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 "Gestational diabetes and maternal obesity are both independently
associated with adverse maternal and neonatal outcomes," and many
women who have gestational diabetes develop type 2 diabetes within
10 years, said lead author Dr. Saila B. Koivusalo of Helsinki
University Hospital and Katiloopisto Maternity Hospital.
Between 2 and 18 percent of pregnancies involve gestational
diabetes, Koivusalo told Reuters Health by email.
Women who do not have diabetes before getting pregnant may develop
it during pregnancy, especially if they have risk factors like being
overweight, or they had gestational diabetes in a past pregnancy.
The condition can be managed during pregnancy and often goes away
afterward, according to the Centers for Disease Control and
Prevention.
To see if it can be avoided entirely, even by women with heightened
risk, the researchers recruited 293 women who were less than five
months into their pregnancies and either had a history of
gestational diabetes or were obese, but did not have type 1 or 2
diabetes.
The women were randomly divided into two groups, with half the women
receiving only standard prenatal care.
In the intervention group, however, the women received one-on-one
counseling on diet, physical activity and weight control with
trained nurses as well as one group meeting with a dietitian.
Obese women were advised to avoid any weight gain during the first
two trimesters. Dietary counseling focused on optimizing the amount
of vegetables, fruits and berries, whole grains, low-fat dairy,
unsaturated fatty acids, fish and lean meats in the diet, and
reducing sugar intake.
For physical activity, the women aimed to get a minimum of 150 min
of moderate-intensity physical activity each week. They also had
free access to public swimming pools and guided exercise groups once
a week.
Close to 14 percent of the women in the counseling group developed
gestational diabetes, compared to almost 22 percent of the
standard-care group, after the researchers accounted for age and
prepregnancy weight, according to the report in Diabetes Care.
That represents a 39 percent risk reduction in this group of
high-risk women, the authors note.
Women in the counseling group tended to gain less weight during
pregnancy, about 1.3 pounds less than those in the comparison group.
They also increased their physical activity and improved their diet
quality compared to the other group.
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"This is a very nice trial that demonstrates that small changes in
eating habits and physical activity patterns may have an important
impact in women at risk for gestational diabetes," said Dr. Kaberi
Dasgupta of McGill University in Montreal.
"What is remarkable is that the occurrence of (gestational diabetes)
was reduced by a relatively simple intervention with only three
in-person sessions," Dasgupta, who was not part of the study, told
Reuters Health by email. "There may also be a 'healthier culture' in
Scandinavian countries that makes people more responsive to health
behavior change interventions."
Since this is the first randomized controlled trial to test
lifestyle interventions for preventing gestational diabetes, it's
still unclear when is the best time in pregnancy to start making
changes to reduce risk, Koivusalo said.
"Taken together, prevention of overweight and obesity already before
the first pregnancy is an important factor when aiming at optimal
maternal and neonatal outcomes," she said. "And weight control
should also continue after pregnancy when the maintenance of a
healthy lifestyle among children also needs to be stressed."
Most women can make healthier lifestyle choices on their own, she
said. "But it may be important to have a support person during the
process of lifestyle changes, as we know that they are not
necessarily easy to carry out," she said.
In the Finnish study, the study nurses were midwives with strong
expertise in counseling pregnant women, she noted.
SOURCE: http://bit.ly/1SUWvJ4 Diabetes Care, online July 29, 2015.
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