Association between gestational weight gain, gestational diabetes risk, and obstetric outcomes: A randomized controlled trial post hoc analysis

David Simmons, Roland Devlieger, Andre van Assche, Sander Galjaard, Rosa Corcoy, Juan M. Adelantado, Fidelma Dunne, Gernot Desoye, Alexandra Kautzky-Willer, Peter Damm, Elisabeth R. Mathiesen, Dorte M. Jensen, Lise Lotte T. Andersen, Annunziata Lapolla, Maria G. Dalfra, Alessandra Bertolotto, Ewa Wender-Ozegowska, Agnieszka Zawiejska, David Hill, Frank J. Snoek & 1 others Mireille N.M. van Poppel

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Excess gestational weight gain (GWG) is associated with the development of gestational diabetes mellitus (GDM). Lifestyle trials have not achieved much GWG limitation, and have largely failed to prevent GDM. We compared the effect of substantial GWG limitation on maternal GDM risk. Pregnant women with a body mass index (BMI) ≥29 kg/m2 <20 weeks gestation without GDM (n = 436) were randomized, in a multicenter trial, to usual care (UC), healthy eating (HE), physical activity (PA), or HE and PA lifestyle interventions. GWG over the median was associated with higher homeostasis model assessment insulin resistance (HOMA-IR) and insulin secretion (Stumvoll phases 1 and 2), a higher fasting plasma glucose (FPG) at 24–28 weeks (4.66 ± 0.43 vs. 4.61 ± 0.40 mmol/L, p < 0.01), and a higher rate of caesarean section (38% vs. 27% p < 0.05). The GWG over the median at 35–37 weeks was associated with a higher rate of macrosomia (25% vs. 16%, p < 0.05). A post hoc comparison among women from the five sites with a GWG difference >3 kg showed no significance difference in glycaemia or insulin resistance between HE and PA, and UC. We conclude that preventing even substantial increases in GWG after the first trimester has little effect on maternal glycaemia. We recommend randomized controlled trials of effective lifestyle interventions, starting in or before the first trimester.

Original languageEnglish
Article number1568
JournalNutrients
Volume10
Issue number11
DOIs
Publication statusPublished - 1 Nov 2018

Cite this

Simmons, David ; Devlieger, Roland ; van Assche, Andre ; Galjaard, Sander ; Corcoy, Rosa ; Adelantado, Juan M. ; Dunne, Fidelma ; Desoye, Gernot ; Kautzky-Willer, Alexandra ; Damm, Peter ; Mathiesen, Elisabeth R. ; Jensen, Dorte M. ; Andersen, Lise Lotte T. ; Lapolla, Annunziata ; Dalfra, Maria G. ; Bertolotto, Alessandra ; Wender-Ozegowska, Ewa ; Zawiejska, Agnieszka ; Hill, David ; Snoek, Frank J. ; van Poppel, Mireille N.M. / Association between gestational weight gain, gestational diabetes risk, and obstetric outcomes : A randomized controlled trial post hoc analysis. In: Nutrients. 2018 ; Vol. 10, No. 11.
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title = "Association between gestational weight gain, gestational diabetes risk, and obstetric outcomes: A randomized controlled trial post hoc analysis",
abstract = "Excess gestational weight gain (GWG) is associated with the development of gestational diabetes mellitus (GDM). Lifestyle trials have not achieved much GWG limitation, and have largely failed to prevent GDM. We compared the effect of substantial GWG limitation on maternal GDM risk. Pregnant women with a body mass index (BMI) ≥29 kg/m2 <20 weeks gestation without GDM (n = 436) were randomized, in a multicenter trial, to usual care (UC), healthy eating (HE), physical activity (PA), or HE and PA lifestyle interventions. GWG over the median was associated with higher homeostasis model assessment insulin resistance (HOMA-IR) and insulin secretion (Stumvoll phases 1 and 2), a higher fasting plasma glucose (FPG) at 24–28 weeks (4.66 ± 0.43 vs. 4.61 ± 0.40 mmol/L, p < 0.01), and a higher rate of caesarean section (38{\%} vs. 27{\%} p < 0.05). The GWG over the median at 35–37 weeks was associated with a higher rate of macrosomia (25{\%} vs. 16{\%}, p < 0.05). A post hoc comparison among women from the five sites with a GWG difference >3 kg showed no significance difference in glycaemia or insulin resistance between HE and PA, and UC. We conclude that preventing even substantial increases in GWG after the first trimester has little effect on maternal glycaemia. We recommend randomized controlled trials of effective lifestyle interventions, starting in or before the first trimester.",
keywords = "Gestational diabetes mellitus, Healthy eating, Lifestyle intervention, Motivational interviewing, Overweight, Physical activity, Pregnancy, Prevention, Randomised controlled trial",
author = "David Simmons and Roland Devlieger and {van Assche}, Andre and Sander Galjaard and Rosa Corcoy and Adelantado, {Juan M.} and Fidelma Dunne and Gernot Desoye and Alexandra Kautzky-Willer and Peter Damm and Mathiesen, {Elisabeth R.} and Jensen, {Dorte M.} and Andersen, {Lise Lotte T.} and Annunziata Lapolla and Dalfra, {Maria G.} and Alessandra Bertolotto and Ewa Wender-Ozegowska and Agnieszka Zawiejska and David Hill and Snoek, {Frank J.} and {van Poppel}, {Mireille N.M.}",
year = "2018",
month = "11",
day = "1",
doi = "10.3390/nu10111568",
language = "English",
volume = "10",
journal = "Nutrients",
issn = "2072-6643",
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Simmons, D, Devlieger, R, van Assche, A, Galjaard, S, Corcoy, R, Adelantado, JM, Dunne, F, Desoye, G, Kautzky-Willer, A, Damm, P, Mathiesen, ER, Jensen, DM, Andersen, LLT, Lapolla, A, Dalfra, MG, Bertolotto, A, Wender-Ozegowska, E, Zawiejska, A, Hill, D, Snoek, FJ & van Poppel, MNM 2018, 'Association between gestational weight gain, gestational diabetes risk, and obstetric outcomes: A randomized controlled trial post hoc analysis' Nutrients, vol. 10, no. 11, 1568. https://doi.org/10.3390/nu10111568

Association between gestational weight gain, gestational diabetes risk, and obstetric outcomes : A randomized controlled trial post hoc analysis. / Simmons, David; Devlieger, Roland; van Assche, Andre; Galjaard, Sander; Corcoy, Rosa; Adelantado, Juan M.; Dunne, Fidelma; Desoye, Gernot; Kautzky-Willer, Alexandra; Damm, Peter; Mathiesen, Elisabeth R.; Jensen, Dorte M.; Andersen, Lise Lotte T.; Lapolla, Annunziata; Dalfra, Maria G.; Bertolotto, Alessandra; Wender-Ozegowska, Ewa; Zawiejska, Agnieszka; Hill, David; Snoek, Frank J.; van Poppel, Mireille N.M.

In: Nutrients, Vol. 10, No. 11, 1568, 01.11.2018.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Association between gestational weight gain, gestational diabetes risk, and obstetric outcomes

T2 - A randomized controlled trial post hoc analysis

AU - Simmons, David

AU - Devlieger, Roland

AU - van Assche, Andre

AU - Galjaard, Sander

AU - Corcoy, Rosa

AU - Adelantado, Juan M.

AU - Dunne, Fidelma

AU - Desoye, Gernot

AU - Kautzky-Willer, Alexandra

AU - Damm, Peter

AU - Mathiesen, Elisabeth R.

AU - Jensen, Dorte M.

AU - Andersen, Lise Lotte T.

AU - Lapolla, Annunziata

AU - Dalfra, Maria G.

AU - Bertolotto, Alessandra

AU - Wender-Ozegowska, Ewa

AU - Zawiejska, Agnieszka

AU - Hill, David

AU - Snoek, Frank J.

AU - van Poppel, Mireille N.M.

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Excess gestational weight gain (GWG) is associated with the development of gestational diabetes mellitus (GDM). Lifestyle trials have not achieved much GWG limitation, and have largely failed to prevent GDM. We compared the effect of substantial GWG limitation on maternal GDM risk. Pregnant women with a body mass index (BMI) ≥29 kg/m2 <20 weeks gestation without GDM (n = 436) were randomized, in a multicenter trial, to usual care (UC), healthy eating (HE), physical activity (PA), or HE and PA lifestyle interventions. GWG over the median was associated with higher homeostasis model assessment insulin resistance (HOMA-IR) and insulin secretion (Stumvoll phases 1 and 2), a higher fasting plasma glucose (FPG) at 24–28 weeks (4.66 ± 0.43 vs. 4.61 ± 0.40 mmol/L, p < 0.01), and a higher rate of caesarean section (38% vs. 27% p < 0.05). The GWG over the median at 35–37 weeks was associated with a higher rate of macrosomia (25% vs. 16%, p < 0.05). A post hoc comparison among women from the five sites with a GWG difference >3 kg showed no significance difference in glycaemia or insulin resistance between HE and PA, and UC. We conclude that preventing even substantial increases in GWG after the first trimester has little effect on maternal glycaemia. We recommend randomized controlled trials of effective lifestyle interventions, starting in or before the first trimester.

AB - Excess gestational weight gain (GWG) is associated with the development of gestational diabetes mellitus (GDM). Lifestyle trials have not achieved much GWG limitation, and have largely failed to prevent GDM. We compared the effect of substantial GWG limitation on maternal GDM risk. Pregnant women with a body mass index (BMI) ≥29 kg/m2 <20 weeks gestation without GDM (n = 436) were randomized, in a multicenter trial, to usual care (UC), healthy eating (HE), physical activity (PA), or HE and PA lifestyle interventions. GWG over the median was associated with higher homeostasis model assessment insulin resistance (HOMA-IR) and insulin secretion (Stumvoll phases 1 and 2), a higher fasting plasma glucose (FPG) at 24–28 weeks (4.66 ± 0.43 vs. 4.61 ± 0.40 mmol/L, p < 0.01), and a higher rate of caesarean section (38% vs. 27% p < 0.05). The GWG over the median at 35–37 weeks was associated with a higher rate of macrosomia (25% vs. 16%, p < 0.05). A post hoc comparison among women from the five sites with a GWG difference >3 kg showed no significance difference in glycaemia or insulin resistance between HE and PA, and UC. We conclude that preventing even substantial increases in GWG after the first trimester has little effect on maternal glycaemia. We recommend randomized controlled trials of effective lifestyle interventions, starting in or before the first trimester.

KW - Gestational diabetes mellitus

KW - Healthy eating

KW - Lifestyle intervention

KW - Motivational interviewing

KW - Overweight

KW - Physical activity

KW - Pregnancy

KW - Prevention

KW - Randomised controlled trial

UR - http://www.scopus.com/inward/record.url?scp=85055617405&partnerID=8YFLogxK

U2 - 10.3390/nu10111568

DO - 10.3390/nu10111568

M3 - Article

VL - 10

JO - Nutrients

JF - Nutrients

SN - 2072-6643

IS - 11

M1 - 1568

ER -