Discussion
depression, LGA, GDM, prematurity
CHILDHOOD OBESITY, ADVERSE EVENTS, HYPOGLYCEMIA, GDM, HYPERBILIRUBINEMIA
To our knowledge, the Regarding birth and neonatal outcomes, we had very low rates of neonatal hospitalization, hypoglycemia, hyperbilirubinemia, and prematurity in both groups. Prior intervention studies investigating the effect of lifestyle interventions on offspring birth and neonatal outcomes are scarce. A recent retrospective analysis of a cohort using a special program for women, infants, and children (“WIC” program including nutrition education, breastfeeding education and support, referral to prenatal and pediatric health care and other maternal, child health, and human service programs) in women recently diagnosed with GDM showed a reduction in the risk of prematurity in the group of women with GDM who had benefitted from this program (Anthropometric outcomes at birth were close to a healthy control population in the entire GDM group with 11% LGA and 11% SGA (defined as > 90Regarding psychobehavioral outcomes in the offspring, the fact that we used a subscale of the Parenting Stress Index makes it difficult to compare to prior studies. However, regarding sleep, the mean night-time sleep duration was 639 minutes/night, which is lower than the Swiss mean recommended amount per night, as described in a previous paper in women with GDM (In general, our results align with prior studies performed in other populations with and without GDM. Importantly, we had a very active guidelines-based control group. Thus, in both groups, the rates of perinatal adverse events were very low and anthropometric outcomes were close to a healthy control group despite women having GDM. Similarly, the number of night wakings were comparable to the general population. Also, rates of breastfeeding were 96% in the intervention and 97% in the usual-care group at 6-8 weeks and 71% in the intervention and 72% in the usual-care group at one year, which is much higher than in the general Swiss population. The fact that the offspring of this study had better outcomes, or outcomes comparable to the general swiss population, and the fact that there were no major improvements regarding outcomes in the offspring from the intervention group suggests that our usual care already follows high standards and allows improvements in offspring outcomes. This absence in differences could also be explained with participation bias, whereby individuals agreeing to take part in the study are individuals who may be more willing to make positive changes in their lifestyle behaviors. Finally, it could be explained by the fact that clinicians seeing these women were aware that a study was taking place and may have delivered higher quality care to women from both groups.An interesting avenue for future studies seems to be the use of technology rather than face-to-face interventions focusing specifically on infant nutrition and health. As described above by our intervention did use text messaging to summarize behavioral goals for the mother, but less focus was placed on the offspring’s behavioral goals, as our primary aim was to reduce maternal weight and depression symptoms. Thus, the lack of group differences in our study may have been caused by the larger focus placed on maternal outcomes and may have involved too many components and behaviors to adapt in a short period. We suggest that future interventions should focus on technological interventions that target behaviours in the offspring beyond the first year of life, given their higher risk of childhood obesity (