Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, U.K. University of Western Sydney, Campbelltown, NSW, Australia
Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
Diabetes Care. 2015 Sep;38(9):1650-6. doi: 10.2337/dc15-0360. Epub 2015 Jun 25.
Ways to prevent gestational diabetes mellitus (GDM) remain unproven. We compared the impact of three lifestyle interventions (healthy eating [HE], physical activity [PA], and both HE and PA [HE+PA]) on GDM risk in a pilot multicenter randomized trial.
Pregnant women at risk for GDM (BMI ≥29 kg/m2) from nine European countries were invited to undertake a 75-g oral glucose tolerance test before 20 weeks' gestation. Those without GDM were randomized to HE, PA, or HE+PA. Women received five face-to-face and four optional telephone coaching sessions, based on the principles of motivational interviewing. A gestational weight gain (GWG) <5 kg was targeted. Coaches received standardized training and an intervention toolkit. Primary outcome measures were GWG, fasting glucose, and insulin sensitivity (HOMA) at 35-37 weeks.
Among the 150 trial participants, 32% developed GDM by 35-37 weeks and 20% achieved GWG <5 kg. HE women had less GWG (-2.6 kg [95% CI -4.9, -0.2]; P = 0.03) and lower fasting glucose (-0.3 mmol/L [-0.4, -0.1]; P = 0.01) than those in the PA group at 24-28 weeks. HOMA was comparable. No significant differences between HE+PA and the other groups were observed.
An antenatal HE intervention is associated with less GWG and lower fasting glucose compared with PA alone. These findings require a larger trial for confirmation but support the use of early HE interventions in obese pregnant women.
预防妊娠糖尿病（GDM）的方法尚未得到证实。我们比较了三种生活方式干预措施（健康饮食[HE]、体力活动[PA]和 HE+PA）对一项多中心随机试验中 GDM 风险的影响。
邀请来自九个欧洲国家的有 GDM 风险的孕妇（BMI≥29kg/m2）在 20 周妊娠前进行 75g 口服葡萄糖耐量试验。无 GDM 的孕妇随机分为 HE、PA 或 HE+PA 组。孕妇接受五次面对面和四次可选电话咨询，基于动机访谈原则。目标是妊娠体重增加（GWG）<5kg。教练接受了标准化培训和干预工具包。主要结局指标为 35-37 周时 GWG、空腹血糖和胰岛素敏感性（HOMA）。
在 150 名试验参与者中，32%的人在 35-37 周时发生 GDM，20%的人实现了 GWG<5kg。与 PA 组相比，HE 组的 GWG 减少（-2.6kg[95%CI-4.9，-0.2]；P=0.03），空腹血糖降低（-0.3mmol/L[-0.4，-0.1]；P=0.01），而 HOMA 则无差异。HE+PA 组与其他组之间无显著差异。
与单独的 PA 相比，产前 HE 干预与 GWG 减少和空腹血糖降低相关。这些发现需要更大的试验来证实，但支持在肥胖孕妇中早期使用 HE 干预。
