Effect of physical activity and/or healthy eating on GDM risk: The DALI Lifestyle Study
Year: 2016
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: CONTEXT: Lifestyle approaches for preventing gestational diabetes mellitus (GDM) have produced mixed results. OBJECTIVE: The aim of the present study was to compare the effectiveness of 3 lifestyle interventions [healthy eating (HE), physical activity (PA), and both HE and PA (HE+PA)] with usual care (UC) in reducing GDM risk. DESIGN: The present study was a multicenter randomized controlled trial conducted from 2012 to 2014 [the DALI (vitamin D and lifestyle intervention for GDM prevention) lifestyle study]. SETTING: The study occurred at antenatal clinics across 11 centers in 9 European countries. PATIENTS: Consecutive pregnant women at <20 weeks of gestation with a body mass index (BMI) of ≥29 kg/m2 and without GDM using the International Association of Diabetes and Pregnancy Study Group criteria (n = 436). For the intervention, women were randomized, stratified by site, to UC, HE, PA, or HE+PA. The women received 5 face-to-face and ≤4 telephone coaching sessions using the principles of motivational interviewing. A gestational weight gain (GWG) <5 kg was targeted. The coaches received standardized training and an intervention toolkit tailored to their culture and language. MAIN OUTCOME MEASURES: The endpoints were the GWG at 35 to 37 weeks and the fasting glucose and insulin sensitivity [homeostasis model assessment insulin resistance (HOMA-IR)] at 24 to 28 weeks. RESULTS: We randomized 108 women to HE+PA, 113 to HE, 110 to PA, and 105 to UC. In the HE+PA group, but not HE or PA alone, women achieved substantially less GWG than did the controls (UC) by 35 to 37 weeks (-2.02; 95% confidence interval, -3.58 to -0.46 kg). Despite this reduction, no improvements were seen in fasting or postload glucose levels, insulin concentrations, or HOMA-IR. The birthweights and large and small for gestational age rates were similar. CONCLUSIONS: The combined HE+PA intervention was able to limit GWG but did not reduce fasting glycemia. Thus, lifestyle changes alone are unlikely to prevent GDM among women with a BMI of ≥29 kg/m2.
DOI: 10.1210/jc.2016-3455
Authors: David Simmons, Roland Devlieger, André van Assche, Goele Jans, Sander Galjaard, Rosa Corcoy, Juan M Adelantado, Fidelma Dunne, Gernot Desoye, Jürgen Harreiter, Alexandra Kautzky-Willer, Peter Damm, Elisabeth R Mathiesen, Dorte M Jensen, Liselotte Andersen, Annunziata Lapolla, Maria G Dalfrà, Alessandra Bertolotto, Ewa Wender-Ozegowska, Agnieszka Zawiejska, David Hill, Frank J Snoek, Judith GM Jelsma, Mireille NM van Poppel
Institutions: Wellcome/MRC Institute of Metabolic Science, Addenbrooke's Hospital, Western Sydney University, KU Leuven, Erasmus MC, Hospital de Sant Pau, Institut de Recerca Sant Pau, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red, Ollscoil na Gaillimhe – University of Galway, University of Graz, Medical University of Graz, Medical University of Vienna, University of Copenhagen, Rigshospitalet, University of Southern Denmark, Odense University Hospital, University of Padua, Azienda Ospedaliera Universitaria Pisana, Poznan University of Medical Sciences, Amsterdam UMC Location University of Amsterdam, Amsterdam Public Health, Amsterdam UMC Location Vrije Universiteit Amsterdam
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2560342673