Results From a European Multicenter Randomized Trial of Physical Activity and/or Healthy Eating to Reduce the Risk of Gestational Diabetes Mellitus: The DALI Lifestyle Pilot

• Published in: Diabetes care Vol. 38; no. 9; pp. 1650 - 1656
• Main Authors: Simmons, David, Jelsma, Judith G M, Galjaard, Sander, Devlieger, Roland, van Assche, Andre, Jans, Goele, Corcoy, Rosa, Adelantado, Juan M, Dunne, Fidelma, Desoye, Gernot, Harreiter, Jürgen, Kautzky-Willer, Alexandra, Damm, Peter, Mathiesen, Elisabeth R, Jensen, Dorte M, Andersen, Lise Lotte, Lapolla, Annunziata, Dalfra, Maria, Bertolotto, Alessandra, Wender-Ozegowska, Ewa, Zawiejska, Agnieszka, Hill, David, Rebollo, Pablo, Snoek, Frank J, van Poppel, Mireille N M
• Format: Journal Article
• Language: English
• Published: United States American Diabetes Association 01.09.2015
• Subjects: Adult; Comparative analysis; Diabetes; Diabetes, Gestational - epidemiology; Diabetes, Gestational - prevention & control; Europe; Feeding Behavior - physiology; Female; Glucose; Glucose Tolerance Test; Humans; Insulin Resistance; Intervention; Life Style; Motivational Interviewing; Motor Activity; Obesity - complications; Obesity - prevention & control; Pilot Projects; Pregnancy; Risk assessment; Risk Reduction Behavior; Weight Gain; Europe
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc15-0360

Ways to prevent gestational diabetes mellitus (GDM) remain unproven. We compared the impact of three lifestyle interventions (healthy eating [HE], physical activity [PA], and both HE and PA [HE+PA]) on GDM risk in a pilot multicenter randomized trial. Pregnant women at risk for GDM (BMI ≥29 kg/m2) from nine European countries were invited to undertake a 75-g oral glucose tolerance test before 20 weeks' gestation. Those without GDM were randomized to HE, PA, or HE+PA. Women received five face-to-face and four optional telephone coaching sessions, based on the principles of motivational interviewing. A gestational weight gain (GWG) <5 kg was targeted. Coaches received standardized training and an intervention toolkit. Primary outcome measures were GWG, fasting glucose, and insulin sensitivity (HOMA) at 35-37 weeks. Among the 150 trial participants, 32% developed GDM by 35-37 weeks and 20% achieved GWG <5 kg. HE women had less GWG (-2.6 kg [95% CI -4.9, -0.2]; P = 0.03) and lower fasting glucose (-0.3 mmol/L [-0.4, -0.1]; P = 0.01) than those in the PA group at 24-28 weeks. HOMA was comparable. No significant differences between HE+PA and the other groups were observed. An antenatal HE intervention is associated with less GWG and lower fasting glucose compared with PA alone. These findings require a larger trial for confirmation but support the use of early HE interventions in obese pregnant women.