Redman Leanne M, Drews Kimberly L, Klein Samuel, Horn Linda Van, Wing Rena R, Pi-Sunyer Xavier, Evans Mary, Joshipura Kaumudi, Arteaga S Sonia, Cahill Alison G, Clifton Rebecca G, Couch Kimberly A, Franks Paul W, Gallagher Dympna, Haire-Joshu Debra, Martin Corby K, Peaceman Alan M, Phelan Suzanne, Thom Elizabeth A, Yanovski Susan Z, Knowler William C
Pennington Biomedical Research Center, Baton Rouge, LA, USA.
The Biostatistics Center, George Washington University, Washington, DC, USA.
Diabetes Res Clin Pract. 2021 Jan;171:108549. doi: 10.1016/j.diabres.2020.108549. Epub 2020 Nov 22.
To examine the effect of lifestyle (diet and physical activity) interventions on the prevalence of GDM, considering the method of GDM ascertainment and its association with early pregnancy characteristics and maternal and neonatal outcomes in the LIFE-Moms consortium.
LIFE-Moms evaluated the effects of lifestyle interventions to optimize gestational weight gain in 1148 pregnant women with BMI ≥ 25 kg/m and without known diabetes at enrollment, compared with standard care. GDM was assessed between 24 and 31-weeks gestation by a 2-hour, 75-gram OGTT or by local clinical practice standards.
Lifestyle interventions initiated prior to 16 weeks reduced early excess GWG compared with standard care (0.35 ± 0.24 vs 0.43 ± 0.26 kg per week, p=<0.0001) but did not affect GDM diagnosis (11.1% vs 11.6%, p = 0.91). Using the 75-gram, 2-hour OGTT, 13. 0% of standard care and 11.0% of the intervention group had GDM by the IADPSG criteria (p = 0.45). The 'type of diagnostic test' did not change the result (p = 0.86). Women who developed GDM were significantly heavier, more likely to have obesity, and more likely to have dysglycemia at baseline.
Moderate-to-high intensity lifestyle interventions grounded in behavior change theory initiated between 9 and 16-weeks gestation did not affect the prevalence of GDM despite reducing early GWG. CLINICALTRIALS.GOV: NCT01545934, NCT01616147, NCT01771133, NCT01631747, NCT01768793, NCT01610752, NCT01812694.
在LIFE-Moms联盟中，考虑妊娠期糖尿病（GDM）的确诊方法及其与孕早期特征、母婴结局的关联，研究生活方式（饮食和体育活动）干预对GDM患病率的影响。
LIFE-Moms评估了生活方式干预对1148名孕早期体重指数（BMI）≥25kg/m²且入组时无已知糖尿病的孕妇孕期体重增加优化的效果，并与标准护理进行比较。在妊娠24至31周期间，通过2小时75克口服葡萄糖耐量试验（OGTT）或当地临床实践标准评估GDM。
与标准护理相比，在孕16周前开始的生活方式干预减少了早期过度的孕期体重增加（每周0.35±0.24千克对0.43±0.26千克，p<0.0001），但未影响GDM诊断（11.1%对11.6%，p = 0.91）。根据国际糖尿病和妊娠研究组（IADPSG）标准，使用75克2小时OGTT时，标准护理组的13.0%和干预组的11.0%患有GDM（p = 0.45）。“诊断测试类型”未改变结果（p = 0.86）。发生GDM的女性在基线时体重更重，更有可能肥胖，且更有可能存在血糖异常。
基于行为改变理论在妊娠9至16周之间开始的中高强度生活方式干预，尽管减少了早期孕期体重增加，但并未影响GDM的患病率。临床试验注册编号：NCT01545934、NCT01616147、NCT01771133、NCT01631747、NCT01768793、NCT01610752、NCT01812694。
