 % of the faecal sample s after treatment with the probiotic bacterium . Insulin sensitivity was preserved among volunteers in the L. acidophilus NCFM group , whereas it decreased in the placebo group . Both baseline inflammatory markers and the systemic inflammatory response were , however , unaffected by the intervention . In conclusion , intake of L. acidophilus NCFM for 4 weeks preserved insulin sensitivity compared with placebo , but did not affect the systemic inflammatory response BACKGROUND Exercise may influence glucose metabolism during pregnancy . We examined the effect of exercise intensity and duration on capillary glucose responses in pregnant women at low and high risk for gestational diabetes mellitus ( GDM ) who followed a modified GDM meal plan . METHODS R and omization occurred at study entry ( 16 - 20 weeks ' gestation ) into a low-intensity [ 30 % heart rate reserve , low risk-30%I , n = 12 ; high risk-30%I , n = 11 ] or vigorous-intensity ( 70 % heart rate reserve , low risk-70%I , n = 12 ; R-70%I , n = 11 ) exercise program with similar nutritional control . Exercise consisted of walking three to four times a week , gradually increasing time from 25 to 40 min/session . Free-living capillary glucose concentrations were measured once a week pre-exercise and post-exercise . RESULTS Capillary glucose responses to exercise were strongly influenced by an interaction between GDM risk , exercise duration and exercise intensity ( p = 0.006 ) . Decreases in glucose concentrations were observed after 25 ( 4 ± 13 % ) , 35 ( 21 ± 12 % ) and 40 min ( 15 ± 18 % ) of walking in high risk-30%I women , with the most noticeable decline after 35 and 40 min . In the high risk-70%I , glucose concentrations decreased significantly only after 25 ( 22 ± 14 % ) and 35 min ( 7 ± 23 % ) and increasing the exercise time attenuated glucose concentrations decline . In low risk women , regardless of exercise intensity and duration , decreases in glucose concentrations were significant and similar . CONCLUSION To achieve the best decline in glucose concentrations , pregnant women who follow a modified GDM meal plan should walk for 25 min/session at vigorous intensity or for 35 - 40 min/session at low intensity if they are at risk for GDM and for at least 25 min at either low or vigorous intensity if they are at low risk for GDM Background The consumption of foods containing probiotic and prebiotic ingredients is growing consistently every year , and in view of the limited number of studies investigating their effect in the elderly . Objective The objective of this study was to evaluate the effect of the consumption of a symbiotic shake containing Lactobacillus acidophilus , Bifidobacterium bifidum and fructooligosaccharides on glycemia and cholesterol levels in elderly people . Methods A r and omized , double-blind , placebo-controlled study was conducted on twenty volunteers ( ten for placebo group and ten for symbiotic group ) , aged 50 to 60 years . The criteria for inclusion in the study were : total cholesterol > 200 mg/dL ; triglycerides > 200 mg/dL and glycemia > 110 mg/dL. Over a total test period of 30 days , 10 individuals ( the symbiotic group ) consumed a daily dose of 200 mL of a symbiotic shake containing 108 UFC/mL Lactobacillus acidophilus , 108 UFC/mL Bifidobacterium bifidum and 2 g oligofructose , while 10 other volunteers ( the  placebo group ) drank daily the same amount of a shake that did not contain any symbiotic bacteria . Blood sample s were collected 15 days prior to the start of the experiment and at 10-day intervals after the beginning of the shake intake . The st and ard lipid profile ( total cholesterol , triglycerides and HDL cholesterol ) and glycemia , or blood sugar levels , were evaluated by an enzyme colorimetric assay . Results The results of the symbiotic group showed a non-significant reduction ( P > 0.05 ) in total cholesterol and triglycerides , a significant increase ( P < 0.05 ) in HDL cholesterol and a significant reduction ( P < 0.05 ) in fasting glycemia . No significant changes were observed in the placebo group . Conclusion The consumption of symbiotic shake result ed in a significant increase in HDL and a significant decrease of glycemia . Trial Registration Clinical Trials.gov : 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 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 In the Netherl and s , 30 % of subfertile women are overweight or obese , and at present there is no agreement on fertility care for them . Data from observational and small intervention studies suggest that reduction of weight will increase the chances of conception , decrease pregnancy complications and improve perinatal outcome , but this has not been confirmed in r and omised controlled trials . This study will assess the cost and effects of a six-months structured lifestyle program aim ing at weight reduction followed by conventional fertility care ( intervention group ) as compared to conventional fertility care only ( control group ) in overweight and obese subfertile women . We hypothesize that the intervention will decrease the need for fertility treatment , diminish overweight-related pregnancy complications , and will improve perinatal outcome . Methods / Design Multicenter r and omised controlled trial in subfertile women ( age 18 - 39 year ) with a body mass index between 29 and 40 kg/m2 . Exclusion criteria are azoospermia , use of donor semen , severe endometriosis , premature ovarian failure , endocrinopathies or pre-existent hypertensive disorders . In the intervention group the aim is a weight loss of at least 5 % to10 % in a six-month period , to be achieved by the combination of a diet , increase of physical activity and behavioural modification . After six months , in case no conception has been achieved , these patients will start fertility treatment according to the Dutch fertility guidelines . In the control group treatment will be started according to Dutch fertility guidelines , independently of the patient 's weight . Outcome measures and analysis The primary outcome measure is a healthy singleton born after at least 37 weeks of gestation after vaginal delivery . Secondary outcome parameters including pregnancy outcome and complications , percentage of women needing fertility treatment , clinical and ongoing pregnancy rates , body weight , quality of life and costs . Data will be analysed according to the intention to treat principle , and cost-effectiveness analysis will be performed to compare the costs and health effects in the intervention and control group . Discussion The trial will provide evidence for costs and effects of a lifestyle intervention aim ing at weight reduction in overweight and obese subfertile women and will offer guidance to clinicians for the treatment of these patients .Trial registration Dutch Trial Register Objective The influence of an exercise programme performed by healthy pregnant women on maternal glucose tolerance was studied . Study design A physical activity ( PA , l and /aquatic activities ) programme during the entire pregnancy ( three sessions per week ) was conducted by a qualified instructor . 83 healthy pregnant women were r and omly assigned to either an exercise group ( EG , n=40 ) or a control ( CG , n=43 ) group . 50 g maternal glucose screen ( MGS ) , maternal weight gain and several pregnancy outcomes were recorded . Results Significant differences were found between study groups on the 50 g MGS . Values corresponding to the EG ( 103.8±20.4 mg/dl ) were better than those of the CG ( 126.9±29.5 mg/dl ) , p=0.000 . In addition , no differences in maternal weight gain and no cases of gestational diabetes in EG versus 3 in CG ( 7 % ) ( p>0.05 ) were found . Conclusion A moderate PA programme performed during pregnancy improves levels of maternal glucose tolerance Background Obesity is increasing in the child-bearing population as are the rates of gestational diabetes . Gestational diabetes is associated with higher rates of Cesarean Section for the mother and increased risks of macrosomia , higher body fat mass , respiratory distress and hypoglycemia for the infant . Prevention of gestational diabetes through life style intervention has proven to be difficult . A Finnish study showed that ingestion of specific probiotics altered the composition of the gut microbiome and thereby metabolism from early gestation and decreased rates of gestational diabetes in normal weight women . In SPRING ( the Study of Probiotics IN the prevention of Gestational diabetes ) , the effectiveness of probiotics ingestion for the prevention of gestational diabetes will be assessed in overweight and obese women . Methods / design SPRING is a multi-center , prospect i ve , double-blind r and omized controlled trial run at two tertiary maternity hospitals in Brisbane , Australia . Five hundred and forty ( 540 ) women with a BMI > 25.0 kg/m2 will be recruited over 2 years and receive either probiotics or placebo capsules from 16 weeks gestation until delivery . The probiotics capsules contain > 1x109 cfu each of Lactobacillus rhamnosus GG and Bifidobacterium lactis BB-12 per capsule . The primary outcome is diagnosis of gestational diabetes at 28 weeks gestation . Secondary outcomes include rates of other pregnancy complications , gestational weight gain , mode of delivery , change in gut microbiome , preterm birth , macrosomia , and infant body composition . The trial has 80 % power at a 5 % 2-sided significance level to detect a > 50 % change in the rates of gestational diabetes in this high-risk group of pregnant women . Discussion SPRING will show if probiotics can be used as an easily implementable method of preventing gestational diabetes in the high-risk group of overweight and obese pregnant women 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 The perinatal nutritional environment impacts upon the health and well-being of mother and child also in the long term . The aim of the present study was to determine the safety and efficacy of perinatal probiotic-supplemented dietary counselling by evaluating pregnancy outcome and fetal and infant growth during the 24 months ' follow-up . Altogether , 256 women were r and omised at their first trimester of pregnancy into a control and a dietary intervention group . The intervention group received intensive dietary counselling provided by a nutritionist and were further r and omised , double-blind to receive probiotics ( Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb12 ; diet/probiotics ) or placebo ( diet/placebo ) . Firstly , probiotic intervention reduced the frequency of gestational diabetes mellitus ( GDM ) ; 13 % ( diet/probiotics ) v. 36 % ( diet/placebo ) and 34 % ( control ) ; P = 0.003 . Secondly , the safety of this approach was attested by normal duration of pregnancies with no adverse events in mothers or children . No significant differences in prenatal or postnatal growth rates among the study groups were detected . Thirdly , distinctive effects of the two interventions were detected ; probiotic intervention reduced the risk of GDM and dietary intervention diminished the risk of larger birth size in affected cases ; P = 0.035 for birth weight and P = 0.028 for birth length . The results of the present study show that probiotic-supplemented perinatal dietary counselling could be a safe and cost-effective tool in addressing the metabolic epidemic . In view of the fact that birth size is a risk marker for later obesity , the present results are of significance for public health in demonstrating that this risk is modifiable Background / objectives : Owing to excess body weight and increased secretion of inflammatory cytokines primarily during the third trimester , pregnancy is associated with elevated insulin resistance . To our knowledge , no report is available indicating the effects of probiotic yoghurt consumption on serum insulin levels in pregnant women . This study was design ed to determine the effects of daily consumption of probiotic yoghurt on insulin resistance and serum insulin levels of Iranian pregnant women . Subjects/ methods : In this r and omized controlled clinical trial , 70 primigravida pregnant women with singleton pregnancy at their third trimester were participated . We r and omly assigned participants to consume 200 g per day of conventional ( n=33 ) or the probiotic group ( n=37 ) for 9 weeks . The probiotic yoghurt was a commercially available product prepared with the starter cultures of Streptococcus thermophilus and Lactobacillus bulgaricus , enriched with probiotic culture of two strains of lactobacilli ( Lactobacillus acidophilus LA5 ) and bifidobacteria ( Bifidobacterium animalis BB12 ) with a total of min 1 × 107 colony-forming units . Fasting blood sample s were taken at baseline and after 9-week intervention to measure fasting plasma glucose and serum insulin levels . Homeostatic model assessment of insulin resistance ( HOMA-IR ) was used to calculate insulin resistance score . Results : Although consumption of probiotic yogurt for 9 weeks did not affect serum insulin levels and HOMA-IR score , significant differences were found comparing changes in these variables between probiotic and conventional yogurts ( changes from baseline in serum insulin levels : + 1.2±1.2 vs + 5.0±1.1 μIU/ml , respectively , P=0.02 ; and in HOMA-IR score : −0.2±0.3 vs 0.7±0.2 , respectively , P=0.01 ) . Conclusions : It is concluded that in contrast to conventional yogurt , daily consumption of probiotic yogurt for 9 weeks maintains serum insulin levels and might help pregnant women prevent developing insulin resistance 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 OBJECTIVE Oxidative stress plays a major role in the pathogenesis and progression of diabetes . Among various functional foods with an antioxidant effect , probiotic foods have been reported to repress oxidative stress . The objective of this clinical trial was to assess the effects of probiotic and conventional yogurt on blood glucose and antioxidant status in type 2 diabetic patients . METHODS Sixty-four patients with type 2 diabetes mellitus , 30 to 60 y old , were assigned to two groups in this r and omized , double-blind , controlled clinical trial . The patients in the intervention group consumed 300 g/d of probiotic yogurt containing Lactobacillus acidophilus La5 and Bifidobacterium lactis Bb12 and those in the control group consumed 300 g/d of conventional yogurt for 6 wk .  Fasting blood sample s , 24-h dietary recalls , and anthropometric measurements were collected at the baseline and at the end of the trial . RESULTS Probiotic yogurt significantly decreased fasting blood glucose ( P < 0.01 ) and hemoglobin A1c ( P < 0.05 ) and increased erythrocyte superoxide dismutase and glutathione peroxidase activities and total antioxidant status ( P < 0.05 ) compared with the control group . In addition , the serum malondialdehyde concentration significantly decreased compared with the baseline value in both groups ( P < 0.05 ) . No significant changes from baseline were shown in insulin concentration and erythrocyte catalase activity within either group ( P > 0.05 ) . CONCLUSION The consumption of probiotic yogurt improved fasting blood glucose and antioxidant status in type 2 diabetic patients . These results suggest that probiotic yogurt is a promising agent for diabetes management OBJECTIVE We assessed the relation between prepregnancy body mass index ( BMI ) and the likelihood of  major depressive disorder ( MDD ) during pregnancy and tested whether this association was modified by gestational weight gain . METHOD Women ( N = 242 ) were enrolled at < 20 weeks gestation into a prospect i ve cohort study . Diagnosis of MDD was made with the Structured Clinical Interview for DSM-IV at 20 , 30 , and 36 weeks gestation .  Gestational weight gain was compared with the 1990 Institute of Medicine weight gain recommendations . To assess the independent association between prepregnancy BMI and the odds of MDD , MDD at each time point was used as the dependent measure in a multivariable longitudinal logistic regression model employing generalized estimating equations . The data were collected from 2003 - 2007 . RESULTS There was a strong , positive dose-response association between prepregnancy BMI and the likelihood of MDD ( P = .002 ) . Compared with a BMI of 18 , the adjusted odds ratios ( 95 % confidence interval ) for BMI s of 23 , 28 , and 33 were 1.4 ( 1.1 to 1.7 ) , 1.9 ( 1.3 to 2.9 ) , and 2.6 ( 1.4 to 4.3 ) , respectively . Gestational weight gain significantly modified this effect . Among women with weight gains within and above the 1990 Institute of Medicine recommendations , pregravid overweight was associated with a greater likelihood of MDD . In contrast , all women with weight gains below recommended levels had an elevated odds of depression regardless of their pregravid BMI ( P < .05 ) . CONCLUSIONS Because pregravid overweight , poor gestational weight gain , and MDD all pose substantial risks for fetal development and birth outcomes , health care providers should monitor depression levels in these women to facilitate appropriate depression intervention Obesity can affect ovulation and the chances of pregnancy . In this prospect i ve study , a weight loss programme was assessed to determine whether it could help infertile overweight anovulatory women to establish ovulation and assist in achieving pregnancy , ideally without further medical intervention . The subjects acted as their own historical controls . They underwent a weekly programme of behavioural change in relation to exercise and diet over 6 months ; those who did not complete the 6 months were treated as the comparison group . Women in the study group lost an average of 6.3 kg , with 12 of the 13 subjects resuming ovulation and 11 becoming pregnant , five of these spontaneously . Fitness , diet and psychometric measurements all improved . Fasting insulin and testosterone concentrations dropped significantly , while sex hormone binding globulin concentrations rose . None of these changes occurred in the comparison group . Thus , weight loss with a result ant improvement in ovulation , pregnancy outcome , self-esteem and endocrine parameters is the first therapeutic option for women who are infertile and overweight Objective To examine the effect of regular moderate-intensity exercise ( three training sessions/week ) on the incidence of  gestational diabetes mellitus ( GDM  , primary outcome ) . We also examined if the exercise intervention modifies the association between GDM and birth weight and risk of macrosomia , gestational age , risk of caesarean delivery and maternal weight gain ( secondary outcomes ) . Methods We r and omly assigned 510 healthy gravida to either an exercise intervention or a usual care ( control ) group ( n=255 each ) . The exercise programme focused on moderate-intensity resistance and aerobic exercises ( three times/week , 50–55 min/session ) . GDM diabetes was diagnosed according to the WHO criteria and the International Association for Diabetes in Pregnancy Study Group ( IADPSG ) . Results The intervention did not reduce the risk of developing GDM ( OR 0.84 , 95 % CI 0.50 to 1.40 ) when using the WHO criteria . We observed that the intervention reduced by 58 % the GDM-related risk ( WHO criteria ) of having a newborn with macrosomia ( OR 1.76 , 95 % CI 0.04 to 78.90 vs 4.22 , 95 % CI 1.35 to 13.19 ) in exercise and control groups , respectively ) , and by 34 % the GDM-related risk of having acute and elective caesarean delivery ( OR 1.30 , 95 % CI 0.44 to 3.84 vs 1.99 , 95 % CI 0.98 to 4.06 in exercise and control groups , respectively ) . Gestational age was similar across the treatment groups ( control , exercise ) and GDM category ( GDM or non-GDM ) , and maternal weight gain was ∼12 % lower in the exercise group independent of whether women developed GDM . The results were similar when the IADPSG criteria were used instead . Conclusions Regular moderate-intensity exercise performed over the second-third trimesters of pregnancy can be used to attenuate important GDM-related adverse outcomes Obesity affects ovulation , response to fertility treatment , pregnancy rates and outcome . In this prospect i ve study , a weight loss programme was assessed to determine whether it could help obese infertile women , irrespective of their infertility diagnosis , to achieve a viable pregnancy , ideally without further medical intervention . The subjects underwent a weekly programme aim ed at lifestyle changes in relation to exercise and diet for 6 months ; those that did not complete the 6 months were treated as a comparison group . Women in the study lost an average of 10.2 kg/m2 , with 60 of the 67 anovulatory subjects resuming spontaneous ovulation , 52 achieving a pregnancy ( 18 spontaneously ) and 45 a live birth . The miscarriage rate was 18 % , compared to 75 % for the same women prior to the programme . Psychometric measurements also improved . None of these changes occurred in the comparison group . The cost savings of the programme were considerable . Prior to the programme , the 67 women had had treatment costing a total of A$ 550,000 for two live births , a cost of A$ 275,000 per baby . After the programme , the same women had treatment costing a total of A$ 210,000 for 45 babies , a cost of A$ 4600 per baby . Thus weight loss should be considered as a first option for women who are infertile and overweight Background : Physical activity has been associated with decreased risk of  gestational diabetes mellitus .  Exp and ing on 2 previously published analyses of absolute exertion measures ( time spent and energy expended ) , we assessed the relation between perceived exertion during usual prepregnancy recreational physical activity and gestational diabetes . Methods : We analyzed data from a Washington State 1998–2002 case – control study ( 216 cases , 472 controls ) and a 1996–2002 prospect i ve cohort study ( 897 participants ) separately . We used logistic regression models to derive odds ratios ( ORs ) and 95 % confidence intervals ( CIs ) . Results : Among case – control participants , risk of gestational diabetes was markedly lower for women who reported very strenuous to maximal exertion in usual activity during the year before pregnancy versus those who reported negligible or minimal exertion ( adjusted OR = 0.19 ; CI = 0.15–0.50 ) . There was a direct inverse relation between perceived exertion and risk of gestational diabetes . This relation was also evident among the subset of participants who did not meet physical activity guidelines in the year before pregnancy . Similarly , the OR among cohort participants reporting very strenuous to maximal exertion was 0.57 ( 0.24–1.37 ) versus those reporting negligible to moderate exertion . Conclusions : These results suggest that risk of gestational diabetes is inversely related to the exertion perceived during recreational physical activity in the year before pregnancy . Perceived exertion may be a valuable addition to behavior and fitness measures in assessing relations between physical activity and pregnancy-related health outcomes Please cite this paper as : Oostdam N , van Poppel M , Wouters M , Eekhoff E , Bekedam D , Kuchenbecker W , Quartero H , Heres M , van Mechelen W. No effect of the FitFor2 exercise programme on blood glucose , insulin sensitivity , and birthweight in pregnant women who were overweight and at risk for gestational diabetes : results of a r and omised controlled trial . BJOG 2012;119:1098–1107 OBJECTIVE A prospect i ve r and omized controlled trial was design ed to assess the benefits and possible risks of aerobic exercise during pregnancy , using a fitness regimen based on the 2002 American College of Obstetricians and Gynecologists guidelines for exercise during pregnancy . METHODS Inactive women were r and omized at 12 - 14 wk gestation to a group that remained sedentary or to a group that performed moderate aerobic exercise 45 - 60 min , 4 d·wk , through 36 wk gestation . Thirty-one subjects in each group completed the study . RESULTS Compared with women who remained sedentary , active women improved aerobic fitness ( P < 0.05 ) and muscular strength ( P < 0.01 ) , delivered comparable size infants with significantly fewer cesarean deliveries ( P < 0.01 ) , and recovered faster postpartum ( P < 0.05 ) , at least related to the lower incidence of cesarean section . Active women developed no gestational hypertension ( P = 0.16 compared with controls ) and reported no injuries related to the exercise regimen . In the active group , there was one premature birth at 33 wk by a woman with a history of premature delivery of twins at 34 wk . There were no differences between groups in the incidence of gestational diabetes , musculoskeletal pains during pregnancy , flexibility on sit- and -reach test , mean length of pregnancy , neonatal Apgar scores , placenta weights , overall length of labor , weight gain during pregnancy , or weight retention postpartum . CONCLUSION Previously sedentary women who began exercising at 12 - 14 wk improved fitness and delivery outcomes 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 This study identified the impact of intensive therapy on neonatal outcomes in women with gestational diabetes mellitus ( GDM ) and determined the effects on the postpartum metabolic status of the mothers . RESEARCH DESIGN AND METHODS In total , 127 pregnant women with GDM were r and omly selected to receive an intensive treatment regimen , which included one-to-one education , lifestyle intervention , scheduled clinic visits , strict glucose control , and frequent glucose self-monitoring . Meanwhile , 148 age-matched pregnant women with GDM were selected as controls and given the st and ard treatment regimen .  Pregnancy outcomes including parameters related to the GDM mothers and to their neonates were comparatively analyzed between the two treatment groups . GDM patient follow-up ( range , 1 - 3 years after delivery ) included an oral glucose tolerance test and measurements of lipid concentration and insulin secretion . The insulinogenic index ( ΔInsulin(30 min)/ΔBlood glucose(30 min ) ) and homeostasis model assessment index of β-cell function and insulin resistance were calculated . The patients ' demographic and anthropometric data were also recorded for comparative analysis . RESULTS Compared with GDM patients receiving st and ard treatment , GDM patients receiving intensive treatment had lower instances of premature delivery ( 2.4 % vs. 8.3 % , P<0.05 ) and neonatal care unit admission ( 21.3 % vs. 33.3 % , P<0.05 ) and lower neonatal birth weight ( 3.26±0.53 vs. 3.45±0.55 kg , P<0.0001 ) . At follow-up , GDM patients from the intensive treatment group had a smaller waist circumference ( 75.83±3.11 vs. 78.34±4.20 cm , P<0.01 ) , lower 30-min glucose levels after a 75-g glucose load ( 8.26±1.85 vs. 9.46±2.74 mmol/L , P<0.05 ) , and higher high-density lipoprotein levels ( 1.30±0.24 vs. 1.18±0.23 mmol/L , P<0.05 ) . CONCLUSIONS The intensive GDM treatment regimen led to healthier outcomes for the women , the neonates , and the birth event and was associated with better maternal metabolic situations in the months and years after delivery 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 OBJECTIVE A prospect i ve study of the impact of obesity on pregnancy outcome in glucose-tolerant women . RESEARCH DESIGN AND METHODS The Irish Atlantic Diabetes in Pregnancy network advocates universal screening for gestational diabetes .  Women with normoglycemia and a recorded booking BMI were included .  Maternal and infant outcomes correlated with booking BMI are reported . RESULTS A total of 2,329 women fulfilled the criteria .  Caesarean deliveries increased in overweight ( OW ) ( odds ratio 1.57 [ 95 % CI 1.24–1.98 ] ) and obese ( OB ) ( 2.65 [ 2.03–3.46 ] ) women . Hypertensive disorders increased in OW ( 2.30 [ 1.55–3.40 ] ) and OB ( 3.29 [ 2.14–5.05 ] ) women . Reported miscarriages increased in OB ( 1.4 [ 1.11–1.77 ] ) women . Mean birth weight was 3.46 kg in normal BMI ( N BMI ) , 3.54 kg in OW , and 3.62 kg in OB ( P < 0.01 ) mothers . Macrosomia occurred in 15.5 , 21.4 , and 27.8 % of babies of N BMI , OW , and OB mothers , respectively ( P < 0.01 ) . Shoulder dystocia occur in 4 % ( > 4 kg ) compared with 0.2 % ( < 4 kg ) babies ( P < 0.01 ) . Congenital malformation risk increased for OB ( 2.47 [ 1.09–5.60 ] ) women . CONCLUSIONS OW and OB glucose-tolerant women have greater adverse pregnancy outcomes 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
Gestational diabetes mellitus ( GDM ) is associated with increased rates of fetal morbidity and mortality , both during the pregnancy and in the postnatal life .
Current treatment of GDM includes diet with or without medications , but this management is expensive and poorly cost-effective for the health care systems .
Strategies to prevent such condition would be preferable with respect to its treatment .
The aim of this literature review was to evaluate studies reporting the efficacy of the most used approaches to prevent GDM as well as evidence s of efficacy and safety of dietary supplementations .