Association between Gestational Weight Gain, Gestational Diabetes Risk, and Obstetric Outcomes: A Randomized Controlled Trial Post Hoc Analysis

David Simmons, Roland Devlieger, Andre van Assche, Sander Galjaard, Rosa Corcoy, Juan M Adelantado, Fidelma Dunne, Gernot Desoye, Alexandra Kautzky-Willer, Peter Damm, Elisabeth R Mathiesen, Dorte M Jensen, Lise Lotte T Andersen, Annunziata Lapolla, Maria G Dalfra, Alessandra Bertolotto, Ewa Wender-Ozegowska, Agnieszka Zawiejska, David Hill, Frank J SnoekMireille N M van Poppel

    19 Citationer (Scopus)

    Abstract

    Excess gestational weight gain (GWG) is associated with the development of gestational diabetes mellitus (GDM). Lifestyle trials have not achieved much GWG limitation, and have largely failed to prevent GDM. We compared the effect of substantial GWG limitation on maternal GDM risk. Pregnant women with a body mass index (BMI) ≥29 kg/m² <20 weeks gestation without GDM (n = 436) were randomized, in a multicenter trial, to usual care (UC), healthy eating (HE), physical activity (PA), or HE and PA lifestyle interventions. GWG over the median was associated with higher homeostasis model assessment insulin resistance (HOMA-IR) and insulin secretion (Stumvoll phases 1 and 2), a higher fasting plasma glucose (FPG) at 24⁻28 weeks (4.66 ± 0.43 vs. 4.61 ± 0.40 mmol/L, p < 0.01), and a higher rate of caesarean section (38% vs. 27% p < 0.05). The GWG over the median at 35⁻37 weeks was associated with a higher rate of macrosomia (25% vs. 16%, p < 0.05). A post hoc comparison among women from the five sites with a GWG difference >3 kg showed no significance difference in glycaemia or insulin resistance between HE and PA, and UC. We conclude that preventing even substantial increases in GWG after the first trimester has little effect on maternal glycaemia. We recommend randomized controlled trials of effective lifestyle interventions, starting in or before the first trimester.

    OriginalsprogEngelsk
    TidsskriftNutrients
    Vol/bind10
    Udgave nummer11
    Sider (fra-til)1568
    Antal sider13
    ISSN2072-6643
    DOI
    StatusUdgivet - 23 okt. 2018

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