Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Diabetes Care. 2018 Oct;41(10):2079-2085. doi: 10.2337/dc18-0808. Epub 2018 Jul 30.
To study effects of lifestyle intervention on metabolic and clinical outcomes in obese women fulfilling the World Health Organization (WHO) 2013 diagnostic criteria for gestational diabetes mellitus (GDM) in early gestation.
Secondary analysis of data from the Lifestyle in Pregnancy (LiP) study, a lifestyle randomized controlled trial in 304 pregnant women with BMI ≥30 kg/m. Early GDM (week 12-15) was diagnosed according to modified WHO 2013 GDM criteria: fasting venous plasma glucose ≥5.1 mmol/L and/or 2-h capillary blood glucose (CBG) ≥8.5 mmol/L (75-g oral glucose tolerance test [OGTT]). Women with treated GDM fulfilling local Danish GDM criteria (2-h CBG ≥9.0 mmol/L) ( = 16) and women with normal OGTT ( = 198) were excluded.
Of 90 women with early GDM, 36 received lifestyle intervention and 54 standard care. All were Caucasian, and median age was 29 years (interquartile range 27-33) and BMI 34.5 kg/m (32.3-38.1). All baseline characteristics were similar in the lifestyle intervention and standard care groups. At gestational week 28-30, the women in the lifestyle intervention group had significantly higher fasting total cholesterol and fasting LDL. All other metabolic parameters including measurements of glucose, insulin, and HOMA of insulin resistance were similar. There were more planned cesarean sections in the lifestyle intervention group (22.2 vs. 5.6%), but all other obstetric outcomes were similar.
Lifestyle intervention in obese women fulfilling WHO 2013 GDM criteria in early pregnancy was not effective in improving obstetric or metabolic outcomes. Future studies should focus on interventions starting prepregnancy.
研究生活方式干预对满足世界卫生组织（WHO）2013 年妊娠期糖尿病（GDM）诊断标准的早期妊娠肥胖女性代谢和临床结局的影响。
对生活方式妊娠（LiP）研究数据的二次分析，这是一项针对 304 名 BMI≥30kg/m 的孕妇的生活方式随机对照试验。根据修改后的 WHO 2013 年 GDM 标准诊断早期 GDM（第 12-15 周）：空腹静脉血浆葡萄糖≥5.1mmol/L 和/或 2 小时毛细血管血糖（CBG）≥8.5mmol/L（75g 口服葡萄糖耐量试验[OGTT]）。患有经治疗的 GDM 并符合当地丹麦 GDM 标准（2 小时 CBG≥9.0mmol/L）的女性（=16）和 OGTT 正常的女性（=198）被排除在外。
90 例早期 GDM 女性中，36 例接受生活方式干预，54 例接受标准护理。所有女性均为白种人，中位年龄为 29 岁（四分位间距 27-33），BMI 为 34.5kg/m（32.3-38.1）。生活方式干预组和标准护理组的所有基线特征均相似。在妊娠 28-30 周时，生活方式干预组的女性空腹总胆固醇和空腹 LDL 明显升高。所有其他代谢参数，包括血糖、胰岛素和胰岛素抵抗的 HOMA 测量值均相似。生活方式干预组计划剖宫产的比例较高（22.2%比 5.6%），但所有其他产科结局均相似。
在满足 WHO 2013 年 GDM 标准的早期妊娠肥胖女性中进行生活方式干预并未改善产科或代谢结局。未来的研究应侧重于孕前开始的干预措施。
