UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital,Dublin,Republic of Ireland.
Br J Nutr. 2014 Aug 28;112(4):583-9. doi: 10.1017/S000711451400110X. Epub 2014 Jun 4.
The present study is a secondary analysis of the ROLO study, a randomised control trial of a low-glycaemic index (GI) diet in pregnancy to prevent the recurrence of fetal macrosomia. The objectives of the present study were to identify which women are most likely to respond to a low-GI dietary intervention in pregnancy with respect to three outcome measures: birth weight; maternal glucose intolerance; gestational weight gain (GWG). In early pregnancy, 372 women had their mid-upper arm circumference recorded and BMI calculated. Concentrations of glucose, insulin and leptin were measured in early pregnancy and at 28 weeks. At delivery, infant birth weight was recorded and fetal glucose, C-peptide and leptin concentrations were measured in the cord blood. Women who benefited in terms of infant birth weight were shorter, with a lower education level. Those who maintained weight gain within the GWG guidelines were less overweight in both their first and second pregnancies, with no difference being observed in maternal height. Women who at 28 weeks of gestation developed glucose intolerance, despite the low-GI diet, had a higher BMI and higher glucose concentrations in early pregnancy with more insulin resistance. They also had significantly higher-interval pregnancy weight gain. For each analysis, women who responded to the intervention had lower leptin concentrations in early pregnancy than those who did not. These findings suggest that the maternal metabolic environment in early pregnancy is important in determining later risks of excessive weight gain and metabolic disturbance, whereas birth weight is mediated more by genetic factors. It highlights key areas, which warrant further interrogation before future pregnancy intervention studies, in particular, maternal education level and inter-pregnancy weight gain.
本研究是对 ROLO 研究的二次分析，ROLO 研究是一项关于低血糖指数（GI）饮食在妊娠中预防胎儿巨大儿复发的随机对照试验。本研究的目的是确定哪些女性在妊娠期间对低 GI 饮食干预最有可能产生反应，具体表现在三个结果指标上：出生体重；产妇葡萄糖耐量；妊娠体重增加（GWG）。在孕早期，372 名女性记录了她们的中上臂周长并计算了 BMI。在孕早期和 28 周时测量了葡萄糖、胰岛素和瘦素的浓度。分娩时，记录了婴儿的出生体重，并在脐血中测量了胎儿的葡萄糖、C 肽和瘦素浓度。在婴儿出生体重方面受益的女性更矮，教育水平更低。那些在 GWG 指南范围内保持体重增加的女性在第一和第二孕期都超重程度较低，而母亲身高没有差异。尽管进行了低 GI 饮食，但在 28 周时出现葡萄糖耐量异常的女性，其 BMI 更高，孕早期葡萄糖浓度更高，胰岛素抵抗更严重。她们的孕期体重增加也明显更高。对于每项分析，与未响应干预的女性相比，在孕早期对干预有反应的女性的瘦素浓度更低。这些发现表明，妊娠早期的母体代谢环境在决定后期体重过度增加和代谢紊乱的风险方面很重要，而出生体重更多地由遗传因素决定。它强调了一些关键领域，这些领域需要在未来的妊娠干预研究中进一步研究，特别是母亲的教育水平和孕期体重增加。
