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Calancie L, Brown MO, Choi WA, Caouette JL, McCann J, Nam EY, Werner EF. Systematic review of interventions in early pregnancy among pregnant individuals at risk for hyperglycemia. Am J Obstet Gynecol MFM 2025; 7:101606. [PMID: 39788428 PMCID: PMC11885049 DOI: 10.1016/j.ajogmf.2025.101606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 12/06/2024] [Accepted: 12/15/2024] [Indexed: 01/12/2025]
Abstract
OBJECTIVE The maternal metabolic environment in early pregnancy can influence fetal growth trajectories. Our objective was to identify interventions initiated in early pregnancy (<20 weeks gestation) in pregnant individuals with risk factors for hyperglycemia and report their impact on primary (neonatal adiposity, small for gestational age, large for gestational age, macrosomia) and secondary outcomes (gestational weight gain, maternal hypertensive disorder, birth injury, NICU admission, preterm delivery, emergency cesarean section). DATA SOURCES We searched Cochrane Central database, Medline, Embase, CINAHL databases, and clinicaltrials.gov (September 2024) for clinical trials published between 2009 and 2024. Search terms included the key words "early OR during" OR "first trimester OR second trimester" AND "gestation OR pregnancy" OR "prenatal care" AND "insulin resistance" OR "metabolic health" OR "diabet*" OR "body composition" OR "obes*" OR "weight gain" OR "gestational diabetes" OR "hyperglycemia" OR "metabolic syndrome" AND "clinical trial." STUDY ELIGIBILITY CRITERIA Randomized controlled trials (RCTs) and other trials reporting interventions initiated before 20 weeks gestation in participants with singleton pregnancies at risk for hyperglycemia (overweight and/or obesity, history of type 2 diabetes, and/or history of GDM) that reported at least one primary outcome were included. Studies had to be conducted with humans in high income countries as defined by the World Bank, written in English. STUDY APPRAISAL AND SYNTHESIS METHODS We used the Downs and Black checklist to evaluate the methodological quality and risk. Data was extracted independently and any questions were resolved through group discussion. Interventions were categorized and synthesized by type. RESULTS 21,924 records were identified and 70 full-text articles met inclusion criteria. 65 articles were RCTs. Eight intervention categories were identified: diet only, physical activity or exercise only, diet and physical activity or exercise combined, lifestyle counseling, supplements, pharmaceuticals, early GDM screening, and mixed interventions. Only 12 studies reported statistically significant effects on primary neonatal outcomes. CONCLUSIONS Interventions initiated in early pregnancy (<20 weeks) among pregnant individuals at risk for hyperglycemia that include one or more of the following strategies can reduce risk of excess neonatal adiposity, macrosomia, large for gestational age and small for gestational age neonates: goal-setting and motivational strategies to improve diet and increase physical activity through individual and group sessions; lifestyle coaching that included behavioral techniques designed to empower participants by fostering autonomy in a supportive environment; structured group exercise classes three times per week; and personalized dietary recommendations. El resumen está disponible en Español al final del artículo.
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Affiliation(s)
- Larissa Calancie
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA (Calancie, Caouette and McCann).
| | - Madelin O Brown
- School of Medicine, Tufts University, Boston, MA (Brown, Choi, Nam and Werner)
| | - Wooyon A Choi
- School of Medicine, Tufts University, Boston, MA (Brown, Choi, Nam and Werner)
| | - Jessica L Caouette
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA (Calancie, Caouette and McCann)
| | - James McCann
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA (Calancie, Caouette and McCann)
| | - Eunice Y Nam
- School of Medicine, Tufts University, Boston, MA (Brown, Choi, Nam and Werner)
| | - Erika F Werner
- School of Medicine, Tufts University, Boston, MA (Brown, Choi, Nam and Werner); Tufts Medical Center, Boston, MA (Werner)
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Liu Q, Zhu S, Zhao M, Ma L, Wang C, Sun X, Feng Y, Wu Y, Zeng Z, Zhang L. Machine learning approaches for predicting fetal macrosomia at different stages of pregnancy: a retrospective study in China. BMC Pregnancy Childbirth 2025; 25:140. [PMID: 39934718 PMCID: PMC11817776 DOI: 10.1186/s12884-025-07239-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Accepted: 01/28/2025] [Indexed: 02/13/2025] Open
Abstract
BACKGROUND Macrosomia presents significant risks to both maternal and neonatal health, however, accurate antenatal prediction remains a major challenge. This study aimed to develop machine learning approaches to enhance the prediction of fetal macrosomia at different stages of pregnancy. METHODS This retrospective study involved 500 pregnant women who delivered singleton infants at Beijing Tsinghua Changgung Hospital between December 2019 and July 2024. The training set comprised 208 cases of macrosomia and 208 non-macrosomia cases, with 84 additional cases used for external validation. A total of 23 candidate variables, including maternal characteristics, physical measurements, and laboratory tests were collected for feature selection. Seven algorithms were applied in combination with three sets of selected features, resulting in 21 fitted models. Model performance was evaluated via the area under the receiver operating characteristic curve (AUC), accuracy, precision, sensitivity, specificity, and F1-score. RESULTS Maternal height, pre-pregnancy weight, first-trimester weight, pre-labor weight, gestational age at birth, gestational weight gain, and the proportion of male neonates were significantly greater in the macrosomia group compared to non-macrosomia group in the training set (p < 0.05). The top five predictors for macrosomia were pre-labor weight, gestational weight gain, the Pre-labor Hb/First-trimester Hb ratio, first-trimester Hb, and maternal height. Logistic regression yielded the highest AUC values in the pre-pregnancy (0.790) and first-trimester (0.815) periods in the validation set, whereas the ensemble model achieved the highest AUC value of 0.930 before labor. SHapley Additive exPlanations (SHAP) analysis highlighted pre-labor weight, gestational age, gestational weight gain, first-trimester Hb, and neonatal sex as important factors for the prediction of macrosomia. CONCLUSION This is the first study to utilize machine learning with data from the pre-pregnancy, first-trimester, and pre-labor periods to predict macrosomia. The logistic regression model and the final ensemble model demonstrated strong predictive performance, offering valuable insights to improve pre-pregnancy counseling, antenatal assessment, and intrapartum decision-making.
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Affiliation(s)
- Qingyuan Liu
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
- School of Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Simin Zhu
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Meng Zhao
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Lan Ma
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Chenqian Wang
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xiaotong Sun
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yanyan Feng
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yifan Wu
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Zhen Zeng
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
| | - Lei Zhang
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
- Institute for Precision Medicine, Tsinghua University, Beijing, China.
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Dodd JM, Deussen AR, Poprzeczny AJ, Slade LJ, Mitchell M, Louise J. Investigating discrepancies in findings between rigorous randomized trials and meta-analyses evaluating pregnancy interventions to limit gestational weight gain. Obes Rev 2024; 25:e13826. [PMID: 39363588 DOI: 10.1111/obr.13826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 07/26/2024] [Accepted: 08/18/2024] [Indexed: 10/05/2024]
Abstract
INTRODUCTION Robust randomized trials consistently demonstrate little impact from diet and physical activity interventions on gestational weight gain (GWG) and clinical outcomes, although meta-analyses report some benefit. Our aim was to evaluate the effect of trial quality on treatment effect estimates and review conclusions. METHODS We conducted a systematic review of dietary and/or physical activity interventions for pregnant women with a body mass index ≥18.5 kg/m2. We assessed studies for risk of bias and methodological features impacting reliability. Outcomes included GWG; gestational diabetes mellitus (GDM); pre-eclampsia; caesarean birth; and birth weight measures. For each outcome, a sequence of meta-analyses was performed based on intervention group and level of potential bias in the effect estimate. RESULTS We identified 128 eligible studies. The most robust estimate from a combined diet and physical activity behavioral intervention, with only studies at negligible risk of bias, was a difference in GWG of 1.10 kg (95% CI -1.62 to -0.58; 17,755 women). There was no evidence of an effect on any clinical outcomes. CONCLUSIONS Our findings highlight discrepancies produced by the indiscriminate inclusion of studies with methodological flaws in previous systematic reviews. Regular weighing of pregnant women is futile in the absence of clinical benefit.
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Affiliation(s)
- Jodie M Dodd
- Department of Obstetrics and Gynaecology and The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Obstetrics and Gynaecology, The Women's and Children's Hospital, Women's and Babies Division, Adelaide, South Australia, Australia
| | - Andrea R Deussen
- Department of Obstetrics and Gynaecology and The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Amanda J Poprzeczny
- Department of Obstetrics and Gynaecology and The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Obstetrics and Gynaecology, The Women's and Children's Hospital, Women's and Babies Division, Adelaide, South Australia, Australia
| | - Laura J Slade
- Department of Obstetrics and Gynaecology and The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Obstetrics and Gynaecology, The Women's and Children's Hospital, Women's and Babies Division, Adelaide, South Australia, Australia
| | - Megan Mitchell
- Department of Obstetrics and Gynaecology and The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jennie Louise
- Women's and Children's Hospital Research Centre, Adelaide, South Australia, Australia
- Biostatistics Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Watt GE, Hubbard ME, Mottola MF. The association of physical activity during pregnancy with birthweight extremes: A scoping review. J Sci Med Sport 2024; 27:684-690. [PMID: 38866653 DOI: 10.1016/j.jsams.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 05/13/2024] [Accepted: 05/28/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVES Birthweight (BW) indicates newborn health and is a risk factor for development of chronic diseases later in life. The aim was to investigate whether or not prenatal physical activity (PA) influences BW extremes and how PA influences BW extremes in those diagnosed with pregnancy-related diseases. DESIGN We performed a scoping review. METHODS Searches were completed on five databases and studies identified were uploaded to Covidence. RESULTS Across the five databases 3114 studies were identified and after screening, 69 of these studies were used for the final review. Of the 61 studies that considered low BW (LBW)/small for gestational age (SGA) infants, the majority of results (69 %) indicated that PA during pregnancy had no significant impact on LBW or SGA infants. In addition, 11 % of studies reported a significant decrease in the prevalence of LBW infants, however two studies (3 %) reported a significant increase in LBW or SGA infants, likely relating to individuals with high body mass index and poor adherence to PA. Of the 41 studies that did report LGA/macrosomia, 34 % reported that PA significantly reduced the prevalence of higher BW infants. One study reported the association between meeting exercise recommendations and reducing the odds of LGA infants in those with pregnancy-related diseases. CONCLUSIONS We provide evidence on the association of prenatal PA with BW extremes. It is suggested that prenatal PA does not increase the risk of delivering LBW/SGA infants and may reduce the prevalence of large BW infants. Further research is needed to confirm these relationships and explain their underlying mechanisms.
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Affiliation(s)
- Grace Emma Watt
- R. Samuel McLaughlin Foundation - Exercise and Pregnancy Lab, University of Western Ontario, Canada; School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, Canada
| | - Madeline E Hubbard
- R. Samuel McLaughlin Foundation - Exercise and Pregnancy Lab, University of Western Ontario, Canada; School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, Canada; Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
| | - Michelle F Mottola
- R. Samuel McLaughlin Foundation - Exercise and Pregnancy Lab, University of Western Ontario, Canada; School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, Canada; Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, Canada; Children's Health Research Institute, University of Western Ontario, Canada.
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Huang WK, Jalleh RJ, Rayner CK, Wu TZ. Management of gestational diabetes mellitus via nutritional interventions: The relevance of gastric emptying. World J Diabetes 2024; 15:1394-1397. [PMID: 39099817 PMCID: PMC11292344 DOI: 10.4239/wjd.v15.i7.1394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/09/2024] [Accepted: 04/18/2024] [Indexed: 07/08/2024] Open
Abstract
Gestational diabetes mellitus (GDM) represents one of the most common medical complications of pregnancy and is important to the well-being of both mothers and offspring in the short and long term. Lifestyle intervention remains the mainstay for the management of GDM. The efficacy of nutritional approaches (e.g. calorie restriction and small frequent meals) to improving the maternal-neonatal outcomes of GDM was attested to by Chinese population data, discussed in two articles in recent issues of this journal. However, a specific focus on the relevance of postprandial glycaemic control was lacking. Postprandial rather than fasting hyperglycaemia often represents the predominant manifestation of disordered glucose homeostasis in Chinese women with GDM. There is now increasing appreciation that the rate of gastric emptying, which controls the delivery of nutrients for digestion and absorption in the small intestine, is a key determinant of postprandial glycaemia in both health, type 1 and 2 diabetes. It remains to be established whether gastric emptying is abnormally rapid in GDM, particularly among Chinese women, thus contributing to a predisposition to postprandial hyperglycaemia, and if so, how this influences the therapeutic response to nutritional interventions. It is essential that we understand the role of gastric emptying in the regulation of postprandial glycaemia during pregnancy and the potential for its modulation by nutritional strategies in order to improve post-prandial glycaemic control in GDM.
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Affiliation(s)
- Wei-Kun Huang
- Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide 5000, Australia
| | - Ryan J Jalleh
- Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide 5000, Australia
| | - Christopher K Rayner
- Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide and Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide 5000, Australia
| | - Tong-Zhi Wu
- Adelaide Medical School and Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide 5000, Australia
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Barakat R, Silva-José C, Sánchez-Polán M, Zhang D, Lobo P, De Roia G, Montejo R. Physical Activity during Pregnancy and Childhood Obesity: Systematic Review and Meta-Analysis. J Clin Med 2024; 13:3726. [PMID: 38999292 PMCID: PMC11242316 DOI: 10.3390/jcm13133726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/03/2024] [Accepted: 06/22/2024] [Indexed: 07/14/2024] Open
Abstract
Background and Objectives: The repercussions of childhood overweight and obesity are multifaceted, extending beyond the realm of physiology and giving rise to psychological and emotional disturbances in affected children. The precise effects of gestational physical activity (PA) on parameters related to childhood overweight and obesity remain inadequately understood. The aim of this study (Registration CRD42022372490) was to evaluate the literature regarding the influence of PA during pregnancy on the risk of childhood overweight and obesity. Materials and Methods: Only randomized controlled trials (RCTs) were considered for inclusion. Determinant parameters of childhood obesity were analyzed. A total of 30 studies involving 16,137 pregnant women were examined. Five meta-analyses about the effects of PA during pregnancy on determinants of childhood overweight and obesity were conducted. Results: Although favorable trends were observed, Meta-Analyses showed no statistical differences in the effects of PA on weight at birth (Z = 0.03, p = 0.97), Ponderal Index at birth (Z = 0.64, p = 0.52), Macrosomia and Large for Gestational Age at birth (Z = 0.93, p = 0.35), children's BMI (Z = 0.78, p = 0.44), weight (Z = 0.50, p = 0.62), and skinfold thicknesses (Z = 0.45, p = 0.65). Conclusions: The engagement in physical activity during pregnancy exhibits a favorable trend in parameters associated with childhood overweight and obesity while presenting no adverse effects on such outcomes.
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Affiliation(s)
- Rubén Barakat
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Cristina Silva-José
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Miguel Sánchez-Polán
- GICAF Research Group, Department of Education, Research and Evaluation Methods, Universidad Pontificia Comillas, 28049 Madrid, Spain
| | - Dingfeng Zhang
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Pablo Lobo
- Laboratorio de Estudios en Actividad Física (LEAF), Universidad de Flores (UFLO), Buenos Aires C1406, Argentina
| | - Gabriela De Roia
- Laboratorio de Estudios en Actividad Física (LEAF), Universidad de Flores (UFLO), Buenos Aires C1406, Argentina
| | - Rocío Montejo
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, 405 30 Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
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Tsironikos GI, Zakynthinos GE, Tatsioni A, Tsolaki V, Kagias IG, Potamianos P, Bargiota A. Gestational Metabolic Risk: A Narrative Review of Pregnancy-Related Complications and of the Effectiveness of Dietary, Exercise and Lifestyle Interventions during Pregnancy on Reducing Gestational Weight Gain and Preventing Gestational Diabetes Mellitus. J Clin Med 2024; 13:3462. [PMID: 38929991 PMCID: PMC11204633 DOI: 10.3390/jcm13123462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/06/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Objective: This study is a Narrative Review that aims at investigating the implications of obesity, excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM). Additionally, this Review seeks to explore the effectiveness of nutrition, and/or exercise interventions during pregnancy on reducing GWG and preventing GDM. Materials and Methods: The search in literature included studies that identified obesity, GWG, GDM and associated risks during pregnancy. Also, SR and MA focusing on interventions including diet, or physical activity (PA), or combined (i.e., lifestyle interventions) and their impact on metabolic risk during pregnancy, were identified through searches in PubMed, Cochrane Database of Systematic Reviews (CDSRs), and Scopus. Results: The study findings suggest that lifestyle interventions during pregnancy may be effective in reducing excessive GWG. Regarding the prevention of GDM, results from studies evaluating lifestyle interventions vary. However, significant and less controversial results were reported from studies assessing the efficacy of exercise interventions, particularly in high-risk pregnant women. Conclusions: Lifestyle interventions during pregnancy may reduce excessive GWG. Exercise during pregnancy may prevent GDM, especially in high-risk pregnant women. Future research is warranted to tailor lifestyle interventions for optimal effectiveness during pregnancy.
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Affiliation(s)
- Georgios I. Tsironikos
- Department of Medicine, University of Ioannina, University Campus, 45110 Ioannina, Greece;
| | - George E. Zakynthinos
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Athina Tatsioni
- Department of Research for General Medicine and Primary Health Care, Faculty of Medicine, University of Ioannina, University Campus, 45110 Ioannina, Greece;
| | - Vasiliki Tsolaki
- Department of Critical Care, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece;
| | - Iraklis-Georgios Kagias
- Department of Neurosurgery, University Hospitals Sussex NHS Foundation Trust, Brighton BN2 5BE, UK;
| | - Petros Potamianos
- Department of Gastroenterology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece;
| | - Alexandra Bargiota
- Department of Internal Medicine-Endocrinology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece;
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Dodd JM, Louise J, Deussen AR, Mitchell M, Poston L. Rethinking causal assumptions about maternal BMI, gestational weight gain, and adverse pregnancy outcomes. BMC Med 2024; 22:197. [PMID: 38750522 PMCID: PMC11094971 DOI: 10.1186/s12916-024-03410-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 04/29/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The aim of this study was to evaluate commonly assumed causal relationships between body mass index (BMI), gestational weight gain (GWG), and adverse pregnancy outcomes, which have formed the basis of guidelines and interventions aimed at limiting GWG in women with overweight or obesity. We explored relationships between maternal BMI, total GWG (as a continuous variable and as 'excessive' GWG), and pregnancy outcomes (including infant birthweight measures and caesarean birth). METHODS Analysis of individual participant data (IPD) from the i-WIP (International Weight Management in Pregnancy) Collaboration, from randomised trials of diet and/or physical activity interventions during pregnancy reporting GWG and maternal and neonatal outcomes. Women randomised to the control arm of 20 eligible randomised trials (4370 of 8908 participants) from the i-WIP dataset of 36 randomised trials (total 12,240 women). The main research questions were to characterise the relationship between maternal BMI and (a) total GWG, (b) the risk of 'excessive' GWG (using the Institute of Medicine's guidelines), and (c) adverse pregnancy outcomes as mediated via GWG versus other pathways to determine the extent to which the observed effect of maternal BMI on pregnancy outcomes is mediated via GWG. We utilised generalised linear models and regression-based mediation analyses within an IPD meta-analysis framework. RESULTS Mean GWG decreased linearly as maternal BMI increased; however, the risk of 'excessive' GWG increased markedly at BMI category thresholds (i.e. between the normal and overweight BMI category threshold and between the overweight and obese BMI category threshold). Increasing maternal BMI was associated with increased risk of all pregnancy outcomes assessed; however, there was no evidence that this effect was mediated via effects on GWG. CONCLUSIONS There is evidence of a meaningful relationship between maternal BMI and GWG and between maternal BMI and adverse pregnancy outcomes. There is no evidence that the effect of maternal BMI on outcomes is via an effect on GWG. Our analyses also cast doubt on the existence of a relationship between 'excessive' GWG and adverse pregnancy outcomes. Our findings challenge the practice of actively managing GWG throughout pregnancy.
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Affiliation(s)
- Jodie M Dodd
- Department of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.
- Department of Obstetrics and Gynaecology, Women's and Babies Division, The Women's and Children's Hospital, 72 King William Road, North Adelaide, South Australia, 5006, Australia.
| | - Jennie Louise
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Women's and Children's Research Centre, Women's and Children's Hospital Research Network, Adelaide, South Australia, Australia
| | - Andrea R Deussen
- Department of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Megan Mitchell
- Department of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lucilla Poston
- Women and Children's Health and School of Life Course Sciences, King's College London, London, UK
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Takele WW, Vesco KK, Josefson J, Redman LM, Hannah W, Bonham MP, Chen M, Chivers SC, Fawcett AJ, Grieger JA, Habibi N, Leung GKW, Liu K, Mekonnen EG, Pathirana M, Quinteros A, Taylor R, Ukke GG, Zhou SJ, Lim S. Effective interventions in preventing gestational diabetes mellitus: A systematic review and meta-analysis. COMMUNICATIONS MEDICINE 2024; 4:75. [PMID: 38643248 PMCID: PMC11032369 DOI: 10.1038/s43856-024-00491-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 03/22/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Lifestyle choices, metformin, and dietary supplements may prevent GDM, but the effect of intervention characteristics has not been identified. This review evaluated intervention characteristics to inform the implementation of GDM prevention interventions. METHODS Ovid, MEDLINE/PubMed, and EMBASE databases were searched. The Template for Intervention Description and Replication (TIDieR) framework was used to examine intervention characteristics (who, what, when, where, and how). Subgroup analysis was performed by intervention characteristics. RESULTS 116 studies involving 40,940 participants are included. Group-based physical activity interventions (RR 0.66; 95% CI 0.46, 0.95) reduce the incidence of GDM compared with individual or mixed (individual and group) delivery format (subgroup p-value = 0.04). Physical activity interventions delivered at healthcare facilities reduce the risk of GDM (RR 0.59; 95% CI 0.49, 0.72) compared with home-based interventions (subgroup p-value = 0.03). No other intervention characteristics impact the effectiveness of all other interventions. CONCLUSIONS Dietary, physical activity, diet plus physical activity, metformin, and myoinositol interventions reduce the incidence of GDM compared with control interventions. Group and healthcare facility-based physical activity interventions show better effectiveness in preventing GDM than individual and community-based interventions. Other intervention characteristics (e.g. utilization of e-health) don't impact the effectiveness of lifestyle interventions, and thus, interventions may require consideration of the local context.
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Affiliation(s)
- Wubet Worku Takele
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Kimberly K Vesco
- Kaiser Permanente Northwest, Kaiser Permanente Center for Health Research, Oakland, USA
| | - Jami Josefson
- Northwestern University/ Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | - Wesley Hannah
- Madras Diabetes Research Foundation Chennai, Chennai, India
- Deakin University, Melbourne, Australia
| | - Maxine P Bonham
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
| | - Mingling Chen
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Sian C Chivers
- Department of Women and Children's Health, King's College London, London, UK
| | - Andrea J Fawcett
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Clinical & Organizational Development, University of Chicago, Chicago, IL, USA
| | - Jessica A Grieger
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Nahal Habibi
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Gloria K W Leung
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
| | - Kai Liu
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
| | | | - Maleesa Pathirana
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Alejandra Quinteros
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Rachael Taylor
- School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
| | - Gebresilasea G Ukke
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Shao J Zhou
- School of Agriculture, Food and Wine, The University of Adelaide, Adelaide, Australia
| | - Siew Lim
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.
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10
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Almazyad NS, Jahan S. Awareness of Gestational Diabetes Mellitus Maternal and Neonatal Outcomes Among Women Attending Primary Healthcare Centers in Qassim, Saudi Arabia. Cureus 2024; 16:e59345. [PMID: 38817476 PMCID: PMC11137627 DOI: 10.7759/cureus.59345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 06/01/2024] Open
Abstract
Background Gestational diabetes mellitus (GDM), diagnosed during pregnancy, can harm both mothers and neonates. GDM awareness among women varies among various countries. Understanding the level of awareness is vital for designing effective health interventions. Objectives This study aimed to evaluate GDM awareness among married females at primary healthcare centers (PHCCs) in Qassim, Saudi Arabia, focusing on knowledge regarding adverse maternal and fetal outcomes of GDM. Methods An observational cross-sectional study was conducted among married females at PHCCs in Qassim, from June 2023 to October 2023. A two-stage cluster sampling method was used. Four PHCCs were selected in the first stage, and study participants were selected from these centers in the second stage. A self-administered questionnaire was used. Statistical Product and Service Solutions (SPSS, version 23; IBM SPSS Statistics for Windows, Armonk, NY) was used for statistical analysis. Results Of the 270 participants, the majority (72.2%) demonstrated 'poor' knowledge about GDM adverse outcomes for both mothers and neonates, 17.8% demonstrated a 'fair' level, and only 10% displayed a 'good' knowledge. Participants' educational level, personal history of diabetes, and age were associated with knowledge levels. Awareness of specific outcomes related to GDM, both maternal and neonatal, varied among participants. Information on GDM was mainly obtained from mass media and personal networks, while healthcare providers were reported as the least common source. Conclusion Based on the results of our study, we conclude that educational interventions, especially involving healthcare providers, are essential to improve awareness about GDM adverse outcomes. Strategies involving educational sessions by healthcare providers and health education materials at PHCCs can improve awareness leading to effective management of GDM and improved maternal and neonatal outcomes.
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Affiliation(s)
- Nouf S Almazyad
- Family Medicine Academy, Qassim Health Cluster, Buraidah, SAU
| | - Saulat Jahan
- Family Medicine Academy, Qassim Health Cluster, Buraidah, SAU
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11
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Peña A, Miller AM, Campbell AG, Holden RJ, Scifres CM. Mapping Lifestyle Interventions for Gestational Diabetes Prevention: A Scoping Review. Curr Diab Rep 2024; 24:74-83. [PMID: 38367172 DOI: 10.1007/s11892-024-01535-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE OF REVIEW The purpose of this study was to conduct a scoping review to map intervention, sample, and physiologic measurement characteristics of lifestyle interventions for gestational diabetes mellitus (GDM) prevention. RECENT FINDINGS A total of 19 studies met selection criteria from 405 articles screened (PubMed, Web of Science). No studies were US-based (47% multi-site), and all were delivered in clinical settings. The most targeted nutrition components were low carbohydrate intake (sugar rich foods/added sugars, low glycemic index), low fat intake (mainly low-fat meat, dairy, and saturated fat), and increased fruits and vegetables. Many studies promoted 150 min/week moderate-intensity physical activity. Only two studies provided supervised physical activity sessions. Dietitians and nurses were the most common implementers. Samples were characterized as adults with obesity (mean age 31 yr, BMI 31 kg/m2). Asian populations were predominantly studied. Four studies used theoretical frameworks (75% of which used Social Cognitive Theory). GDM diagnostic criteria set forth by the American Diabetes Association were the most widely used. Insulin sensitivity was commonly assessed via fasting indices. There was a lack of multi-disciplinary, multi-level, and theory-based lifestyle interventions for reducing GDM risk. Addressing these gaps and prioritizing high-risk populations in the US with measurement of traditional and novel biomarkers will advance the field.
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Affiliation(s)
- Armando Peña
- Department of Health & Wellness Design, School of Public Health in Bloomington, Indiana University, Bloomington, IN, USA.
| | - Alison M Miller
- Department of Health & Wellness Design, School of Public Health in Bloomington, Indiana University, Bloomington, IN, USA
| | - Angela G Campbell
- Applied Health Sciences, School of Public Health in Bloomington, Indiana University, Bloomington, IN, USA
| | - Richard J Holden
- Department of Health & Wellness Design, School of Public Health in Bloomington, Indiana University, Bloomington, IN, USA
| | - Christina M Scifres
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, IN, USA
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12
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Fair FJ, Soltani H. Association of child weight with attendance at a healthy lifestyle service among women with obesity during pregnancy. MATERNAL & CHILD NUTRITION 2024; 20:e13629. [PMID: 38311775 PMCID: PMC10981489 DOI: 10.1111/mcn.13629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/13/2023] [Accepted: 01/08/2024] [Indexed: 02/06/2024]
Abstract
Women with obesity during pregnancy are at increased risk of excessive gestational weight gain (GWG) and other maternal and infant adverse outcomes, which all potentially increase childhood obesity. This study explored infant weight outcomes for women with a body mass index (BMI) ≥ 35 kg/m² who were offered an antenatal healthy lifestyle service. A retrospective cohort study, including linking data from two separate health care Trusts, was undertaken. Data were collected from maternity records for women with a BMI ≥ 35 kg/m2 referred to an antenatal healthy lifestyle service from 2009 to 2015. The respective child's weight outcome data was additionally collected from health and National Child Measurement Programme records. Univariate logistic regression determined the odds of childhood overweight, obesity and severe obesity according to attendance at the antenatal healthy lifestyle service, GWG and sociodemographic characteristics. Factors significant (p < 0.05) within the univariate analysis were entered into multiple logistic regression models. Among women with a BMI ≥ 35 kg/m², 30.4% of their children were obese at school entry and 13.3% severely obese. Healthy lifestyle service attendance was not associated with childhood overweight or obesity at any point within the univariate analysis. At school age multiple regression analysis showed the odds of overweight and obesity increased with excessive GWG and the odds of obesity decreased with a parent in a professional occupation, additionally having a mother who smoked in pregnancy increased severe obesity. Women should be supported to optimise their BMI before pregnancy. Additionally, rather than exclusively focusing on changing an individual's behaviour, future interventions should consider external influences such as the woman's family, friends and sociodemographic background.
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Affiliation(s)
- Frankie J. Fair
- College of Health, Wellbeing and Life SciencesSheffield Hallam UniversitySheffieldUK
| | - Hora Soltani
- College of Health, Wellbeing and Life SciencesSheffield Hallam UniversitySheffieldUK
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13
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Quotah OF, Andreeva D, Nowak KG, Dalrymple KV, Almubarak A, Patel A, Vyas N, Cakir GS, Heslehurst N, Bell Z, Poston L, White SL, Flynn AC. Interventions in preconception and pregnant women at risk of gestational diabetes; a systematic review and meta-analysis of randomised controlled trials. Diabetol Metab Syndr 2024; 16:8. [PMID: 38178175 PMCID: PMC10765912 DOI: 10.1186/s13098-023-01217-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/13/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Women at risk of gestational diabetes mellitus (GDM) need preventative interventions. OBJECTIVE To evaluate targeted interventions before and during pregnancy for women identified as being at risk of developing GDM. METHODS Systematic review and meta-analysis conducted following PRISMA guidelines. MEDLINE, EMBASE and the Cochrane Library in addition to reference and citation lists were searched to identify eligible randomised controlled trials (RCTs) utilising risk stratification during the preconception period or in the first/early second trimester. Screening and data extraction were carried out by the authors independently. Quality assessment was conducted based on the Cochrane risk-of-bias tool. Random effects meta-analysis and narrative synthesis were performed. RESULTS Eighty-four RCTs were included: two during preconception and 82 in pregnancy, with a pooled sample of 22,568 women. Interventions were behavioural (n = 54), dietary supplementation (n = 19) and pharmacological (n = 11). Predictive factors for risk assessment varied; only one study utilised a validated prediction model. Gestational diabetes was reduced in diet and physical activity interventions (risk difference - 0.03, 95% CI 0.06, - 0.01; I2 58.69%), inositol (risk difference - 0.19, 95% CI 0.33, - 0.06; I2 92.19%), and vitamin D supplements (risk difference - 0.16, 95% CI 0.25, - 0.06; I2 32.27%). Subgroup analysis showed that diet and physical activity interventions were beneficial in women with ≥ 2 GDM risk factors (risk difference - 0.16, 95% CI 0.25, - 0.07; I2 11.23%) while inositol supplementation was effective in women with overweight or obesity (risk difference - 0.17, 95% CI 0.22, - 0.11; I2 0.01%). Effectiveness of all other interventions were not statistically significant. CONCLUSIONS This review provides evidence that interventions targeted at women at risk of GDM may be an effective strategy for prevention. Further studies using validated prediction tools or multiple risk factors to target high-risk women for intervention before and during pregnancy are warranted.
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Affiliation(s)
- Ola F Quotah
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK.
- Department of Clinical Nutrition, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Daria Andreeva
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Katarzyna G Nowak
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
- Department of Nutrition and Dietetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Kathryn V Dalrymple
- Department of Nutritional Sciences, School of Life Course Sciences and Population Sciences, King's College London, London, UK
| | - Aljawharah Almubarak
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Anjali Patel
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Nirali Vyas
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Gözde S Cakir
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Zoe Bell
- Department of Nutritional Sciences, School of Life Course Sciences and Population Sciences, King's College London, London, UK
| | - Lucilla Poston
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Sara L White
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Angela C Flynn
- Department of Nutritional Sciences, School of Life Course Sciences and Population Sciences, King's College London, London, UK
- School of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland
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14
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Barakat R, Silva-Jose C, Zhang D, Sánchez-Polán M, Refoyo I, Montejo R. Influence of Physical Activity during Pregnancy on Maternal Hypertensive Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Pers Med 2023; 14:10. [PMID: 38276226 PMCID: PMC10817323 DOI: 10.3390/jpm14010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Gestational hypertension is a notable concern with ramifications for maternal and fetal health. Preemptive measures, including physical activity (PA), are crucial. There is a pressing need for comprehensive investigations into the impact of various forms of PA on hypertensive disorders. A systematic review and meta-analysis (CRD42022372468) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. Our review exclusively considered randomized clinical trials (RCTs) between 2010 and 2023, using the following databases: EBSCO, including Academic Search Premier, Education Resources Information Center, PubMed/MEDLINE, SPORTDiscus, and OpenDissertations; Clinicaltrials.gov; Web of Science; Scopus; the Cochrane Database of Systematic Reviews; and the Physiotherapy Evidence Database (PEDro). The primary outcome was hypertensive disorders occurring during pregnancy (14 studies). Diagnosed preeclampsia (15 studies) and blood pressure levels were also examined (17 studies). PA during pregnancy was significantly associated with a reduced risk of hypertensive disorders (RR = 0.44, 95% CI = 0.30, 0.66). The data also indicate a positive correlation between PA during pregnancy and both systolic (MD = -2.64, 95% CI = -4.79, -0.49) and diastolic (MD = -1.99, 95% CI = -3.68, -0.29) blood pressure levels. The relationship between PA and the incidence of diagnosed preeclampsia did not demonstrate a statistically significant association (RR = 0.81, 95% CI = 0.59, 1.11; p = 0.20). Random effects were used for all analyses. PA during pregnancy promises to improve maternal health by reducing the risk of gestational hypertension and positively affecting systolic and diastolic blood pressure.
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Affiliation(s)
- Rubén Barakat
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.S.-J.); (D.Z.); (M.S.-P.)
| | - Cristina Silva-Jose
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.S.-J.); (D.Z.); (M.S.-P.)
| | - Dingfeng Zhang
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.S.-J.); (D.Z.); (M.S.-P.)
| | - Miguel Sánchez-Polán
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.S.-J.); (D.Z.); (M.S.-P.)
| | - Ignacio Refoyo
- Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain;
| | - Rocío Montejo
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 41346 Gothenburg, Sweden;
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, 41346 Gothenburg, Sweden
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15
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Zhou B, Liu Y, Ren Y, Yan X, Fan J, Tang L, Wen M. Serum Vaspin Levels in Gestational Diabetes Mellitus: A Meta-Analysis. Metab Syndr Relat Disord 2023; 21:535-544. [PMID: 37883666 DOI: 10.1089/met.2023.0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
The objective of this study was to evaluate the potential relationship between serum vaspin levels and gestational diabetes mellitus (GDM). The PubMed, EBSCO, Web of Science, the Cochrane Library, and the China National Knowledge Infrastructure (CNKI) database were searched for articles published before December 2022. The publication language was restricted to English and Chinese. A meta-analysis was conducted by combining all studies that met the inclusion and exclusion criteria. Twenty-two studies (1990 women with GDM and 1597 pregnant women without GDM) were ultimately included in this meta-analysis. The meta-analysis showed that the serum vaspin levels are significantly higher in GDM compared with the controls (standardized mean difference: 0.720, 95% confidence interval: 0.440-1.000, Z = 5.041, P < 0.001). Subgroup analyses by stage of pregnancy and body mass index showed results similar to the overall outcome. No publication bias was identified, and the sensitivity analysis confirmed the robustness of the final result. Our results show that the serum vaspin levels are significantly higher in GDM. These findings suggest that high vaspin concentration is closely related to GDM and the serum vaspin levels might be a potential biomarker to indicate risk of GDM, more randomized control trials comparing the expression levels of vaspin between early and standard diagnosis of GDM are needed to strengthen our findings.
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Affiliation(s)
- Bo Zhou
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guiyang, China
- Guizhou Provincial Engineering Technology Research Center for Chemical Drug R&D, Guizhou Medical University, Guiyang, China
- College of Pharmacy, Guizhou Medical University, Guiyang, China
| | - Yibu Liu
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guiyang, China
- Guizhou Provincial Engineering Technology Research Center for Chemical Drug R&D, Guizhou Medical University, Guiyang, China
- College of Pharmacy, Guizhou Medical University, Guiyang, China
| | - Yibing Ren
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guiyang, China
- Guizhou Provincial Engineering Technology Research Center for Chemical Drug R&D, Guizhou Medical University, Guiyang, China
- College of Pharmacy, Guizhou Medical University, Guiyang, China
| | - Xuehui Yan
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guiyang, China
- Guizhou Provincial Engineering Technology Research Center for Chemical Drug R&D, Guizhou Medical University, Guiyang, China
- College of Pharmacy, Guizhou Medical University, Guiyang, China
| | - Judi Fan
- College of Pharmacy, Guizhou Medical University, Guiyang, China
| | - Lei Tang
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guiyang, China
- Guizhou Provincial Engineering Technology Research Center for Chemical Drug R&D, Guizhou Medical University, Guiyang, China
- College of Pharmacy, Guizhou Medical University, Guiyang, China
| | - Min Wen
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guiyang, China
- Guizhou Provincial Engineering Technology Research Center for Chemical Drug R&D, Guizhou Medical University, Guiyang, China
- College of Pharmacy, Guizhou Medical University, Guiyang, China
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16
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Tsironikos GI, Potamianos P, Zakynthinos GE, Tsolaki V, Tatsioni A, Bargiota A. Effectiveness of Lifestyle Interventions during Pregnancy on Preventing Gestational Diabetes Mellitus in High-Risk Women: A Systematic Review and Meta-Analyses of Published RCTs. J Clin Med 2023; 12:7038. [PMID: 38002654 PMCID: PMC10672732 DOI: 10.3390/jcm12227038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/01/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Until now, it is uncertain whether lifestyle interventions during pregnancy can prevent gestational diabetes mellites (GDM) in high-risk pregnant women. OBJECTIVE This study aims at investigating the effectiveness of dietary interventions and/or exercise interventions during pregnancy for preventing GDM in high-risk pregnant women. MATERIALS AND METHODS Eligible randomized controlled trials (RCTs) were selected after a search in CENTRAL, Scopus, and PubMed. Synthesis was performed for the outcome of GDM in women with any identified GDM risk factor. Separate meta-analyses (MA) were performed to assess the efficacy of either nutrition or physical activity (PA) interventions or both combined compared with standard prenatal care for preventing GDM. Subgroup and sensitivity analyses, as well as meta-regressions against OR, were performed to assess potentional heterogeneity. Overall quality, the quality of RCTs, and publication bias were also evaluated. RESULTS A total of 13,524 participants comprising high-risk pregnant women in 41 eligible RCTs were analyzed for GDM. Women receiving only a nutrition intervention during pregnancy were less likely to experience GDM compared with women following standard prenatal care. Among 3109 high-risk pregnant women undergoing only dietary intervention for preventing GDM, 553 (17.8%) developed GDM; however, the result of the MA was marginally not significant (OR 0.73, 95%CI 0.51, 1.03; p-value 0.07), (Q 21.29, p-value 0.01; I2 58% (95%CI 10, 78%)). Subgroup analyses demonstrated an effect for studies that were conducted in Great Britain (OR 0.65, 95%CI 0.49, 0.81; p-value 0.003), and in Spain (OR 0.50, 95%CI 0.27, 0.94; p-value 0.03), for studies with forms of the Mediterranean diet as the intervention's component (OR 0.61; 95%CI 0.46, 0.81; p-value 0.0005), and for studies including a motivation arm in the intervention (OR 0.71, 95%CI 0.58, 0.87; p-value 0.0008). Among 2742 high-risk pregnant women being analyzed for GDM outcome after receiving only an exercise intervention, 461 (16.8%) were diagnosed with GDM. Women after receiving PA intervention were less likely to develop GDM (OR 0.64, 95%CI 0.51, 0.80; p-value < 0.0001), (Q 11.27, p-value 0.51; I2 0% (95%CI 0, 99%)). Finally, 1308 (17%) cases of GDM were diagnosed among 7673 high-risk pregnant women undergoing both diet and PA intervention. Women in the group of mixed lifestyle intervention had a significant reduction in incidence of GDM (OR 0.70, 95%CI 0.55, 0.90; p-value 0.005), (Q 50.32, p-value < 0.0001, I2 66%, (95% CI 44, 79%)). CONCLUSIONS The results of this study support the efficacy of lifestyle interventions during pregnancy for preventing GDM in high-risk women if an exercise component is included in the intervention arm, either alone, or combined with diet. A combined lifestyle intervention including physical exercise and a Mediterranean diet accompanied by motivation support may be considered the most effective way to prevent GDM among high-risk women during pregnancy. Future research is needed to strengthen these findings.
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Affiliation(s)
- Georgios I. Tsironikos
- Department of Medicine, University of Ioannina, University Campus, 45110 Ioannina, Greece;
| | - Petros Potamianos
- Department of Gastroenterology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece;
| | - George E. Zakynthinos
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Vasiliki Tsolaki
- Department of Critical Care, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece
| | - Athina Tatsioni
- Department of Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, University of Ioannina, University Campus, 45110 Ioannina, Greece;
| | - Alexandra Bargiota
- Department of Internal Medicine-Endocrinology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece;
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17
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Moore KR, Stotz SA, Terry MA, Seely EW, Gonzales K, Marshall G, Nadeau KJ, Akers A, Garcia-Reyes Y, Charron-Prochownik D. Respecting tribal voices in the development of a gestational diabetes risk reduction preconception counseling program for American Indian/Alaska Native adolescent females: a qualitative study. BMC Pregnancy Childbirth 2023; 23:552. [PMID: 37528363 PMCID: PMC10392008 DOI: 10.1186/s12884-023-05850-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/12/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND American Indians and Alaska Natives (AI/AN) are disproportionately affected by adolescent obesity, adolescent pregnancy and gestational diabetes mellitus (GDM). GDM is associated with increased risk for perinatal death, obesity, and subsequent type 2 diabetes (T2D) for the offspring. Moreover, mothers with GDM are also at increased risk for T2D post-partum. Yet few lifestyle interventions exist to reduce GDM risk prior to pregnancy. We describe the process of adapting an existing validated preconception counseling intervention for AI/AN adolescent girls at-risk for GDM and their mothers. Perspectives and recommendations were gathered from a diverse array of stakeholders to assure the new program called Stopping GDM was culturally responsive and developed with tribal voices and perspectives represented. METHODS We conducted focus groups and individual interviews with multiple AI/AN stakeholders (n = 55). Focus groups and interviews were digitally recorded, transcribed verbatim, and analyzed using a thematic content approach to construct cross-cutting themes across the focus groups and interviews. RESULTS Four key themes emerged reflecting issues important to planning a reproductive health intervention: 1) Limited awareness, knowledge, and health education resources about GDM; 2) The importance of acknowledging traditional AI/AN values and the diversity of traditions and culture among AI/AN tribes; 3) The need to cultivate healthy decision-making skills and empower girls to make safe and healthy choices; and 4) Lack of communication about reproductive health between AI/AN mothers and daughters and between AI/AN women and health care professionals. CONCLUSION Findings have been used to inform the cultural tailoring and adaptation of an existing preconception counseling program, originally designed for non-AI/AN adolescent girls with diabetes, for AI/AN adolescents at-risk for GDM in future pregnancies.
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Affiliation(s)
- Kelly R Moore
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sarah A Stotz
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Martha Ann Terry
- School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ellen W Seely
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kelly Gonzales
- School of Public Health, Oregon Health & Science University - Portland State University, Portland, OR, USA
| | | | - Kristen J Nadeau
- Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | | | | | - Denise Charron-Prochownik
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
- Department of Health Promotion and Development, Professor Nursing and School of Public Health, School of Nursing, University of Pittsburgh, 440 Victoria Bldg, Pittsburgh, USA.
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18
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Saidi L, Godbout PD, Morais-Savoie C, Registe PPW, Bélanger M. Association between physical activity education and prescription during prenatal care and maternal and fetal health outcomes: a quasi-experimental study. BMC Pregnancy Childbirth 2023; 23:496. [PMID: 37407926 PMCID: PMC10320878 DOI: 10.1186/s12884-023-05808-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 06/22/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Physical activity (PA) during pregnancy is associated with healthy gestational weight gain (GWG) and a reduced risk of developing gestational diabetes (GD), gestational hypertension (GHT) and fetal macrosomia. However, in Canada, less than 20% of pregnant women meet PA recommendations. This study assessed associations between an intervention including PA education by prenatal nurses and a PA prescription delivered by physicians and fetal and maternal outcomes. METHODS This is a quasi-experimental study. Two groups of women who received their prenatal care at the obstetrics clinic of a university hospital were created. In the first group, 394 pregnant women followed at the clinic received standard care. In the second group, 422 women followed at the clinic received standard care supplemented with education on the relevance of PA during pregnancy and a prescription for PA. Data for both study groups were obtained from the medical records of the mothers and their newborns. Logistic regressions were used to compare the odds of developing excessive GWG, GD, GHT, and fetal macrosomia between the two study groups. RESULTS The addition of PA education and PA prescription to prenatal care was associated with 29% lower odds of developing excessive GWG (adjusted odds ratios (OR) 0.71, 95% confidence intervals (CI) 0.51-0.99), 73% lower odds of developing GHT (0.27, 0.14-0.53), 44% lower odds of fetal macrosomia (> 4 kg) (0.56, 0.34-0.93), and 40% lower odds of being large for gestational age (0.60, 0.36-0.99). The intervention was not associated with a difference in odds of developing GD (0.48, 0.12-1.94). CONCLUSIONS The inclusion of education and prescription of PA as part of routine prenatal care was associated with improvements in maternal and fetal health outcomes, including significantly lower odds of GWG, GHT and macrosomia.
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Affiliation(s)
- Latifa Saidi
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 2500, boul. de l ’Université, Sherbrooke, Québec J1K 2R1 Canada
| | - Pierre D. Godbout
- School of Nursing, Université de Moncton, Campus de Shippagan, 725, Rue du Collège, Bathurst, NB E2A 3Z2 Canada
| | - Camille Morais-Savoie
- Centre de Formation Médicale du Nouveau-Brunswick, Université de Sherbrooke, Pavillon J-Raymond-Frenette, 50 Rue de La Francophonie St, Moncton, NB E1A 7R1 Canada
| | - Pierre Philippe Wilson Registe
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 2500, boul. de l ’Université, Sherbrooke, Québec J1K 2R1 Canada
| | - Mathieu Bélanger
- Department of Family and Emergency Medicine, Université de Sherbrooke, Centre de Formation Médicale du Nouveau-Brunswick, Vitalité Health Network, Pavillon J-Raymond-Frenette, 18, Avenue Antonine-Maillet, Moncton, NB E1A 3E9 Canada
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19
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Goddard L, Patel R, Astbury NM, Tucker K, McManus RJ. Evidence of lifestyle interventions in a pregnant population with chronic hypertension and/or pre-existing diabetes: A systematic review and narrative synthesis. Pregnancy Hypertens 2023; 31:60-72. [PMID: 36608587 DOI: 10.1016/j.preghy.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/06/2022] [Accepted: 12/21/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pregnant people with chronic hypertension, pre-existing diabetes or both are at high risk of developing cardiovascular disease. Lifestyle interventions play an important role in disease management in non-pregnant populations. AIM To review the existing evidence of randomised controlled trials (RCTs) that examine lifestyle interventions in pregnant people with chronic hypertension and/or pre-existing diabetes. METHODS A systematic review and narrative synthesis was conducted. Five electronic databases were searched from inception to April 2021 for RCTs evaluating antenatal lifestyle interventions in people with chronic hypertension and/or pre-existing diabetes with outcomes to include weight or blood pressure change. RESULTS Nine randomised controlled trials including 7438 pregnant women were eligible. Eight studies were mixed pregnant populations that included women with chronic hypertension and/or pre-existing diabetes. One study included only pregnant women with pre-existing diabetes. Intervention characteristics and procedures varied and targeted diet, physical activity and/or gestational weight. All studies reported weight and one study reported blood pressure change. Outcome data were frequently unavailable for the subset of women of interest, including subgroup data on important pregnancy and birth complications. Eligibility criteria were often ambiguous and baseline data on chronic hypertension was often omitted. CONCLUSION A lack of primary interventional trials examining the effect of lifestyle interventions on weight and blood pressure outcomes in pregnant populations with chronic hypertension and/or pre-existing diabetes was evident. Lifestyle modification has the potential to alter disease progression. Future trials should address the ambiguity and frequent exclusion of these important populations.
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Affiliation(s)
- Lucy Goddard
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford OX2 6GG, United Kingdom.
| | - Rajan Patel
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford OX2 6GG, United Kingdom.
| | - Nerys M Astbury
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford OX2 6GG, United Kingdom.
| | - Katherine Tucker
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford OX2 6GG, United Kingdom.
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford OX2 6GG, United Kingdom.
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20
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Fortin-Miller S, Plonka B, Gibbs H, Christifano D, Hull H. Prenatal interventions and the development of childhood obesity. Pediatr Obes 2023; 18:e12981. [PMID: 36104864 DOI: 10.1111/ijpo.12981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 08/08/2022] [Accepted: 08/15/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Excess maternal adiposity during pregnancy has lasting effects on child outcomes including increased risk of overweight/obesity, which drives disease development. Prenatal interventions are a potential avenue to curb childhood obesity rates, but little is known on their long-term influence on offspring adiposity. OBJECTIVE Review the evidence for lasting effects of prenatal interventions on child adiposity. METHODS Three databases were searched for follow-up studies of completed prenatal RCTs that involved a diet, exercise, or combined (diet and exercise) intervention, and assessed offspring adiposity-related outcomes beyond birth. RESULTS A total of 18 follow-up studies describing 4277 offspring were included. Anthropometrics were collected in all studies while body composition was measured in 15 of the studies. Diet or exercise interventions did not have a consistent significant effect on child adiposity. Three combined interventions resulted in lower levels of child adiposity at 3, 6, and 12 months. CONCLUSIONS No strong association was found between prenatal diet, exercise, or combined interventions and child adiposity. Data are limited due to 63.6% overall retention rate for the follow-up studies and heterogeneity of intervention approach and child adiposity measures. Findings suggest combined interventions initiated early in pregnancy may decrease offspring adiposity in the first year of life.
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Affiliation(s)
- Sara Fortin-Miller
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Brendel Plonka
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Heather Gibbs
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Danielle Christifano
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Holly Hull
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
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21
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Herzberger V, Bäz E, Kunze M, Markfeld-Erol F, Juhasz-Böss I. Exercise During Pregnancy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:793-797. [PMID: 36045499 PMCID: PMC9902891 DOI: 10.3238/arztebl.m2022.0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Pregnancy is a good time to motivate women to implement health-promoting behaviors in their everyday lives. There is no official German-language guideline for the counseling of pregnant women by professionals involved in their care. The goal of this review is, therefore, to discuss the links between exercise and gestational diabetes mellitus (GDM), low birth weight, and prematurity. METHODS This review is based on pertinent articles retrieved by a systematic search of PubMed and the Web of Science. The articles included in the evaluation were reports of randomized controlled trials (RCTs) and meta-analyses of RCTs of exercise interventions in pregnant women that were published from 1 January 2011 to 15 November 2021. RESULTS A structured exercise program during pregnancy can lower the risk of gestational diabetes by as much as 49%. A 25% risk reduction for GDM was achieved with 140 minutes of exercise per week. The mean birth weight was not affected but the rate of excessively heavy newborns was lowered by 32-59% in the normal-weight subgroup. This effect was not seen in the overweight subgroup, possibly because of poorer compliance. Exercise did not elevate the risk of preterm delivery. CONCLUSION Regular exercise during pregnancy lessens gestationally induced weight gain and lowers the risk of excessive weight gain, as well as the risk of GDM, without elevating the risk of preterm delivery.
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Affiliation(s)
- Veerle Herzberger
- Department of Obstetrics and Gynecology, Medical Center – University of Freiburg, Freiburg, Germany
| | - Elke Bäz
- Department of Obstetrics and Gynecology, Medical Center – University of Freiburg, Freiburg, Germany
| | - Mirjam Kunze
- Department of Obstetrics and Gynecology, Medical Center – University of Freiburg, Freiburg, Germany
| | - Filiz Markfeld-Erol
- Department of Obstetrics and Gynecology, Medical Center – University of Freiburg, Freiburg, Germany
| | - Ingolf Juhasz-Böss
- Department of Obstetrics and Gynecology, Medical Center – University of Freiburg, Freiburg, Germany
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22
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Michalopoulou M, Jebb SA, MacKillop LH, Dyson P, Hirst JE, Wire A, Astbury NM. Development and testing of a reduced carbohydrate intervention for the management of obesity and reduction of gestational diabetes (RECORD): protocol for a feasibility randomised controlled trial. BMJ Open 2022; 12:e060951. [PMID: 36581990 PMCID: PMC10441568 DOI: 10.1136/bmjopen-2022-060951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 08/03/2022] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Previous trials of dietary interventions to prevent gestational diabetes mellitus (GDM) have yielded only limited success. Low-carbohydrate diets have shown promise for the treatment of type 2 diabetes, but there is no evidence to support their use in pregnancy. The aim of this study is to explore the feasibility of a moderately reduced-carbohydrate dietary intervention delivered from mid-pregnancy alongside routine antenatal care. METHODS AND ANALYSIS This is a feasibility randomised controlled trial (RCT) with embedded qualitative study. Sixty women who are pregnant <20 weeks' gestation, with body mass index ≥30 kg/m2 at their antenatal booking appointment, will be randomised 2:1 intervention or control (usual care) and followed up until delivery. The intervention is a moderately reduced-carbohydrate diet (~130-150 g total carbohydrate/day), designed to be delivered alongside routine antenatal appointments. Primary outcomes are measures of adoption of the diet and retention of participants. Secondary outcomes include incidence of GDM, change in markers of glycaemic control, gestational weight gain, total carbohydrate and energy intake. Process outcomes will examine resources and management issues. Exploratory outcomes include further dietary changes, quality of life, maternal and neonatal outcomes, and qualitative measures. ETHICS AND DISSEMINATION This trial was reviewed and approved by the South-Central Oxford B Research Ethics Committee NHS National Research Ethics Committee and the Health Research Authority (Reference: 20/SC/0442). The study results will inform whether to progress to a full-scale RCT to test the clinical effectiveness of the RECORD programme to prevent GDM in women at high risk. The findings will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER ISRCTN16235884.
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Affiliation(s)
- Moscho Michalopoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Lucy H MacKillop
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Pamela Dyson
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, Oxford, UK
| | - Jane E Hirst
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Amy Wire
- Berkshire Healthcare NHS Foundation Trust, Bracknell, UK
| | - Nerys M Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
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23
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Tsironikos GI, Perivoliotis K, Bargiota A, Zintzaras E, Doxani C, Tatsioni A. Effectiveness of exercise intervention during pregnancy on high-risk women for gestational diabetes mellitus prevention: A meta-analysis of published RCTs. PLoS One 2022; 17:e0272711. [PMID: 35930592 PMCID: PMC9355219 DOI: 10.1371/journal.pone.0272711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/26/2022] [Indexed: 11/19/2022] Open
Abstract
Objective We aimed at investigating the preventive role of exercise intervention during pregnancy, in high-risk women for gestational diabetes mellitus (GDM). Materials and methods We searched PubMed, CENTRAL, and Scopus for randomized controlled trials (RCTs) that evaluated exercise interventions during pregnancy on women at high risk for GDM. Data were combined with random effects models. Between study heterogeneity (Cochran’s Q statistic) and the extent of study effects variability [I2 with 95% confidence interval (CI)] were estimated. Sensitivity analyses examined the effect of population, intervention, and study characteristics. We also evaluated the potential for publication bias. Results Among the 1,508 high-risk women who were analyzed in 9 RCTs, 374 (24.8%) [160 (21.4%) in intervention, and 214 (28.1%) in control group] developed GDM. Women who received exercise intervention during pregnancy were less likely to develop GDM compared to those who followed the standard prenatal care (OR 0.70, 95%CI 0.52, 0.93; P-value 0.02) [Q 10.08, P-value 0.26; I2 21% (95%CI 0, 62%]. Studies with low attrition bias also showed a similar result (OR 0.70, 95%CI 0.51, 0.97; P-value 0.03). A protective effect was also supported when analysis was limited to studies including women with low education level (OR 0.55; 95%CI 0.40, 0.74; P-value 0.0001); studies with exercise intervention duration more than 20 weeks (OR 0.54; 95%CI 0.40, 0.74; P-value 0.0007); and studies with a motivation component in the intervention (OR 0.69, 95%CI 0.50, 0.96; P-value 0.03). We could not exclude large variability in study effects because the upper limit of I2 confidence interval was higher than 50% for all analyses. There was no conclusive evidence for small study effects (P-value 0.31). Conclusions Our study might support a protective effect of exercise intervention during pregnancy for high-risk women to prevent GDM. The protective result should be corroborated by large, high quality RCTs.
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Affiliation(s)
| | | | - Alexandra Bargiota
- Department of Internal Medicine-Endocrinology, University Hospital of Larissa, Larissa, Greece
| | - Elias Zintzaras
- Department of Biomathematics, University of Thessaly, Larissa, Greece
| | - Chrysoula Doxani
- Department of Biomathematics, University of Thessaly, Larissa, Greece
| | - Athina Tatsioni
- Department of Research Unit for General Medicine and Primary Health Care, University of Ioannina, Ioannina, Greece
- * E-mail:
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24
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Ranasinha S, Hill B, Teede HJ, Enticott J, Wang R, Harrison CL. Efficacy of behavioral interventions in managing gestational weight gain (GWG): A component network meta-analysis. Obes Rev 2022; 23:e13406. [PMID: 34927351 DOI: 10.1111/obr.13406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/04/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify the most effective behavioral components within lifestyle interventions to optimize gestational weight gain (GWG) to inform guidelines, policy and translation into healthcare. METHODS Behavioral components were identified from study level data of randomized antenatal lifestyle interventions using a behavioral taxonomy framework and analyzed using component network meta-analysis (NMA). The NMA ranked behavioral combinations hierarchically by efficacy of optimizing GWG. Direct and estimated indirect comparisons between study arms (i.e., control and intervention) and between different component combinations were estimated to evaluate component combinations associated with greater efficacy. RESULTS Overall, 32 studies with 11,066 participants were included. Each intervention contained between 3 and 7 behavioral components with 26 different behavioral combinations identified. The majority (n = 24) of combinations were associated with optimizing GWG, with standard mean differences (SMD) ranging from -1.01 kg (95% CI -1.64 to -0.37) and -0.07 kg (-0.38 to 0.24), compared with controls. The behavioral cluster identified as most effective, included components of goals, feedback and monitoring, natural consequences, comparison of outcomes, and shaping knowledge (SMD -1.01 kg [95% CI -1.64 to -0.37]). CONCLUSION Findings support the application of goal setting, feedback and monitoring, natural consequences, comparison of outcomes, and shaping knowledge as essential, core components within lifestyle interventions to optimize gestational weight gain.
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Affiliation(s)
- Sanjeeva Ranasinha
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Briony Hill
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rui Wang
- Department of Obstetrics and Gynaecology, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia
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25
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Chen H, Wei F, Chen X, Chen K. Global Research Trends in Gestational Diabetes Mellitus from 2000 to 2020: A Bibliometric Study. Z Geburtshilfe Neonatol 2022; 226:197-204. [PMID: 35276736 DOI: 10.1055/a-1756-5518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS This study analyzed major trends and topics in the field of gestational diabetes mellitus research between 2000 and 2020. METHODS Studies that investigated gestational diabetes mellitus published between 2000 and 2020 were retrieved from the Web of Science Core Collection database. Data from the identified studies were analyzed using CiteSpace software. RESULTS A total of 22,713 publications were retrieved, among which 21,722 publications were included in this scientometric analysis. Clustering analysis revealed 13 themes across all fields. Physical activity is an emerging trend. Co-word analysis showed that subject high-frequency keywords were: risk factor, obesity, insulin resistance, prevalence, and association. Centrality indices identified the most influential keywords to be: body mass index, risk factors, gestational weight gain, and obesity. Burst keywords revealed that there were six research frontier subtopics: i) prediction of adverse neonatal outcomes in gestational diabetes mellitus; ii) postpartum period research - blood glucose levels and insulin resistance; iii) meta-analysis - understanding the best evidence in pregnancy gestational diabetes mellitus; iv) gene expression profiles and DNA methylation in gestational diabetes mellitus; v) biomarkers for predicting higher birth and children weights; and vi) discussion on diagnostic criteria for gestational diabetes mellitus classification. CONCLUSION The number of studies on gestational diabetes mellitus is increasing. For two decades, the United States has been the global leader in the number of published studies. Studies on gestational diabetes mellitus are mainly from developed countries, with a few of them being from developing countries. An emerging field of research aims at elucidating the association between physical activity and gestational diabetes mellitus.
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Affiliation(s)
- Hongyan Chen
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China.,Central Laboratory, Longgang District Maternity & Child Healthcare Hospital, Shenzhen, China
| | - Fengxiang Wei
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China.,Central Laboratory, Longgang District Maternity & Child Healthcare Hospital, Shenzhen, China
| | - Xiaohang Chen
- Central Laboratory, Longgang District Maternity & Child Healthcare Hospital, Shenzhen, China
| | - Ken Chen
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
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26
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Deng Y, Hou Y, Wu L, Liu Y, Ma L, Yao A. Effects of Diet and Exercise Interventions to Prevent Gestational Diabetes Mellitus in Pregnant Women With High-Risk Factors in China: A Randomized Controlled Study. Clin Nurs Res 2021; 31:836-847. [PMID: 34775875 DOI: 10.1177/10547738211055576] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This is a randomized controlled study to determine whether diet and exercise interventions can reduce the incidence of gestational diabetes mellitus (GDM) in pregnant women with high-risk factors. Ninety-four pregnant women were randomly divided into the intervention (n = 47) and control (n = 47) groups. A diet and exercise program was provided for the intervention group by researchers and was adjusted every 2 weeks by outpatient or WeChat intervention. The control group only received the routine health management in the hospital. Follow-up continued until the birth of the baby. The incidence of GDM (23.9%) in the intervention group was lower than in the control group (51.1%) (p = .007). Weight gain did not differ significantly between the two groups throughout pregnancy (p = .572). It is concluded that diet and exercise interventions can reduce the incidence of GDM in pregnant women with high-risk factors.
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Affiliation(s)
- Yafang Deng
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yixuan Hou
- Peking University First Hospital, Beijing, China
| | - Liping Wu
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanping Liu
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liangkun Ma
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Aimin Yao
- Shunyi District Maternal and Child Health Hospital, Beijing, China
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27
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Harris RG, Batterham M, Neale EP, Ferreira I. Impact of missing outcome data in meta-analyses of lifestyle interventions during pregnancy to reduce postpartum weight retention: An overview of systematic reviews with meta-analyses and additional sensitivity analyses. Obes Rev 2021; 22:e13318. [PMID: 34477276 DOI: 10.1111/obr.13318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/20/2021] [Accepted: 06/22/2021] [Indexed: 12/01/2022]
Abstract
High risk of bias associated with missing outcome data (MOD) in meta-analyses (MAs) of the effects of lifestyle interventions during pregnancy on postpartum weight retention (PPWR) casts doubt on whether such interventions can be relied upon as truly effective. This systematic overview of three MAs (19 RCTs), each with high MOD rates in the subset of RCTs included, examined how MOD were addressed in the estimation of summary intervention effects. All MAs reported beneficial and statistically significant intervention effects estimated based on complete case analyses, deemed valid if MOD was missing at random (MAR). Therefore, we conducted sensitivity analyses using pattern mixture models and informative missingness parameters (describing how the outcome in the missing participants may be related to the outcome in the completers), to ascertain the robustness of the estimates to reasonable deviations from the MAR assumption. In plausible scenarios where the response in intervention group participants with versus without MOD was worse (by just 0.5 kg), effect estimates were attenuated in all MAs and no longer statistically significant in two MAs. Statistical significance was retained when all 19 RCTs identified across MAs were examined together in a broader meta-analysis: -0.63 kg (95%CI -0.17, -0.08), but the clinical relevancy of effects of this magnitude remains unclear.
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Affiliation(s)
- Rebecca G Harris
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Marijka Batterham
- School of Mathematics and Applied Statistics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Elizabeth P Neale
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Isabel Ferreira
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Public Health Department, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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28
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Does a MediDiet with additional extra virgin olive oil (EVOO) and pistachios reduce the incidence of gestational diabetes? Endocr Pract 2021; 28:135-141. [PMID: 34481972 DOI: 10.1016/j.eprac.2021.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/05/2021] [Accepted: 08/25/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The present study aimed to evaluate gestational diabetes mellitus (GDM) incidence in pregnant women following the Mediterranean diet with additional extra virgin olive oil (EVOO) and pistachios. METHODS 560 pregnant patients were enrolled in the present study. The Mediterranean diet (MedDiet) was introduced in both the interventional group (IG) and control group (CG). The females received 40 ml of extra virgin olive oil (EVOO) every day along with 25 - 30 gm of roasted pistachios in the interventional group. The incidence of Gestational Diabetes Mellitus (GDM) was recorded along with specific maternal and neonatal outcomes. MATERIALS AND METHODS The nutritional and MEDAS scores were not statistically different among the groups at baseline, but the difference was statistically significant and higher in IG at 24-28 weeks (p = 0.001) and 36-38 weeks (p = 0.001). GDM was diagnosed in 51(20.4%) females in the Control group and 34 (13.6%) females in the Interventional group. The MedDiet significantly reduced the GDM incidence (p=0.02) after adjusting the confounding factors. CONCLUSION The present study depicts that dietary intervention in pregnant women, including MedDiet and increased consumption of EVOO and pistachios, decreased the incidence of GDM.
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29
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Kinnunen T, Liu Y, Koivisto AM, Virtanen S, Luoto R. Effects of dietary counselling on micronutrient intakes in pregnant women in Finland. MATERNAL AND CHILD NUTRITION 2021; 17:e13203. [PMID: 34145734 PMCID: PMC8476417 DOI: 10.1111/mcn.13203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/10/2021] [Accepted: 04/23/2021] [Indexed: 11/30/2022]
Abstract
The intake of some micronutrients is still a public health challenge for pregnant women in Finland. This study examined the effects of dietary counselling on micronutrient intakes among pregnant women at increased risk of gestational diabetes mellitus in Finland. This study utilised data from was a cluster‐randomised controlled trial (n = 399), which aimed to prevent gestational diabetes. In the intervention group, the dietary counselling was carried out at four routine visits to maternity care and focused on dietary fat, fibre and saccharose intake. A validated 181‐item food frequency questionnaire was used for evaluating the participants' food consumption and nutrient intakes. The differences in changes in micronutrient intakes from baseline (pre‐pregnancy) to 36–37 weeks' gestation were compared between the intervention and the usual care groups using multilevel mixed‐effects linear regression models, adjusted for confounders. Based on the multiple‐adjusted model, the counselling increased the intake of niacin equivalent (coefficient 0.50, 95% confidence interval [CI] 0.03–0.97), vitamin D (0.24, CI 0.05–0.43), vitamin E (0.46, CI 0.26–0.66) and magnesium (5.05, CI 0.39–9.70) and maintained the intake of folate (6.50, CI 1.44–11.56), from early pregnancy to 36 to 37 weeks' gestation. Except for folate and vitamin D, the mean intake of the micronutrients from food was adequate in both groups at baseline and the follow‐up. In conclusion, the dietary counselling improved the intake of several vitamins and minerals from food during pregnancy. Supplementation on folate and vitamin D is still needed during pregnancy.
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Affiliation(s)
- Tarja Kinnunen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Yangbo Liu
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland.,Department of Quality Management, Ningxia Center for Disease Control and Prevention, Yinchuan, China
| | - Anna-Maija Koivisto
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Suvi Virtanen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland.,Unit of Welfare and Health Promotion, Finnish Institute for Health and Welfare, Helsinki, Finland.,Research Center for Child Health, Tampere University and University Hospital, Tampere, Finland.,Science Center, Pirkanmaa Hospital District, Tampere, Finland
| | - Riitta Luoto
- The Social Insurance Institution of Finland (Kela), Helsinki, Finland
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30
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Louise J, Poprzeczny AJ, Deussen AR, Vinter C, Tanvig M, Jensen DM, Bogaerts A, Devlieger R, McAuliffe FM, Renault KM, Carlsen E, Geiker N, Poston L, Briley A, Thangaratinam S, Dodd JM. The effects of dietary and lifestyle interventions among pregnant women with overweight or obesity on early childhood outcomes: an individual participant data meta-analysis from randomised trials. BMC Med 2021; 19:128. [PMID: 34074261 PMCID: PMC8170974 DOI: 10.1186/s12916-021-01995-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The impact of maternal obesity extends beyond birth, being independently associated with an increased risk of child obesity. Current evidence demonstrates that women provided with a dietary intervention during pregnancy improve their dietary quality and have a modest reduction in gestational weight gain. However, the effect of this on longer-term childhood obesity-related outcomes is unknown. METHODS We conducted an individual participant data meta-analysis from RCTs in which women with a singleton, live gestation between 10+0 and 20+0 weeks and body mass index (BMI) ≥ 25 kg/m2 in early pregnancy were randomised to a diet and/or lifestyle intervention or continued standard antenatal care and in which longer-term maternal and child follow-up at 3-5 years of age had been undertaken. The primary childhood outcome was BMI z-score above the 90th percentile. Secondary childhood outcomes included skinfold thickness measurements and body circumferences, fat-free mass, dietary and physical activity patterns, blood pressure, and neurodevelopment. RESULTS Seven primary trials where follow-up of participants occurred were identified by a systematic literature search within the International Weight Management in Pregnancy (i-WIP) Collaborative Group collaboration, with six providing individual participant data. No additional studies were identified after a systematic literature search. A total of 2529 children and 2383 women contributed data. Approximately 30% of all child participants had a BMI z-score above the 90th percentile, with no significant difference between the intervention and control groups (aRR 0.97; 95% CI 0.87, 1.08; p=0.610). There were no statistically significant differences identified for any of the secondary outcome measures. CONCLUSIONS In overweight and obese pregnant women, we found no evidence that maternal dietary and/or lifestyle intervention during pregnancy modifies the risk of early childhood obesity. Future research may need to target the pre-conception period in women and early childhood interventions. TRIAL REGISTRATION PROSPERO, CRD42016047165.
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Affiliation(s)
- Jennie Louise
- The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Amanda J Poprzeczny
- The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, South Australia, Australia.,Women's and Babies Division, Department of Perinatal Medicine, The Women's and Children's Hospital, 72 King William Road, Adelaide, South Australia, 5006, Australia
| | - Andrea R Deussen
- The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Christina Vinter
- Institute of Clinical Research University of Southern Denmark, 5230, Odense M, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Mette Tanvig
- Institute of Clinical Research University of Southern Denmark, 5230, Odense M, Denmark
| | - Dorte Moller Jensen
- Institute of Clinical Research University of Southern Denmark, 5230, Odense M, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Steno Diabetes Center, Odense University Hospital, 5000, Odense C, Denmark
| | - Annick Bogaerts
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Antwerp, Belgium
| | - Roland Devlieger
- Division of Mother and Child, Department of Obstetrics and Gynaecology, University Hospitals KU Leuven, Leuven, Belgium
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine & Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Kristina M Renault
- Obstetric Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Obstetrics and Gynaecology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Emma Carlsen
- Department of Pediatrics, Hvidovre University Hospital, Hvidovre, Denmark
| | - Nina Geiker
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Hvidovre, Denmark
| | - Lucilla Poston
- School of Life Course Sciences, Division of Women and Children's Health, King's College London, St. Thomas' Hospital, London, UK
| | - Annette Briley
- School of Life Course Sciences, Division of Women and Children's Health, King's College London, St. Thomas' Hospital, London, UK.,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Jodie M Dodd
- The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, South Australia, Australia. .,Women's and Babies Division, Department of Perinatal Medicine, The Women's and Children's Hospital, 72 King William Road, Adelaide, South Australia, 5006, Australia.
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Karimipour Z, Sharifi N, Seydkhani H, Sayadi H, Jalilian M. Lifestyle intervention for gestational diabetes prevention in rural woman of Shoush city. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:172. [PMID: 34250106 PMCID: PMC8249963 DOI: 10.4103/jehp.jehp_1072_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/19/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Physical activity and nutrition interventions are the most important ways to prevent gestational diabetes. The purpose of the study was to determine the effect of healthy lifestyle intervention to promote preventive behaviors of gestational diabetes in the rural woman of Shoush city. MATERIALS AND METHODS In an experimental study, 60 pregnant women were selected using simple random sampling and allocate into intervention group (n = 30) and nutrition program. The study was conducted from September to June 2018. The data were collected in baseline and 1 month and 3 months of follow-up phase and were analyzed using Chi-square test, repeated-measure test, and generalized linear model (GLM). The α = 0.05 was considered as significance. RESULTS The mean age in the intervention and control group was 25.9 ± 5.6 and 27.2 ± 5.9, respectively. The GLM test showed a significant increase in the physical activity level and the mean of nutrition behaviors within the intervention group over time (P = 0.013). Further, based on the results of repeated-measure test, the mean of weekly MET-minute was increased in the intervention group in comparison to the control group at 1 month and 3 months of follow-up (P < 0.001). DISCUSSION AND CONCLUSION The lifestyle interventions are appropriate programs to the reduction of the risk of development of gestational diabetes in pregnant women.
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Affiliation(s)
- Zahra Karimipour
- Department of Public Health, School of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Nasibeh Sharifi
- Department of Midwifery, School of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Hossein Seydkhani
- Department of Biostatistics, School of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Hojat Sayadi
- Department of Biostatistics, School of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohsen Jalilian
- Department of Public Health, School of Health, Ilam University of Medical Sciences, Ilam, Iran
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Cantor AG, Jungbauer RM, McDonagh M, Blazina I, Marshall NE, Weeks C, Fu R, LeBlanc ES, Chou R. Counseling and Behavioral Interventions for Healthy Weight and Weight Gain in Pregnancy: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2021; 325:2094-2109. [PMID: 34032824 DOI: 10.1001/jama.2021.4230] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Counseling and active behavioral interventions to limit excess gestational weight gain (GWG) during pregnancy may improve health outcomes for women and infants. The 2009 National Academy of Medicine (NAM; formerly the Institute of Medicine) recommendations for healthy GWG vary according to prepregnancy weight category. OBJECTIVE To review and synthesize the evidence on benefits and harms of behavioral interventions to promote healthy weight gain during pregnancy to inform the US Preventive Services Task Force recommendation. DATA SOURCES Ovid MEDLINE and the Cochrane Library to March 2020, with surveillance through February 2021. STUDY SELECTION Randomized clinical trials and nonrandomized controlled intervention studies focused on diet, exercise, and/or behavioral counseling interventions on GWG. DATA EXTRACTION AND SYNTHESIS Independent data abstraction and study quality rating with dual review. MAIN OUTCOMES AND MEASURES Gestational weight-related outcomes; maternal and infant morbidity and mortality; harms. RESULTS Sixty-eight studies (N = 25 789) were included. Sixty-seven studies evaluated interventions during pregnancy, and 1 evaluated an intervention prior to pregnancy. GWG interventions were associated with reductions in risk of gestational diabetes (43 trials, n = 19 752; relative risk [RR], 0.87 [95% CI, 0.79 to 0.95]; absolute risk difference [ARD], -1.6%) and emergency cesarean delivery (14 trials, n = 7520; RR, 0.85 [95% CI, 0.74 to 0.96]; ARD, -2.4%). There was no significant association between GWG interventions and risk of gestational hypertension, cesarean delivery, or preeclampsia. GWG interventions were associated with decreased risk of macrosomia (25 trials, n = 13 990; RR, 0.77 [95% CI, 0.65 to 0.92]; ARD, -1.9%) and large for gestational age (26 trials, n = 13 000; RR, 0.89 [95% CI, 0.80 to 0.99]; ARD, -1.3%) but were not associated with preterm birth. Intervention participants experienced reduced weight gain across all prepregnancy weight categories (55 trials, n = 20 090; pooled mean difference, -1.02 kg [95% CI, -1.30 to -0.75]) and demonstrated lower likelihood of GWG in excess of NAM recommendations (39 trials, n = 14 271; RR, 0.83 [95% CI, 0.77 to 0.89]; ARD, -7.6%). GWG interventions were associated with reduced postpartum weight retention at 12 months (10 trials, n = 3957; mean difference, -0.63 kg [95% CI, -1.44 to -0.01]). Data on harms were limited. CONCLUSIONS AND RELEVANCE Counseling and active behavioral interventions to limit GWG were associated with decreased risk of gestational diabetes, emergency cesarean delivery, macrosomia, and large for gestational age. GWG interventions were also associated with modest reductions in mean GWG and decreased likelihood of exceeding NAM recommendations for GWG.
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Affiliation(s)
- Amy G Cantor
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
- Department of Family Medicine, Oregon Health & Science University, Portland
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Rebecca M Jungbauer
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Marian McDonagh
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Ian Blazina
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Nicole E Marshall
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Chandler Weeks
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Rongwei Fu
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
- School of Public Health, Oregon Health & Science University-Portland State University
| | - Erin S LeBlanc
- Kaiser Permanente, Center for Health Research, Portland, Oregon
| | - Roger Chou
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
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Choi HK, Kim HO. [Effect of Lifestyle Intervention Program for Overweight and Obesity Pregnant Women]. J Korean Acad Nurs 2021; 50:459-473. [PMID: 32632078 DOI: 10.4040/jkan.19228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was conducted to identify the effects of a lifestyle intervention program on weight gain, dietary habits, fatigue and pregnancy stress, blood pressure, and neonatal birth weight, using Cox's interaction model of client health behavior for overweight and obese women. METHODS This was a quasi-experimental research with a non-equivalent control group pre-post test design. A total of 52 patients who met the selection criteria, including 25 in the experimental group and 27 in the control group, were the subjects of the study; they comprised overweight and obese pregnant women who were receiving prenatal care at A and B women's hospital in J province. The lifestyle intervention program ran for 12 weeks in total and consisted of interactions involving affective support, health information, and professional/technical competencies. The data collection period was from February 1, 2017 to August 31, 2017. RESULTS This study showed differences in the appropriate weight gain rate (χ²=6.17, p=.013), suppression of an increase in fatigue (t=-2.32, p=.012), and an increase in pregnancy stress (t=-1.87, p=.034). Yet, no differences in physical activity, dietary habits change, blood pressure, and neonatal birth weight (p>.05) were found. CONCLUSION The study findings indicate that this program could be an effective intervention for the control of appropriate weight gain, fatigue, and pregnancy stress. Therefore, a lifestyle intervention program based on Cox's interaction model of client health behavior could be an efficient strategy for a positive health outcome of overweight and obesity pregnant women.
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Affiliation(s)
- Hye Kyung Choi
- College of Nursing, Jeonbuk National University, Jeonju, Korea
| | - Hyeon Ok Kim
- College of Nursing · Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Korea.
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Phelan S, Jelalian E, Coustan D, Caughey AB, Castorino K, Hagobian T, Muñoz-Christian K, Schaffner A, Shields L, Heaney C, McHugh A, Wing RR. Protocol for a randomized controlled trial of pre-pregnancy lifestyle intervention to reduce recurrence of gestational diabetes: Gestational Diabetes Prevention/Prevención de la Diabetes Gestacional. Trials 2021; 22:256. [PMID: 33827659 PMCID: PMC8024941 DOI: 10.1186/s13063-021-05204-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with several maternal complications in pregnancy, including preeclampsia, preterm labor, need for induction of labor, and cesarean delivery as well as increased long-term risks of type 2 diabetes, metabolic syndrome, and cardiovascular disease. Intrauterine exposure to GDM raises the risk for complications in offspring as well, including stillbirth, macrosomia, and birth trauma, and long-term risk of metabolic disease. One of the strongest risk factors for GDM is the occurrence of GDM in a prior pregnancy. Preliminary data from epidemiologic and bariatric surgery studies suggest that reducing body weight before pregnancy can prevent the development of GDM, but no adequately powered trial has tested the effects of a maternal lifestyle intervention before pregnancy to reduce body weight and prevent GDM recurrence. METHODS The principal aim of the Gestational Diabetes Prevention/Prevención de la Diabetes Gestacional is to determine whether a lifestyle intervention to reduce body weight before pregnancy can reduce GDM recurrence. This two-site trial targets recruitment of 252 women with overweight and obesity who have previous histories of GDM and who plan to have another pregnancy in the next 1-3 years. Women are randomized within site to a comprehensive pre-pregnancy lifestyle intervention to promote weight loss with ongoing treatment until conception or an educational control group. Participants are assessed preconceptionally (at study entry, after 4 months, and at brief quarterly visits until conception), during pregnancy (at 26 weeks' gestation), and at 6 weeks postpartum. The primary outcome is GDM recurrence, and secondary outcomes include fasting glucose, biomarkers of cardiometabolic disease, prenatal and perinatal complications, and changes over time in weight, diet, physical activity, and psychosocial measures. DISCUSSION The Gestational Diabetes Prevention /Prevención de la Diabetes Gestacional is the first randomized controlled trial to evaluate the effects of a lifestyle intervention delivered before pregnancy to prevent GDM recurrence. If found effective, the proposed lifestyle intervention could lay the groundwork for shifting current treatment practices towards the interconception period and provide evidence-based preconception counseling to optimize reproductive outcomes and prevent GDM and associated health risks. TRIAL REGISTRATION ClinicalTrials.gov NCT02763150 . Registered on May 5, 2016.
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Affiliation(s)
- Suzanne Phelan
- Department of Kinesiology & Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, CA USA
| | - Elissa Jelalian
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI USA
| | - Donald Coustan
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI USA
| | - Aaron B. Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | | | - Todd Hagobian
- Department of Kinesiology & Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, CA USA
| | - Karen Muñoz-Christian
- Department of World Languages and Cultures, California Polytechnic State University, San Luis Obispo, CA USA
| | - Andrew Schaffner
- Statistics Department, California Polytechnic State University, San Luis Obispo, CA USA
| | - Laurence Shields
- Dignity Health, Marian Regional Medical Center, Santa Maria, CA USA
| | - Casey Heaney
- Department of Kinesiology & Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, CA USA
| | - Angelica McHugh
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, USA
| | - Rena R. Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, USA
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Kang Y, Huang H, Li H, Sun W, Zhang C. Functional genetic variants in the 3'UTR of PTPRD associated with the risk of gestational diabetes mellitus. Exp Ther Med 2021; 21:562. [PMID: 33850534 DOI: 10.3892/etm.2021.9994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 10/20/2020] [Indexed: 11/06/2022] Open
Abstract
A previous study revealed that protein tyrosine phosphatase receptor type D (PTPRD) is highly associated with diabetes mellitus, particularly for type 2 diabetes, through a genome-wide association study. However, the influence of the human polymorphism in the 3'-untranslated region (3'-UTR) of PTPRD on gestational diabetes mellitus (GDM) has remained to be defined. The present study focused on the functional polymorphism located in the 3'-UTR of PTPRD and whether it is associated with the susceptibility to develop GDM. A total of 1,100 pregnant female patients aged between 28 and 36 years within gestational weeks 24-28 were recruited. The participants enrolled in the study comprised 500 cases of GDM and 600 normal controls. Based on the screening results, the single nucleotide polymorphism (SNP) rs56407701 exhibited the most significant difference and may increase the susceptibility to GDM. A prediction of target microRNAs (miRNAs/miRs) using the miRNA SNP database indicated that SNP rs56407701 may be bound by miR-450a, causing the suppression of PTPRD expression in subjects with the GC or CC genotype. In conclusion, The CC genotype of PTPRD rs56407701, which may be bound by miR-450a, may increase the susceptibility of Chinese Han females to GDM during pregnancy. The present study provided a theoretical basis for the SNP rs56407701 being a source of GDM susceptibility loci.
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Affiliation(s)
- Yan Kang
- Department of Obstetrics and Gynecology, Qinghai Red-Cross Hospital, Xining, Qinghai 810000, P.R. China
| | - Huamin Huang
- Department of Obstetrics and Gynecology, Qinghai Red-Cross Hospital, Xining, Qinghai 810000, P.R. China
| | - Haipeng Li
- Department of Obstetrics and Gynecology, Qinghai Red-Cross Hospital, Xining, Qinghai 810000, P.R. China
| | - Wenping Sun
- Department of Obstetrics and Gynecology, Qinghai Red-Cross Hospital, Xining, Qinghai 810000, P.R. China
| | - Cuicui Zhang
- Department of Obstetrics and Gynecology, Qinghai Red-Cross Hospital, Xining, Qinghai 810000, P.R. China
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Kinshella MLW, Omar S, Scherbinsky K, Vidler M, Magee LA, von Dadelszen P, Moore SE, Elango R. Effects of Maternal Nutritional Supplements and Dietary Interventions on Placental Complications: An Umbrella Review, Meta-Analysis and Evidence Map. Nutrients 2021; 13:472. [PMID: 33573262 PMCID: PMC7912620 DOI: 10.3390/nu13020472] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 01/26/2021] [Indexed: 01/08/2023] Open
Abstract
The placenta is a vital, multi-functional organ that acts as an interface between maternal and fetal circulation during pregnancy. Nutritional deficiencies during pregnancy alter placental development and function, leading to adverse pregnancy outcomes, such as pre-eclampsia, infants with small for gestational age and low birthweight, preterm birth, stillbirths and maternal mortality. Maternal nutritional supplementation may help to mitigate the risks, but the evidence base is difficult to navigate. The primary purpose of this umbrella review is to map the evidence on the effects of maternal nutritional supplements and dietary interventions on pregnancy outcomes related to placental disorders and maternal mortality. A systematic search was performed on seven electronic databases, the PROSPERO register and references lists of identified papers. The results were screened in a three-stage process based on title, abstract and full-text by two independent reviewers. Randomized controlled trial meta-analyses on the efficacy of maternal nutritional supplements or dietary interventions were included. There were 91 meta-analyses included, covering 23 types of supplements and three types of dietary interventions. We found evidence that supports supplementary vitamin D and/or calcium, omega-3, multiple micronutrients, lipid-based nutrients, and balanced protein energy in reducing the risks of adverse maternal and fetal health outcomes. However, these findings are limited by poor quality of evidence. Nutrient combinations show promise and support a paradigm shift to maternal dietary balance, rather than single micronutrient deficiencies, to improve maternal and fetal health. The review is registered at PROSPERO (CRD42020160887).
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Affiliation(s)
- Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, BC V6Z 2K8, Canada; (M.-L.W.K.); (S.O.); (K.S.); (M.V.); (L.A.M.); (P.v.D.)
| | - Shazmeen Omar
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, BC V6Z 2K8, Canada; (M.-L.W.K.); (S.O.); (K.S.); (M.V.); (L.A.M.); (P.v.D.)
| | - Kerri Scherbinsky
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, BC V6Z 2K8, Canada; (M.-L.W.K.); (S.O.); (K.S.); (M.V.); (L.A.M.); (P.v.D.)
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 0B3, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, BC V6Z 2K8, Canada; (M.-L.W.K.); (S.O.); (K.S.); (M.V.); (L.A.M.); (P.v.D.)
| | - Laura A. Magee
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, BC V6Z 2K8, Canada; (M.-L.W.K.); (S.O.); (K.S.); (M.V.); (L.A.M.); (P.v.D.)
- Department of Women & Children’s Health, King’s College London, London WC2R 2LS, UK;
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, BC V6Z 2K8, Canada; (M.-L.W.K.); (S.O.); (K.S.); (M.V.); (L.A.M.); (P.v.D.)
- Department of Women & Children’s Health, King’s College London, London WC2R 2LS, UK;
| | - Sophie E. Moore
- Department of Women & Children’s Health, King’s College London, London WC2R 2LS, UK;
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, P.O. Box 273 Banjul, The Gambia
| | - Rajavel Elango
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 0B3, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Division of Neonatology, BC Women’s Hospital and Health Centre, Vancouver, BC V6H 3N1, Canada
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James P, Morgant R, Merviel P, Saraux A, Giroux-Metges MA, Guillodo Y, Dupré PF, Muller M. How to promote physical activity during pregnancy : A systematic review. J Gynecol Obstet Hum Reprod 2020; 49:101864. [PMID: 32663651 DOI: 10.1016/j.jogoh.2020.101864] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Sedentary lifestyles and physical inactivity have been shown to increase during pregnancy and are a cause of obstetric comorbidity. The objective of this study was to conduct a systematic review of interventions aiming to promote physical activity during pregnancy. MATERIAL AND METHODS Databases were searched from January 2008 to September 2019. Selection criteria included randomized controlled trials evaluating the efficacy of interventions promoting physical activity during pregnancy. RESULTS In total, 256 articles were extracted from databases. 202 articles were excluded. Finally, 15 articles were included in the study. 5633 patients were included from various populations. Six studies rated physical activity (PA) as the primary outcome. Five studies suggested promoting physical activity through individual interviews which in two studies showed an increase in PA. Three studies evaluated an intervention based on group interviews and one of these reported a significant increase in PA. Two studies evaluated the use of a Smartphone application to promote physical activity but they did not conclude that they were effective because they were designed with low statistical power. CONCLUSION The practice of regular PA during pregnancy reduces obstetrical comorbidity. However, interventions seem to have a low impact on the promotion of PA during pregnancy. New intervention strategies need to assessed, such as the use of mobile health interventions.
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Affiliation(s)
- P James
- JAMES Pandora, Resident, Centre Hospitalier Universitaire Brest, France.
| | - R Morgant
- Dr MORGANT Romain, Cabinet de traumatologie du TER, Clinique du TER, 56270, Ploemeur, France
| | - P Merviel
- Pr MERVIEL Philippe, Service de Gynécologie-Obstétrique et Médecine de la reproduction, CHRU Brest - Hôpital Morvan, France
| | - A Saraux
- Pr SARAUX Alain, Service de Rhumatologie, Hôpital de la Cavale Blanche, CHRU Brest, France
| | - M A Giroux-Metges
- Pr GIROUX-METGES Marie-Agnès, Service des EFR, Hôpital de la Cavale Blanche, CHRU Brest, France
| | - Y Guillodo
- Dr GUILLODO Yannick, Service de Rhumatologie, CHRU Brest, France
| | - P F Dupré
- Dr DUPRE Pierre-François, Chirurgie Oncologique Gynécologique et mammaire, CHRU Brest, France
| | - M Muller
- Dr MULLER Matthieu, Service Gynécologie-Obstétrique, Centre Hospitalier des Pays de Morlaix, France
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Griffith RJ, Alsweiler J, Moore AE, Brown S, Middleton P, Shepherd E, Crowther CA. Interventions to prevent women from developing gestational diabetes mellitus: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2020; 6:CD012394. [PMID: 32526091 PMCID: PMC7388385 DOI: 10.1002/14651858.cd012394.pub3] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The prevalence of gestational diabetes mellitus (GDM) is increasing, with approximately 15% of pregnant women affected worldwide, varying by country, ethnicity and diagnostic thresholds. There are associated short- and long-term health risks for women and their babies. OBJECTIVES We aimed to summarise the evidence from Cochrane systematic reviews on the effects of interventions for preventing GDM. METHODS We searched the Cochrane Database of Systematic Reviews (6 August 2019) with key words 'gestational diabetes' OR 'GDM' to identify reviews pre-specifying GDM as an outcome. We included reviews of interventions in women who were pregnant or planning a pregnancy, irrespective of their GDM risk status. Two overview authors independently assessed eligibility, extracted data and assessed quality of evidence using ROBIS and GRADE tools. We assigned interventions to categories with graphic icons to classify the effectiveness of interventions as: clear evidence of benefit or harm (GRADE moderate- or high-quality evidence with a confidence interval (CI) that did not cross the line of no effect); clear evidence of no effect or equivalence (GRADE moderate- or high-quality evidence with a narrow CI crossing the line of no effect); possible benefit or harm (low-quality evidence with a CI that did not cross the line of no effect or GRADE moderate- or high-quality evidence with a wide CI); or unknown benefit or harm (GRADE low-quality evidence with a wide CI or very low-quality evidence). MAIN RESULTS We included 11 Cochrane Reviews (71 trials, 23,154 women) with data on GDM. Nine additional reviews pre-specified GDM as an outcome, but did not identify GDM data in included trials. Ten of the 11 reviews were judged to be at low risk of bias and one review at unclear risk of bias. Interventions assessed included diet, exercise, a combination of diet and exercise, dietary supplements, pharmaceuticals, and management of other health problems in pregnancy. The quality of evidence ranged from high to very low. Diet Unknown benefit or harm: there was unknown benefit or harm of dietary advice versus standard care, on the risk of GDM: risk ratio (RR) 0.60, 95% CI 0.35 to 1.04; 5 trials; 1279 women; very low-quality evidence. There was unknown benefit or harm of a low glycaemic index diet versus a moderate-high glycaemic index diet on the risk of GDM: RR 0.91, 95% CI 0.63 to 1.31; 4 trials; 912 women; low-quality evidence. Exercise Unknown benefit or harm: there was unknown benefit or harm for exercise interventions versus standard antenatal care on the risk of GDM: RR 1.10, 95% CI 0.66 to 1.84; 3 trials; 826 women; low-quality evidence. Diet and exercise combined Possible benefit: combined diet and exercise interventions during pregnancy versus standard care possibly reduced the risk of GDM: RR 0.85, 95% CI 0.71 to 1.01; 19 trials; 6633 women; moderate-quality evidence. Dietary supplements Clear evidence of no effect: omega-3 fatty acid supplementation versus none in pregnancy had no effect on the risk of GDM: RR 1.02, 95% CI 0.83 to 1.26; 12 trials; 5235 women; high-quality evidence. Possible benefit: myo-inositol supplementation during pregnancy versus control possibly reduced the risk of GDM: RR 0.43, 95% CI 0.29 to 0.64; 3 trials; 502 women; low-quality evidence. Possible benefit: vitamin D supplementation versus placebo or control in pregnancy possibly reduced the risk of GDM: RR 0.51, 95% CI 0.27 to 0.97; 4 trials; 446 women; low-quality evidence. Unknown benefit or harm: there was unknown benefit or harm of probiotic with dietary intervention versus placebo with dietary intervention (RR 0.37, 95% CI 0.15 to 0.89; 1 trial; 114 women; very low-quality evidence), or probiotic with dietary intervention versus control (RR 0.38, 95% CI 0.16 to 0.92; 1 trial; 111 women; very low-quality evidence) on the risk of GDM. There was unknown benefit or harm of vitamin D + calcium supplementation versus placebo (RR 0.33, 95% CI 0.01 to 7.84; 1 trial; 54 women; very low-quality evidence) or vitamin D + calcium + other minerals versus calcium + other minerals (RR 0.42, 95% CI 0.10 to 1.73; 1 trial; 1298 women; very low-quality evidence) on the risk of GDM. Pharmaceutical Possible benefit: metformin versus placebo given to obese pregnant women possibly reduced the risk of GDM: RR 0.85, 95% CI 0.61 to 1.19; 3 trials; 892 women; moderate-quality evidence. Unknown benefit or harm:eight small trials with low- to very low-quality evidence showed unknown benefit or harm for heparin, aspirin, leukocyte immunisation or IgG given to women with a previous stillbirth on the risk of GDM. Management of other health issues Clear evidence of no effect: universal versus risk based screening of pregnant women for thyroid dysfunction had no effect on the risk of GDM: RR 0.93, 95% CI 0.70 to 1.25; 1 trial; 4516 women; moderate-quality evidence. Unknown benefit or harm: there was unknown benefit or harm of using fractional exhaled nitrogen oxide versus a clinical algorithm to adjust asthma therapy on the risk of GDM: RR 0.74, 95% CI 0.31 to 1.77; 1 trial; 210 women; low-quality evidence. There was unknown benefit or harm of pharmacist led multidisciplinary approach to management of maternal asthma versus standard care on the risk of GDM: RR 5.00, 95% CI 0.25 to 99.82; 1 trial; 58 women; low-quality evidence. AUTHORS' CONCLUSIONS No interventions to prevent GDM in 11 systematic reviews were of clear benefit or harm. A combination of exercise and diet, supplementation with myo-inositol, supplementation with vitamin D and metformin were of possible benefit in reducing the risk of GDM, but further high-quality evidence is needed. Omega-3-fatty acid supplementation and universal screening for thyroid dysfunction did not alter the risk of GDM. There was insufficient high-quality evidence to establish the effect on the risk of GDM of diet or exercise alone, probiotics, vitamin D with calcium or other vitamins and minerals, interventions in pregnancy after a previous stillbirth, and different asthma management strategies in pregnancy. There is a lack of trials investigating the effect of interventions prior to or between pregnancies on risk of GDM.
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Affiliation(s)
- Rebecca J Griffith
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Jane Alsweiler
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Abigail E Moore
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Stephen Brown
- School of Interprofessional Health Studies, Auckland University of Technology, Auckland, New Zealand
| | - Philippa Middleton
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Emily Shepherd
- Robinson Research Institute, Discipline of Obstetrics and Gynaecology, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
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Moore RL, Geraghty AA, Feehily C, Saldova R, Murphy EF, Van Sinderen D, Cotter PD, McAuliffe FM. Can a probiotic supplement in pregnancy result in transfer to the neonatal gut: A systematic review. Acta Obstet Gynecol Scand 2020; 99:1269-1277. [PMID: 32400910 DOI: 10.1111/aogs.13899] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The establishment of the neonatal gut microbiome is a crucial step that may have lifelong health implications. We aimed to systematically review evidence on maternal probiotic supplementation during pregnancy and vertical transfer of the corresponding strain to the infant gut. MATERIAL AND METHODS Medline, CINAHL, Embase, Web of Science, and OVID were searched from inception to September 2018. Studies of maternal probiotic supplementation for a minimum duration of 2 weeks and analyses of neonatal stool samples were included. The primary outcome was presence of the specific probiotic strain in the infant stool. Electronic databases were searched for relevant studies and references were cross-checked. Risk of bias among included studies was assessed and data were extracted independently by two authors. RESULTS Three studies were included in the review. Only one study was identified involving prenatal maternal probiotic supplementation alone. Neonatal colonization with the maternally administered probiotic was not demonstrated but supplementation with the probiotic influenced levels of a bacterial strain other than that found in the probiotic product. The other two studies identified included both prenatal and postnatal supplementation of either mother or infant. All three studies reported employing strain-specific isolation methodology to isolate the supplemented bacterial strain in infant stool but none used whole metagenome shotgun sequencing. CONCLUSIONS Few studies investigating transfer of a specific probiotic bacterial strain from mother to infant were identified, showing inconclusive evidence of vertical transfer.
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Affiliation(s)
- Rebecca L Moore
- UCD Perinatal Research Center, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Aisling A Geraghty
- UCD Perinatal Research Center, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Conor Feehily
- APC Microbiome Ireland, National University of Ireland, Cork, Ireland.,Teagasc Food Research Center, Moorepark, Fermoy, Cork, Ireland
| | - Radka Saldova
- The National Institute for Bioprocessing, Research, and Training (NIBRT), Dublin, Ireland
| | - Eileen F Murphy
- Precision Biotics Ltd, Cork Airport Business Park, Cork, Ireland
| | - Douwe Van Sinderen
- APC Microbiome Ireland, National University of Ireland, Cork, Ireland.,School of Microbiology, National University of Ireland, Cork, Ireland
| | - Paul D Cotter
- APC Microbiome Ireland, National University of Ireland, Cork, Ireland.,Teagasc Food Research Center, Moorepark, Fermoy, Cork, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Center, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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Ibrahim SH, Jonas MM, Taylor SA, Sanchez LHG, Wolf JL, Sundaram SS. Liver Diseases in the Perinatal Period: Interactions Between Mother and Infant. Hepatology 2020; 71:1474-1485. [PMID: 31925801 PMCID: PMC7150638 DOI: 10.1002/hep.31109] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/19/2019] [Indexed: 12/19/2022]
Abstract
Liver diseases affecting the mother and infant dyad may present in the perinatal period from 20 weeks of gestation to 28 days of life. This review will focus on the current approach to neonatal acute liver failure and the progress made in the diagnosis and management of gestational alloimmune liver disease. It will highlight mother-to-child transmission of viral hepatitis, both management and public health implications. Emerging concepts implicating maternal obesity and nutrition in the development of a rapidly progressive nonalcoholic steatohepatitis phenotype in the offspring will be discussed. Finally, the presentation and management of acute fatty liver of pregnancy and intrahepatic cholestasis of pregnancy, and their impact on the fetus, will be reviewed.
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Affiliation(s)
- Samar H. Ibrahim
- Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Maureen M. Jonas
- Division of Pediatric Gastroenterology and Hepatology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sarah A. Taylor
- Division of Pediatric Gastroenterology and Hepatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, Illinois
| | | | - Jaqueline L. Wolf
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Shikha S. Sundaram
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
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Gestational Exercise and Maternal and Child Health: Effects until Delivery and at Post-Natal Follow-up. J Clin Med 2020; 9:jcm9020379. [PMID: 32023833 PMCID: PMC7074577 DOI: 10.3390/jcm9020379] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/10/2020] [Accepted: 01/27/2020] [Indexed: 01/27/2023] Open
Abstract
We studied the influence of pregnancy exercise on maternal/offspring cardiometabolic health until delivery and at follow-up. We pooled data from two randomized controlled trials from our group that were performed following the same methodology (one unpublished). We also collected follow-up data de novo from the participants of both trials and their offspring. In total, 1348 women with uncomplicated, singleton gestations were assigned to an intervention (n = 688, performing a supervised, moderate-intensity exercise program (three sessions/week)) or control group (n = 660). Maternal outcomes were excessive gestational weight gain (EGWG), gestational hypertension/diabetes and, at follow-up, return to pre-pregnancy weight within six months, hypertension, overweight/obesity, and other cardiometabolic conditions. Offspring outcomes were macrosomia and low-birthweight and, at follow-up, overweight/obesity, low-weight, and cardiometabolic conditions. Adherence to the intervention, which proved safe, was > 95%. Pregnancy exercise reduced the risk of EGWG, gestational hypertension, and diabetes (adjusted odds ratio (OR) and 95% confidence interval: 0.60 (0.46–0.79), 0.39 (0.23–0.67), and 0.48 (0.28–0.84)), and it was associated with a greater likelihood of returning to pre-pregnancy weight (2.37 (1.26–4.54)) and a lower risk of maternal cardiometabolic conditions (0.27 (0.08–0.95)) at the end of follow-up (median 6.1 years (interquartile range 1.8)). Pregnancy exercise also reduced the risk of macrosomia (0.36 (0.20–0.63)) and of childhood overweight/obesity during the first year (0.20 (0.06–0.63)). Our findings suggest that pregnancy exercise might protect maternal/offspring health.
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Huang C, Han W, Fan Y. Correlation study between increased fetal movement during the third trimester and neonatal outcome. BMC Pregnancy Childbirth 2019; 19:467. [PMID: 31801506 PMCID: PMC6894290 DOI: 10.1186/s12884-019-2637-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 11/26/2019] [Indexed: 12/03/2022] Open
Abstract
Background We aimed to analyze the correlation between increased fetal movements in the third trimester and neonatal outcomes. Methods We enrolled pregnant women (n = 219) who reported increased/excessive fetal movements in the third trimester in our hospital. A control group of healthy women (n = 278) who had undergone regular childbirth and delivery in our hospital during the same period and did not report abnormal fetal movements were also recruited. All pregnant women underwent fetal non-stress test. We analyzed the neonatal weight, appearance, pulse, grimace, activity, and respiration score, degrees of amniotic fluid contamination, amniotic fluid volume, conditions of umbilical cord around the neck and cord length, and incidence of small for gestational age. In addition, the incidence of preterm delivery, cesarean section rate, postpartum hemorrhage, and other postpartum complications were also analyzed. We then analyzed the correlation between increased/excessive fetal activity and neonatal outcomes. Results Women with complaints of increased/excessive fetal movements exhibited increased fetal movements mainly around 31 and 39 weeks of gestation. Several pregnancy variables, including number of previous delivery, gestational age (less than 34 weeks and more than 37 weeks) and vaginal birth rate, were associated with increased/excessive fetal movements. In addition, women who reported increased/excessive fetal movements had higher odds of large for gestational age (LGA), particularly those with gestational age over 37 weeks. Conclusion Increased/excessive fetal movements may be used to predict adverse neonatal outcome such as LGA.
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Affiliation(s)
- Cuiqin Huang
- Department of Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600# Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Wei Han
- Department of Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600# Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Yajing Fan
- Department of Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600# Yishan Road, Xuhui District, Shanghai, 200233, China.
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Leppänen MH, Raitanen J, Husu P, Kujala UM, Tuominen PP, Vähä-Ypyä H, Luoto R. Physical Activity and Body Composition in Children and Their Mothers According to Mother's Gestational Diabetes Risk: A Seven-Year Follow-Up Study. ACTA ACUST UNITED AC 2019; 55:medicina55100635. [PMID: 31557895 PMCID: PMC6843146 DOI: 10.3390/medicina55100635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 08/15/2019] [Accepted: 09/17/2019] [Indexed: 12/16/2022]
Abstract
Background and Objectives: There is lack of knowledge on whether mothers' gestational diabetes (GDM) risk is related to their physical activity (PA) or their children's PA and body composition. We aimed to examine the difference in (1) change in self-reported PA from pre-pregnancy to seven-year follow-up and (2) accelerometer-based PA at seven years after delivery between the mothers having GDM risk (GDMRyes-mothers) and not having GDM risk (GDMRno-mothers). Furthermore, we examined the difference in children's PA and/or body composition at six years of age according to their mothers' GDM risk. Materials and Methods: The study included 199 Finnish women. GDM risk factors were screened at the beginning of pregnancy, and the women were classified as GDMRyes-mothers if they had at least one GDM risk factor (body mass index ≥25 kg/m2; age ≥40 years; family history of diabetes; GDM, signs of glucose intolerance, or newborn's macrosomia (≥4500 g) in earlier pregnancy) or as GDMRno-mothers if they had no risk factors. Mothers' PA was assessed by self-reporting at 8-12 gestational weeks concerning pre-pregnancy PA and at a follow-up seven years after the delivery. Moreover, mothers' and their children's PA was measured using a triaxial Hookie AM20-accelerometer at seven years after delivery. Children's body composition was assessed using a TANITA bioelectrical impedance device. Adjusted linear regression analyses were applied. Results: GDMRno-mothers increased their self-reported PA more than GDMRyes-mothers from pre-pregnancy to the seven-year follow-up. Concerning women's measured PA as well as children's PA and body composition at seven years after delivery, the differences were non-significant between GDMRyes-mothers and GDMRno-mothers. However, of the GDM risk factors, mothers' pre-pregnancy body mass index was positively related to unhealthier body composition in boys at six years of age. Conclusion: Health promotion should be targeted at women with GDM risk factors, in particular overweight women, in enhancing women's PA in the long term and their children's healthy body composition.
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Affiliation(s)
- Marja H Leppänen
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40100 Jyväskylä, Finland.
| | - Jani Raitanen
- The UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500 Tampere, Finland.
- Faculty of Social Sciences (Health Sciences), Tampere University, 33014 Tampere, Finland.
| | - Pauliina Husu
- The UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500 Tampere, Finland.
| | - Urho M Kujala
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40100 Jyväskylä, Finland.
| | - Pipsa Pa Tuominen
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40100 Jyväskylä, Finland
- The UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500 Tampere, Finland
| | - Henri Vähä-Ypyä
- The UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500 Tampere, Finland.
| | - Riitta Luoto
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere Finland.
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Connolly CP, Conger SA, Montoye AH, Marshall MR, Schlaff RA, Badon SE, Pivarnik JM. Walking for health during pregnancy: A literature review and considerations for future research. JOURNAL OF SPORT AND HEALTH SCIENCE 2019; 8:401-411. [PMID: 31534815 PMCID: PMC6742678 DOI: 10.1016/j.jshs.2018.11.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/12/2018] [Accepted: 08/31/2018] [Indexed: 05/04/2023]
Abstract
Walking is the most commonly chosen type of physical activity (PA) during pregnancy and provides several health benefits to both mother and child. National initiatives have promoted the importance of walking in general, but little emphasis is directed toward pregnant women, the majority of whom are insufficiently active. Pregnant women face a variety of dynamic barriers to a physically active lifestyle, some of which are more commonly experienced during specific times throughout the pregnancy experience. Walking is unique in that it appears resistant to a number of these barriers that limit other types of PA participation, and it can be meaningfully integrated into some transportation and occupational activities when leisure-time options are unavailable. Preliminary intervention work suggests that walking programs can be effectively adopted into a typical pregnancy lifestyle. However, a great deal of work remains to administer successful pregnancy walking interventions, including developing and using validated methods of PA and walking assessment. This narrative review discusses the unique advantages of walking during pregnancy, provides recommendations for future intervention work, and outlines the need for pregnancy-focused community walking initiatives. Standard search procedures were followed to determine sources from the literature specific to walking during pregnancy for use in each section of this review.
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Affiliation(s)
- Christopher P. Connolly
- Kinesiology Program, Washington State University, Pullman, WA 99164-1410, USA
- Corresponding Author.
| | - Scott A. Conger
- Department of Kinesiology, Boise State University, Boise, ID 83725, USA
| | - Alexander H.K. Montoye
- Department of Integrative Physiology and Health Science, Alma College, Alma, MI 48801, USA
| | | | - Rebecca A. Schlaff
- Department of Kinesiology, Saginaw Valley State University, University Center, MI 48710, USA
| | - Sylvia E. Badon
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA
| | - James M. Pivarnik
- Department of Kinesiology, Michigan State University, East Lansing, MI 48824-1034, USA
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Pregnancy Exercise and Nutrition With Smartphone Application Support: A Randomized Controlled Trial. Obstet Gynecol 2019; 131:818-826. [PMID: 29630009 DOI: 10.1097/aog.0000000000002582] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the effect of a healthy lifestyle package (an antenatal behavior change intervention supported by smartphone application technology) on the incidence of gestational diabetes mellitus (GDM) in overweight and obese women. METHODS Women with body mass indexes (BMIs) 25-39.9 were enrolled into this randomized controlled trial. The intervention consisted of specific dietary and exercise advice that addressed behavior change supported by a tailor-designed smartphone application. Women in the control group received usual care. The primary outcome was the incidence of GDM at 28-30 weeks of gestation. To reduce GDM from 15% to 7.2%, we estimated that 506 women would be required to have 80% power to detect this effect size at a significance of .05, that is, 253 in each group. RESULTS Between March 2013 and February 2016, 565 women were recruited with a mean BMI of 29.3 and mean gestational age of 15.5 weeks. The incidence of GDM did not differ between the two groups, 37 of 241 (15.4%) in the intervention group compared with 36 of 257 (14.1%) in the control group (relative risk 1.1, 95% CI 0.71-1.66, P=.71). CONCLUSIONS A mobile health-supported behavioral intervention did not decrease the incidence of GDM. CLINICAL TRIAL REGISTRATION ISRCTN registry, https://www.isrctn.com/, ISRCTN29316280.
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Feasibility of conducting an early pregnancy diet and lifestyle e-health intervention: the Pregnancy Lifestyle Activity Nutrition (PLAN) project. J Dev Orig Health Dis 2019; 11:58-70. [PMID: 31391133 DOI: 10.1017/s2040174419000400] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Childhood obesity is a global issue. Excessive weight gain in early pregnancy is independently associated with obesity in the next generation. Given the uptake of e-health, our primary aim was to pilot the feasibility of an e-health intervention, starting in the first trimester, to promote healthy lifestyle and prevent excess weight gain in early pregnancy. Methods: Women were recruited between 8 and 11 weeks gestation and randomised to the intervention or routine antenatal care. The intervention involved an e-health program providing diet, physical activity and well-being advice over 12 weeks. RESULTS Women (n = 57, 43.9% overweight/obese) were recruited at 9.38 ± 1.12 (control) and 9.06 ± 1.29 (intervention) weeks' gestation, mainly from obstetric private practices (81.2%). Retention was 73.7% for the 12-week intervention, 64.9% at birth and 55.8% at 3 months after birth.No difference in gestational weight gain or birth size was detected. Overall treatment effect showed a mean increase in score ranking the perceived confidence of dietary change (1.2 ± 0.46, p = 0.009) and score ranking readiness to exercise (1.21 ± 0.51, p = 0.016) over the intervention. At 3 months, infants weighed less in the intervention group (5405 versus 6193 g, p = 0.008) and had a lower ponderal index (25.5 ± 3.0 versus 28.8 ± 4.0 kg/m3) compared with the control group. CONCLUSION AND DISCUSSION A lifestyle intervention starting in the first-trimester pregnancy utilising e-health mode of delivery is feasible. Future studies need strategies to target recruitment of participants of lower socio-economic status and ensure maximal blinding. Larger trials (using technology and focused on early pregnancy) are needed to confirm if decreased infant adiposity is maintained.
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McIntyre HD, Catalano P, Zhang C, Desoye G, Mathiesen ER, Damm P. Gestational diabetes mellitus. Nat Rev Dis Primers 2019; 5:47. [PMID: 31296866 DOI: 10.1038/s41572-019-0098-8] [Citation(s) in RCA: 932] [Impact Index Per Article: 155.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2019] [Indexed: 12/11/2022]
Abstract
Hyperglycaemia that develops during pregnancy and resolves after birth has been recognized for over 50 years, but uniform worldwide consensus is lacking about threshold hyperglycaemic levels that merit a diagnosis of 'gestational diabetes mellitus' (GDM) and thus treatment during pregnancy. GDM is currently the most common medical complication of pregnancy, and prevalence of undiagnosed hyperglycaemia and even overt diabetes in young women is increasing. Maternal overweight and obesity, later age at childbearing, previous history of GDM, family history of type 2 diabetes mellitus and ethnicity are major GDM risk factors. Diagnosis is usually performed using an oral glucose tolerance test (OGTT), although a non-fasting, glucose challenge test (GCT) is used in some parts of the world to screen women for those requiring a full OGTT. Dietary modification and increased physical activity are the primary treatments for GDM, but pharmacotherapy, usually insulin, is used when normoglycaemia is not achieved. Oral hypoglycaemic agents, principally metformin and glibenclamide (glyburide), are also used in some countries. Treatment improves immediate pregnancy outcomes, reducing excess fetal growth and adiposity and pregnancy-related hypertensive disorders. GDM increases the risk of long-term complications, including obesity, impaired glucose metabolism and cardiovascular disease, in both the mother and infant. Optimal management of mother and infant during long-term follow-up remains challenging, with very limited implementation of preventive strategies in most parts of the world.
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Affiliation(s)
- H David McIntyre
- Mater Research and University of Queensland, Brisbane, Queensland, Australia.
| | - Patrick Catalano
- Mother Infant Research Institute, Department of Obstetrics and Gynecology, Tufts University School of Medicine, Friedman School of Nutrition Science and Policy, Boston, MA, USA
| | - Cuilin Zhang
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
| | - Gernot Desoye
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Elisabeth R Mathiesen
- Department of Endocrinology, Center for Pregnant Women with Diabetes, Rigshospitalet and The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Damm
- Department of Obstetrics, Center for Pregnant Women with Diabetes, Rigshospitalet and The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Chan CWH, Au Yeung E, Law BMH. Effectiveness of Physical Activity Interventions on Pregnancy-Related Outcomes among Pregnant Women: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101840. [PMID: 31126153 PMCID: PMC6571580 DOI: 10.3390/ijerph16101840] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/08/2019] [Accepted: 05/21/2019] [Indexed: 12/16/2022]
Abstract
Regular physical activity has been demonstrated to contribute to physical and psychological health. Nevertheless, pregnant women generally exhibit low levels of physical activity. Implementation of interventions that enhance the self-efficacy of pregnant women on increasing physical activity is required. This paper provides an in-depth review of studies reporting the effect of various physical activity interventions dedicated for pregnant women on pregnancy-related issues, including gestational weight gain, pain and depression, physical activity level, and quality of life among these individuals. Five databases were used in searching the literature. Findings of the included studies were presented narratively, and appraisal of their methodological quality was conducted using the quality assessment tool developed by Effective Public Health Practice Project. Review findings demonstrated that physical activity interventions are effective in enhancing physical activity levels of pregnant women. Further, they are potentially useful in alleviating pregnancy-related pain and psychological symptoms, reducing gestational weight gain, and increasing self-efficacy in enhancing physical activity levels among these individuals. Nevertheless, inconsistencies in findings between studies hamper the drawing of firm conclusions on these latter outcomes. Overall, studies demonstrated a positive effect of physical activity interventions on the well-being and physical and psychological health of pregnant women.
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Affiliation(s)
- Carmen W H Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China.
| | - Elce Au Yeung
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China.
| | - Bernard M H Law
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China.
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Griffith RJ, Alsweiler J, Moore AE, Brown S, Middleton P, Shepherd E, Crowther CA. Interventions to prevent women developing gestational diabetes mellitus: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2019; 2019:CD012394. [PMCID: PMC6515838 DOI: 10.1002/14651858.cd012394.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2023]
Abstract
This is a protocol for a Cochrane Review (Overview). The objectives are as follows: To summarise the evidence from Cochrane systematic reviews regarding the effects of interventions to prevent women developing gestational diabetes mellitus (GDM).
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Affiliation(s)
- Rebecca J Griffith
- University of AucklandDepartment of Paediatrics: Child and Youth HealthAucklandNew Zealand
| | - Jane Alsweiler
- University of AucklandDepartment of Paediatrics: Child and Youth HealthAucklandNew Zealand
| | - Abigail E Moore
- The University of AucklandLiggins Institute85 Park RoadAucklandNew Zealand1023
| | - Stephen Brown
- Auckland University of TechnologySchool of Interprofessional Health Studies90 Akoranga DriveAucklandNew Zealand0627
| | - Philippa Middleton
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research InstituteWomen's and Children's Hospital72 King William RoadAdelaideAustralia5006
| | - Emily Shepherd
- The University of AdelaideRobinson Research Institute, Discipline of Obstetrics and Gynaecology, Adelaide Medical SchoolAdelaideAustralia
| | - Caroline A Crowther
- The University of AucklandLiggins Institute85 Park RoadAucklandNew Zealand1023
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Michel S, Raab R, Drabsch T, Günther J, Stecher L, Hauner H. Do lifestyle interventions during pregnancy have the potential to reduce long-term postpartum weight retention? A systematic review and meta-analysis. Obes Rev 2019; 20:527-542. [PMID: 30548769 DOI: 10.1111/obr.12809] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/22/2018] [Accepted: 10/26/2018] [Indexed: 01/21/2023]
Abstract
Reducing postpartum weight retention is a promising strategy for addressing the rising prevalence of overweight and obesity in women. This systematic review and meta-analysis explored whether lifestyle interventions during pregnancy have the potential to reduce weight retention at 4 months postpartum and beyond. A search of five electronic databases for randomized controlled trials comparing the effect of weight-related lifestyle interventions beginning in pregnancy on postpartum weight retention to standard prenatal care groups was performed. Postpartum weight retention data was synthesized in a random-effects meta-analysis. Data from 14 studies of 7116 participants showed that the intervention group retained statistically significant less weight than the control group (weighted mean difference: -0.73 kg, 95% CI: -1.32 to -0.14, P = 0.015). Subgroup analysis showed this effect to be largest in studies with follow-ups from 4 to 6 months (weighted mean difference: -1.32 kg, 95% CI: -2.11 to -0.53, P = 0.001), but it remained significant until 12 months postpartum (weighted mean difference: -0.68 kg, 95% CI: -1.28 to -0.09, P = 0.023). In studies of women with a body mass index above 25.0 kg/m2 , no significant intervention effect was observed. More high-quality studies with a follow-up beyond 12 months postpartum are needed.
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Affiliation(s)
- Sophie Michel
- Else Kroener-Fresenius Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Roxana Raab
- Else Kroener-Fresenius Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Theresa Drabsch
- Else Kroener-Fresenius Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Julia Günther
- Else Kroener-Fresenius Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lynne Stecher
- Else Kroener-Fresenius Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Medical Informatics, Statistics and Epidemiology, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans Hauner
- Else Kroener-Fresenius Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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