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Diet, exercise fail to prevent gestational diabetes in women with obesity
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Pregnant women with obesity who adhere to a healthy diet and exercise regimen remain just as likely to develop gestational diabetes as those who do not practice the same healthy habits, according to research in The Lancet Diabetes & Endocrinology.
Lucilla Poston, PhD, of the division of women’s health at King’s College London, and colleagues analyzed data from 1,555 women older than 16 years with a BMI of at least 30 kg/m² who had a singleton pregnancy between 15 and 18 weeks plus 6 days of gestation at the beginning of the study (mean BMI, 36.3 kg/m²). Within the cohort, 772 women were randomly assigned to standard antenatal care and 783 were assigned behavioral intervention plus standard care. Women in the intervention group attended an individual interview with a health trainer, followed by eight trainer-led group or individual sessions lasting 1 hour, once a week for 8 weeks. Researchers also provided the women in the intervention group with a handbook that included recommended foods and recipes and suggestions for physical activity, as well as a DVD with an exercise regimen safe for pregnancy, a pedometer and a log book for recording their weekly goals.
Researchers administered an oral glucose tolerance test to all participants between 27 and 28 weeks plus 6 days of gestation and used WHO-recommended criteria to diagnose cases of gestational diabetes. Participants also completed food frequency and physical activity questionnaires at baseline and before taking the OGGT.
Researchers found similar incidence of gestational diabetes between groups; 172 women in the standard care group went on to develop gestational diabetes compared with 160 in the intervention group (RR = 0.96; 95% CI, 0.79-1.16). In addition, 61 babies born to women in the standard care group were large for gestational age vs. 71 babies in the intervention group.
Researchers noted improvements in secondary outcomes in the intervention group, including a reduced glycemic load, less weight gain during pregnancy and increased physical activity.
“Our study shows that an intensive diet and exercise regime alone cannot help reduce the risk of developing gestational diabetes in obese women,” Poston said in a press release. “However, using a more stringent diagnostic test for gestational diabetes meant we picked up more cases. We believe the greater number of women treated as a result of this test may explain why our study found a lower than anticipated incidence of [large for gestational age] infants in all women. This has implications for the diagnosis of gestational diabetes in the U.K., as NICE have recently decided against adoption of the WHO [gestational diabetes] criteria.”
Poston said the researchers are currently following the mothers and children from the cohort to see whether changes in the mothers’ diet and activity are sustained and have an effect on their health and the health of their offspring. – by Regina Schaffer
Disclosure: Poston reports receiving a research grant from Abbott Nutrition. Please see the full study for a list of all other authors’ relevant financial disclosures.
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