Institute of Metabolic Science, Addenbrooke's Hospital, CB2 0QQ Cambridge, UK.
Macarthur Clinical School, Western Sydney University, Locked Bag 1797, Campbelltown, Sydney, NSW 2760, Australia.
Nutrients. 2018 Oct 23;10(11):1568. doi: 10.3390/nu10111568.
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 ( = 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, < 0.01), and a higher rate of caesarean section (38% vs. 27% < 0.05). The GWG over the median at 35⁻37 weeks was associated with a higher rate of macrosomia (25% vs. 16%, < 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.
孕期体重过度增加（GWG）与妊娠糖尿病（GDM）的发生有关。生活方式干预试验并未在限制 GWG 方面取得显著成效，并且在很大程度上未能预防 GDM。我们比较了限制 GWG 对孕妇 GDM 风险的影响。在一项多中心试验中，将 20 周妊娠时 BMI≥29kg/m²且无 GDM 的孕妇（=436）随机分为常规护理组（UC）、健康饮食组（HE）、身体活动组（PA）或 HE 和 PA 生活方式干预组。GWG 超过中位数与更高的稳态模型评估胰岛素抵抗（HOMA-IR）和胰岛素分泌（Stumvoll 阶段 1 和 2）、24⁻28 周时更高的空腹血糖（FPG）（4.66±0.43 vs. 4.61±0.40mmol/L， <0.01）和更高的剖宫产率（38% vs. 27%， <0.05）相关。35⁻37 周时 GWG 超过中位数与巨大儿发生率较高（25% vs. 16%， <0.05）相关。对 GWG 差值>3kg 的五个中心的女性进行事后比较，发现 HE 和 PA 与 UC 之间在血糖或胰岛素抵抗方面无显著差异。我们得出结论，即使在孕早期后限制 GWG 的适度增加，对孕妇的血糖也几乎没有影响。我们建议在孕早期或之前开始进行有效的生活方式干预的随机对照试验。
