Association between Gestational Weight Gain, Gestational Diabetes Risk, and Obstetric Outcomes: A Randomized Controlled Trial Post Hoc Analysis

• Main Authors: 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, Mireille N. M. van Poppel
• Format: Article
• Language: English
• Published: MDPI AG 2018-10-01
• Series: Nutrients
• Subjects: gestational diabetes mellitus; pregnancy; lifestyle intervention; randomised controlled trial; healthy eating; physical activity; overweight; motivational interviewing; prevention
• Online Access: https://www.mdpi.com/2072-6643/10/11/1568

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) &#8805;29 kg/m² &lt;20 weeks gestation without GDM (<i>n</i> = 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&#8315;28 weeks (4.66 &#177; 0.43 vs. 4.61 &#177; 0.40 mmol/L, <i>p</i> &lt; 0.01), and a higher rate of caesarean section (38% vs. 27% <i>p</i> &lt; 0.05). The GWG over the median at 35&#8315;37 weeks was associated with a higher rate of macrosomia (25% vs. 16%, <i>p</i> &lt; 0.05). A post hoc comparison among women from the five sites with a GWG difference &gt;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.