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Healthy lifestyle before pregnancy lowered gestational diabetes risk
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Women who avoid smoking, exercise regularly, eat healthy and maintain a healthy weight before becoming pregnant are less likely to develop gestational diabetes, according to research published in BMJ.
Adhering to a low-risk lifestyle could be an effective strategy to prevent the pregnancy-related condition, according to Cuilin Zhang, MD, MPH, PhD, an investigator at the National Institute of Child Health and Human Development of the NIH, and colleagues from other institutions.
Cuilin Zhang
“Our data indicate that adherence to a healthful lifestyle in the period before pregnancy is associated with a substantially lower risk of gestational diabetes,” the researchers wrote.
In a prospective cohort design, the researchers monitored 14,437 women (93% white) without chronic disease who participated in the Nurses’ Health Study II (1989-2001), which enrolled women aged 24 to 44 years. There were 20,136 singleton live births in the group.
The researchers gathered data on weight (BMI), diet (Alternative Healthy Eating Index-2010), level of physical activity (questionnaire) and smoking status. Self-reported cases of gestational diabetes, as diagnosed by a physician, were validated through medical records.
The researchers estimated population attributable risk percentage to gauge the proportion of cases that would hypothetically have not occurred if all pregnancies were in the low-risk group.
First-time gestational diabetes was reported in 823 pregnancies. Each of the four lifestyle factors was independently and significantly associated with gestational diabetes risk; the strongest association was seen with BMI >25 before pregnancy.
The likelihood of developing gestational diabetes was 41% lower (RR=0.59; 95% CI, 0.48-0.71) for women with three low-risk factors (nonsmoker, moderate to vigorous physical activity ≥150 minutes a week, healthy eating) compared with all other pregnancies.
For women with BMI <25 before pregnancy besides the three low-risk factors, gestational diabetes risk was 52% lower (RR=0.48; 95% CI, 0.38-0.61) compared with all other pregnancies. Women with BMI >25 still yielded benefit from adhering to the three other low-risk factors.
“Importantly, among women both normal weight and overweight or obese, a healthy lifestyle was related to a lower risk,” the researchers wrote.
Women meeting all four criteria were at an 83% reduced risk for gestational diabetes (RR=0.17; 95% CI, 0.12-0.25) compared with women meeting none of the low-risk lifestyle factors. Together, the four risk factors demonstrated a 47.5% population attributable risk percentage (95% CI, 35.6-56.6).
In an accompanying editorial, Sara J. Meltzer, MD, FRCPC, FACP, of McGill University in Montreal, praised the study for adding to the knowledge base and offering hope.
“Although successful modification of diet, exercise, body weight, and smoking habits are not easy for anyone, the findings of Zhang and colleagues should give health professionals and women planning a pregnancy the encouragement they need to try even harder,” Meltzer wrote.
Disclosure: This research was supported by the intramural research program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH. The Nurses’ Health Study II was funded by grants from NIH and American Diabetes Association.
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