妊娠期生活方式干预对预防常规护理中过度妊娠体重增加的效果- GeliS 群随机试验。
Effects of a lifestyle intervention during pregnancy to prevent excessive gestational weight gain in routine care - the cluster-randomised GeliS trial.
机构信息
Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany.
Competence Centre for Nutrition (KErn), Am Gereuth 4, 85354, Freising, Germany.
出版信息
BMC Med. 2019 Jan 14;17(1):5. doi: 10.1186/s12916-018-1235-z.
BACKGROUND
Excessive gestational weight gain (GWG) leads to obstetric complications, maternal postpartum weight retention and an increased risk of offspring obesity. The GeliS study examines the effect of a lifestyle intervention during pregnancy on the proportion of women with excessive GWG and pregnancy and obstetric complications, as well as the long-term risk of maternal and infant obesity.
METHODS
The GeliS study is a cluster-randomised multicentre controlled trial including 2286 women with a pre-pregnancy BMI between 18.5 and 40.0 kg/m recruited from gynaecological and midwifery practices prior to the end of the 12 week of gestation in five Bavarian regions. In the intervention regions, four lifestyle counselling sessions covering a balanced healthy diet, regular physical activity and self-monitoring of weight gain were performed by trained healthcare providers alongside routine pre- and postnatal practice visits. In the control regions, leaflets with general recommendations for a healthy lifestyle during pregnancy were provided.
RESULTS
The intervention did not result in a significant reduction of women showing excessive GWG (adjusted OR 0.95, 95% CI 0.66-1.38, p = 0.789), with 45.1% and 45.7% of women in the intervention and control groups, respectively, gaining weight above the Institute of Medicine recommendations. Gestational diabetes mellitus was diagnosed in 10.8% and 11.1% of women in the intervention and control groups, respectively (p = 0.622). Mean birth weight and length were slightly lower in the intervention group (3313 ± 536 g vs. 3363 ± 498 g, p = 0.020; 51.1 ± 2.7 cm vs. 51.6 ± 2.5 cm, p = 0.001).
CONCLUSION
In the setting of routine prenatal care, lifestyle advice given by trained healthcare providers was not successful in limiting GWG and pregnancy complications. Nevertheless, the potential long-term effects of the intervention remain to be assessed.
TRIAL REGISTRATION
NCT01958307 , ClinicalTrials.gov, retrospectively registered October 9, 2013.
背景
过度的孕期体重增加（GWG）会导致产科并发症、产妇产后体重滞留以及子女肥胖的风险增加。GeliS 研究检查了在孕期进行生活方式干预对过多 GWG 和妊娠及产科并发症的女性比例的影响，以及母婴肥胖的长期风险。
方法
GeliS 研究是一项集群随机对照临床试验，共纳入 2286 名 BMI 在 18.5 至 40.0kg/m2之间的孕妇，在巴伐利亚州五个地区的妇产科和助产士诊所，在妊娠 12 周结束前招募。在干预地区，由经过培训的医疗保健提供者与常规的产前和产后访视一起，进行四次涵盖均衡健康饮食、有规律的身体活动和体重增加自我监测的生活方式咨询。在对照地区，提供了有关孕期健康生活方式的一般建议传单。
结果
干预并未显著降低出现过度 GWG 的女性比例（调整后的 OR 0.95，95%CI 0.66-1.38，p = 0.789），干预组和对照组分别有 45.1%和 45.7%的女性体重增加超过医学研究所的建议。干预组和对照组分别有 10.8%和 11.1%的女性被诊断为妊娠期糖尿病（p = 0.622）。干预组的平均出生体重和长度略低（3313±536g 与 3363±498g，p = 0.020；51.1±2.7cm 与 51.6±2.5cm，p = 0.001）。
结论
在常规产前保健的背景下，由经过培训的医疗保健提供者提供的生活方式建议并不能成功限制 GWG 和妊娠并发症。然而，干预的潜在长期影响仍有待评估。
试验注册
NCT01958307，ClinicalTrials.gov，于 2013 年 10 月 9 日回顾性注册。
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