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Yu Y, Ma Q, Groth S. Prepregnancy weight loss and maternal metabolic and inflammatory biomarkers during pregnancy: An analysis of National Health and Nutrition Examination Survey. J Obstet Gynaecol Res 2024; 50:809-820. [PMID: 38369640 DOI: 10.1111/jog.15904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 01/31/2024] [Indexed: 02/20/2024]
Abstract
AIM Women with overweight or obesity are recommended to lose weight before conception to optimize pregnancy outcomes. However, the obstetrical implications of prepregnancy weight loss have been minimally examined. The objective of this study was to investigate the association between prepregnancy weight loss and maternal metabolic and inflammatory profiles during a subsequent pregnancy. METHODS This study was a retrospective analysis of National Health and Nutrition Examination Survey data (2003-2018). Participants were women who were pregnant at the time of assessment. Prepregnancy weight loss was described as percent weight change based on self-reported baseline (1 year before pregnancy) and prepregnancy weight. Metabolic (e.g., blood pressure [BP]) and inflammatory biomarkers (i.e., high-sensitivity C-reactive protein [hs-CRP]) were determined by standard medical tests. Statistical analyses included linear regressions with appropriate imputation, weighting, and variance estimation techniques. RESULTS Participants (N = 236) reported a mean percent weight loss of 4.6% (standard error [SE] = 0.3%) during the year before pregnancy. Regression models showed that prepregnancy weight loss was inversely associated with levels of total cholesterol (β = -1.24, p = 0.01), low-density lipoprotein-cholesterol (β = -0.79, p < 0.01), and high-density lipoprotein-cholesterol (β = -0.18, p < 0.01). The effect of prepregnancy weight loss on BP, insulin sensitivity, and hs-CRP was not significant, although there was a trend toward higher levels of diastolic BP (β = 0.24, p = 0.07) and hs-CRP (β = 0.10, p = 0.08). CONCLUSIONS This study found favorable changes in lipid profiles following prepregnancy weight loss. Due to limitations such as a relatively small sample size, self-reported weight measures, and missing data on several outcome variables, future studies are needed to confirm study findings.
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Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, Rochester, New York, USA
| | - Qianheng Ma
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Susan Groth
- School of Nursing, University of Rochester, Rochester, New York, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Rai AS, Sletner L, Jenum AK, Øverby NC, Stafne SN, Qvigstad E, Pripp AH, Sagedal LR. Employing fasting plasma glucose to safely limit the use of oral glucose tolerance tests in pregnancy: a pooled analysis of four Norwegian studies. Front Endocrinol (Lausanne) 2023; 14:1278523. [PMID: 38098869 PMCID: PMC10720624 DOI: 10.3389/fendo.2023.1278523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/10/2023] [Indexed: 12/17/2023] Open
Abstract
Background/objective There is no international consensus about the optimal approach to screening and diagnosis of gestational diabetes mellitus (GDM). Fasting plasma glucose (FPG) has been proposed as an alternative universal screening test to simplify the diagnosis of GDM. We investigate the ability of the FPG to predict a 2-hour glucose value below the cut-off for GDM, thereby "ruling out" the necessity of a full OGTT and assess the proportion of GDM-related complications associated with the identified FPG level. Materials and methods This study included secondary data from four Norwegian pregnancy cohorts (2002-2013), encompassing 2960 women universally screened with late mid-pregnancy 75g OGTT measuring FPG and 2-hour glucose. For a range of FPG thresholds, we calculated sensitivity to predict elevated 2-hour glucose, number of OGTTs needed and percentage of GDM cases missed, applying modified World Health Organization (WHO) 2013 criteria (2013WHO) and 2017 Norwegian criteria (2017Norwegian). We analyzed pregnancy outcomes for women above and below our selected threshold. Results The prevalence of GDM was 16.6% (2013WHO) and 10.1% (2017Norwegian). A FPG threshold of 4.7 mmol/L had a sensitivity of 76% (2013WHO) and 80% (2017Norwegian) for detecting elevated 2-hour glucose, with few missed GDM cases (2.0% of those ruled out and 7.5% of all GDM cases for 2013WHO, and 1.1% of those ruled out and 7% of all GDM cases for 2017Norwegian). When excluding women with FPG <4.7mmol/l and those with GDM based on FPG, only 24% (2013WHO) and 29% (2017Norwegian) would require OGTT. Women with FPG <4.7mmol/l, including missed GDM cases, had low risk of large-for-gestational-age newborns, cesarean section and operative vaginal delivery. Conclusion A FPG threshold of 4.7mmol/l as a first step when screening for GDM could potentially eliminate the need for OGTT in 70-77% of pregnancies. Women with FPG below this threshold appear to carry low risk of GDM-associated adverse pregnancy outcomes.
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Affiliation(s)
- Anam Shakil Rai
- Department of Research, Sorlandet Hospital, Kristiansand, Norway
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Line Sletner
- Department of Pediatric and Adolescents Medicine, Akershus University Hospital, Akershus, Norway
| | - Anne Karen Jenum
- General Practice Research Unit (AFE), Department of General Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Nina Cecilie Øverby
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Signe Nilssen Stafne
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Clinical Services, St.Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Elisabeth Qvigstad
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Linda Reme Sagedal
- Department of Research, Sorlandet Hospital, Kristiansand, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Obstetrics and Gynaecology, Sorlandet Hospital, Kristiansand, Norway
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Herzberger V, Bäz E, Kunze M, Markfeld-Erol F, Juhasz-Böss I. Exercise During Pregnancy. Dtsch Arztebl Int 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] [What about the content of this article? (0)] [Affiliation(s)] [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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de Castro R, Antunes R, Mendes D, Szumilewicz A, Santos-Rocha R. Can Group Exercise Programs Improve Health Outcomes in Pregnant Women? An Updated Systematic Review. Int J Environ Res Public Health 2022; 19:4875. [PMID: 35457743 PMCID: PMC9024782 DOI: 10.3390/ijerph19084875] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/09/2022] [Accepted: 04/15/2022] [Indexed: 02/06/2023]
Abstract
Current scientific evidence supports the recommendation to initiate or continue physical exercise in healthy pregnant women. Group exercise programs have positive effects on improving health, well-being, and social support. In 2015, a systematic review was provided to evaluate the evidence on the effectiveness of group exercise programs in improving pregnant women's and newborns' health outcomes and to assess the content of the programs. This review aims to update this knowledge between 2015 and 2020. The exercise program designs were analyzed with the Consensus of Exercise Reporting Template (CERT) model, the compliance with the current guidelines, and effectiveness in the maternal health and fitness parameters. Three databases were used to conduct literature searches. Thirty-one randomized control trials were selected for analysis. All studies followed a supervised group exercise program including aerobic, resistance, pelvic floor training, stretching, and relaxation sections. Group interventions during pregnancy improved health and fitness outcomes for the women and newborns, although some gaps were identified in the interventions. Multidisciplinary teams of exercise and health professionals should advise pregnant women that group exercise improves a wide range of health outcomes for them and their newborns.
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Affiliation(s)
- Rebeca de Castro
- ESECS—Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; (R.d.C.); (D.M.)
| | - Raul Antunes
- ESECS—Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; (R.d.C.); (D.M.)
- Life Quality Research Centre (CIEQV), 2040-413 Leiria, Portugal
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2410-541 Leiria, Portugal
| | - Diogo Mendes
- ESECS—Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal; (R.d.C.); (D.M.)
- Life Quality Research Centre (CIEQV), 2040-413 Leiria, Portugal
| | - Anna Szumilewicz
- Department of Fitness, Faculty of Physical Culture, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland;
| | - Rita Santos-Rocha
- ESDRM Sport Sciences School of Rio Maior—Polytechnic Institute of Santarém, 2040-413 Rio Maior, Portugal;
- CIPER Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics (FMH), University of Lisbon, 1499-002 Cruz Quebrada, Portugal
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Tang Q, Zhong Y, Xu C, Li W, Wang H, Hou Y. Effectiveness of five interventions used for prevention of gestational diabetes: A network meta-analysis. Medicine (Baltimore) 2022; 101:e29126. [PMID: 35475799 PMCID: PMC9276162 DOI: 10.1097/md.0000000000029126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/03/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with short- and long-term health issues for mother and child; preventing these complications is crucially important. This study aimed to perform a systematic review and network meta-analysis of the relationships among 5 interventions used to prevent GDM. MATERIALS AND METHODS A comprehensive literature search was performed to pool evidence from inception to June 30, 2020. The type of studies was confined to randomized control trials and quasi-randomized control trials published in English investigating the interventions for preventing GDM, including physical activity, dietary intervention, probiotic intervention, mixed intervention, and inositol supplementation. The data were pooled together to report the odds ratio (OR) of GDM with a corresponding 95% credible interval (CrI) and generate a network plot, the surface under the cumulative ranking curve plot, and contribution plot. In addition, loop inconsistency was examined, and a funnel plot combined with Egger test was used to measure heterogeneity. RESULTS The network meta-analysis included 46 randomized control trials involving 16,545 patients. Compared with placebo, physical activity (OR: 0.64, 95% CrI: 0.46-0.88) and probiotic intervention (OR: 0.57, 95% CrI: 0.34-0.96) reduced the incidence of GDM significantly. However, dietary intervention, a combination of physical activity and diet intervention, and inositol supplementation did not significantly alter GDM risk. CONCLUSIONS Physical activity and probiotic intervention are more effective than placebo in reducing the risk of developing GDM. Future work should focus on the type, duration, frequency, and timing of physical activity and probiotic intervention.
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Affiliation(s)
- Qiongyao Tang
- Operating Theatre, Haikou Maternal, and Child Health Hospital, Haikou, Hainan, China
| | - Ying Zhong
- Operating Theatre, Haikou Maternal, and Child Health Hospital, Haikou, Hainan, China
| | - Chenyun Xu
- Longhua Outpatient Department, Hainan General Hospital, Haikou, Hainan, China
| | - Wangya Li
- Operating Theatre, Haikou Maternal, and Child Health Hospital, Haikou, Hainan, China
| | - Haiyan Wang
- Operating Theatre, Haikou Maternal, and Child Health Hospital, Haikou, Hainan, China
| | - Yu Hou
- Department of Critical Care Medicine, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, Hainan, China
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Lindsay KL, Gyllenhammer LE, Entringer S, Wadhwa PD. Rate of Gestational Weight Gain and Glucose-Insulin Metabolism Among Hispanic Pregnant Women With Overweight and Obesity. J Clin Endocrinol Metab 2022; 107:e734-e744. [PMID: 34468745 PMCID: PMC8764225 DOI: 10.1210/clinem/dgab655] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Indexed: 12/12/2022]
Abstract
CONTEXT Hispanic women are at elevated risk of gestational glucose intolerance and postpartum type 2 diabetes compared with non-Hispanic White women. Identification of potentially modifiable factors contributing to this trajectory of beta-cell dysfunction is warranted. OBJECTIVE We aimed to determine the association between rate of gestational weight gain (rGWG) and glucose-insulin metabolism in Hispanic pregnant women with overweight and obesity. METHODS This cross-sectional, observational study, conducted from 2018-2020 at the clinical research center at University of California, Irvine, included 33 nondiabetic Hispanic pregnant women at 28 to 30 weeks' gestation with pre-pregnancy body mass index (BMI) 25.0 to 34.9 kg/m2. Participants consumed a standardized liquid mixed meal after an overnight fast. Serial blood samples were collected at fasting and up to 2 hours postprandial. The glucose and insulin area under the curve (AUC), insulin sensitivity index (ISI) and insulin secretion sensitivity index (ISSI)-2 were computed. RESULTS Average rGWG (0.36 ± 0.22 kg/week) was classified as excessive in 60% of women. While rGWG was not associated with the glucose or insulin AUC or ISI, it accounted for 13.4% of the variance in ISSI-2 after controlling for covariates (maternal age, parity, and pre-pregnancy BMI); for each 1 unit increase in rGWG, ISSI-2 decreased 2.1 units (P = 0.015). CONCLUSION Even in the absence of gestational diabetes, rGWG was inversely associated with beta-cell function in a high-risk population of Hispanic pregnant women with overweight and obesity. Beta-cell decline is an established risk factor for transition to type 2 diabetes, and these cross-sectional findings highlight rGWG as a potentially modifiable contributor to this process.
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Affiliation(s)
- Karen L Lindsay
- Departments of Pediatrics, UCI School of Medicine, University of California, Irvine, CA 92697, USA
- Susan Samueli Integrative Health Institute, UCI College of Health Sciences, University of California, Irvine, CA 92617, USA
- Correspondence: Karen L Lindsay, PhD, RDN, 5141 California Ave, Suite 200B, University of California, Irvine, Irvine, CA 92617, USA.
| | - Lauren E Gyllenhammer
- Departments of Pediatrics, UCI School of Medicine, University of California, Irvine, CA 92697, USA
- UCI Development health and Disease Research Program, University of California, Irvine, CA 92868, USA
| | - Sonja Entringer
- Departments of Pediatrics, UCI School of Medicine, University of California, Irvine, CA 92697, USA
- UCI Development health and Disease Research Program, University of California, Irvine, CA 92868, USA
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, 10117 Berlin, Germany
| | - Pathik D Wadhwa
- UCI Development health and Disease Research Program, University of California, Irvine, CA 92868, USA
- Departments of Psychiatry and Human Behavior, UCI School of Medicine, University of California, Irvine, CA 92697, USA
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McDonald SM, Strom C, Remchak MM, Chaves A, Broskey NT, Isler C, Haven K, Newton E, DeVente J, Acosta-Manzano P, Aparicio VA, May LE. The effects of aerobic exercise on markers of maternal metabolism during pregnancy. Birth Defects Res 2020; 113:227-237. [PMID: 32803871 DOI: 10.1002/bdr2.1780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/11/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Optimal maternal metabolism during pregnancy is essential for healthy fetal growth and development. Chronic exercise is shown to positively affect metabolism, predominantly demonstrated in nonpregnant populations. OBJECTIVE To determine the effects of aerobic exercise on maternal metabolic biomarkers during pregnancy, with expected lower levels of glucose, insulin, and lipids among exercise-trained pregnant women. METHODS Secondary data analyses were performed using data from two, longitudinal prenatal exercise intervention studies (ENHANCED by MOM and GESTAFIT). Exercisers completed 150 min of weekly moderate-intensity exercise during pregnancy (24+ weeks) while nonexercisers attended stretching sessions. Pregnant women were 31-33 years of age, predominantly non-Hispanic white, and "normal weight" body mass index. At 16 and 36 weeks of gestation, fasting blood samples were collected via fingerstick and venipuncture. Maternal glucose, insulin, insulin resistance (HOMA-IR), total cholesterol (TC), low-density lipoproteins (LDL), high-density lipoproteins (HDL), and triglycerides (TG) were analyzed. ANCOVA analyses were performed to evaluate the effects of aerobic exercise on markers of maternal metabolism in late pregnancy, controlling for baseline levels. RESULTS Our sample included 12 aerobic exercisers and 54 nonexercising control groups. Significant between-groups differences at 16 weeks of gestation were found for TG (92.3 vs. 121.2 mg/dl, p = .04), TC (186.8 vs. 219.6 mg/dl, p = .002), and LDL (104.1 vs. 128.8 mg/dl, p = .002). Aerobic-trained pregnant women exhibited lower insulin levels in late pregnancy (β = -2.6 μIU/ml, 95% CI:-4.2, -0.95, p = .002) and a reduced increase in insulin levels from 16 to 36 week of gestation (β = -2.3 μIU/ml, 95% CI: -4.4, -0.2, p = .034) compared with nonexercising pregnant women. No statistically significant effects were observed for maternal HOMA-IR, TC, LDL, HDL, TC:HDL, and TG in late pregnancy. CONCLUSIONS The observations of this study demonstrate that prenatal exercise may positively affect maternal insulin, with aerobic-trained pregnant women exhibiting lower insulin levels in late pregnancy. Additionally, we found no appreciable effects of prenatal exercise on maternal lipids in late pregnancy.
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Affiliation(s)
- Samantha M McDonald
- School of Dental Medicine, Department of Foundational Sciences and Research, East Carolina University (ECU), Greenville, North Carolina, USA
| | - Cody Strom
- College of Health and Human Performance, Department of Kinesiology, ECU, Greenville, North Carolina, USA
| | - Mary-Margaret Remchak
- College of Health and Human Performance, Department of Kinesiology, ECU, Greenville, North Carolina, USA
| | - Alec Chaves
- College of Health and Human Performance, Department of Kinesiology, ECU, Greenville, North Carolina, USA
| | - Nicholas T Broskey
- College of Health and Human Performance, Department of Kinesiology, ECU, Greenville, North Carolina, USA
| | - Christy Isler
- Department of Obstetrics and Gynecology, Brody School of Medicine, ECU, Greenville, North Carolina, USA
| | - Kelley Haven
- Department of Obstetrics and Gynecology, Brody School of Medicine, ECU, Greenville, North Carolina, USA
| | - Edward Newton
- Department of Obstetrics and Gynecology, Brody School of Medicine, ECU, Greenville, North Carolina, USA
| | - James DeVente
- Department of Obstetrics and Gynecology, Brody School of Medicine, ECU, Greenville, North Carolina, USA
| | - Pedro Acosta-Manzano
- Department of Physiology, Institute of Nutrition and Food Technology, Biomedical Research Center, Sport and Health Research Centre, University of Granada, Granada, Spain
| | - Virginia A Aparicio
- Department of Physiology, Institute of Nutrition and Food Technology, Biomedical Research Center, Sport and Health Research Centre, University of Granada, Granada, Spain
| | - Linda E May
- School of Dental Medicine, Department of Foundational Sciences and Research, East Carolina University (ECU), Greenville, North Carolina, USA
- College of Health and Human Performance, Department of Kinesiology, ECU, Greenville, North Carolina, USA
- Department of Obstetrics and Gynecology, Brody School of Medicine, ECU, Greenville, North Carolina, USA
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O’Brien CM, Louise J, Deussen A, Dodd JM. Maternal cardiometabolic markers are associated with fetal growth: a secondary exploratory analysis of the LIMIT randomised trial. BMC Endocr Disord 2019; 19:97. [PMID: 31601214 PMCID: PMC6785858 DOI: 10.1186/s12902-019-0416-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine the association between maternal cardiometabolic and inflammatory markers with measures of fetal biometry and adiposity. METHODS Women included in this exploratory analysis were randomised to the 'Standard Care' group (N = 911) from the LIMIT randomised trial involving a total of 2212 pregnant women who were overweight or obese (ACTRN12607000161426, Date of registration 9/03/2007, prospectively registered). Fetal biometry including abdominal circumference (AC), estimated fetal weight (EFW), and adiposity measurements (mid-thigh fat mass, subscapular fat mass, abdominal fat mass) were obtained from ultrasound assessments at 28 and 36 weeks' gestation. Maternal markers included C reactive protein (CRP), leptin and adiponectin concentrations, measured at 28 and 36 weeks' gestation and fasting triglycerides and glucose concentrations measured at 28 weeks' gestation. RESULTS There were negative associations identified between maternal serum adiponectin and fetal ultrasound markers of biometry and adiposity. After adjusting for confounders, a 1-unit increase in log Adiponectin was associated with a reduction in the mean AC z score [- 0.21 (- 0.35, - 0.07), P = 0.004] and EFW [- 0.23 (- 0.37, - 0.10), P < 0.001] at 28 weeks gestation. Similarly, a 1-unit increase in log Adiponectin was association with a reduction in the mean AC z score [- 0.30 (- 0.46, - 0.13), P < 0.001] and EFW [- 0.24 (- 0.38, - 0.10), P < 0.001] at 36 weeks gestation. There were no consistent associations between maternal cardiometabolic and inflammatory markers with measurements of fetal adiposity. CONCLUSION Adiponectin concentrations are associated with measures of fetal growth. Our findings contribute to further understanding of fetal growth in the setting of women who are overweight or obesity.
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Affiliation(s)
- Cecelia M. O’Brien
- School of Paediatrics and Reproductive Health, and Robinson Research Institute, University of Adelaide, Adelaide, Australia
- Women’s and Children’s Hospital, The University of Adelaide, 72 King William Road, North Adelaide, SA 5006 Australia
| | - Jennie Louise
- School of Paediatrics and Reproductive Health, and Robinson Research Institute, University of Adelaide, Adelaide, Australia
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - Andrea Deussen
- School of Paediatrics and Reproductive Health, and Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Jodie M. Dodd
- School of Paediatrics and Reproductive Health, and Robinson Research Institute, University of Adelaide, Adelaide, Australia
- Department of Perinatal Medicine, Women’s and Babies Division, Women’s and Children’s Hospital, Adelaide, Australia
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Stubert J, Reister F, Hartmann S, Janni W. The Risks Associated With Obesity in Pregnancy. Dtsch Arztebl Int 2019; 115:276-283. [PMID: 29739495 DOI: 10.3238/arztebl.2018.0276] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 06/20/2017] [Accepted: 02/05/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Approximately one-third of all women of childbearing age are overweight or obese. For these women, pregnancy is associated with increased risks for both mother and child. METHODS This review is based on pertinent publications retrieved by a selective search of PubMed, with special attention to current population-based cohort studies, systematic reviews, meta-analyses, and controlled trials. RESULTS Obesity in pregnancy is associated with unfavorable clinical outcomes for both mother and child. Many of the risks have been found to depend linearly on the body-mass index (BMI). The probability of conception declines linearly, starting from a BMI of 29 kg/m2, by 4% for each additional 1 kg/m2 of BMI (hazard ratio 0.96, 95% confidence interval: [0.91; 0.99]). A 10% increase of pregravid BMI increases the relative risk of gestational diabetes and that of preeclampsia by approximately 10% each. A 5 kg/m2 increase of BMI elevates the relative risk of intrauterine death to 1.24 [1.18; 1.30]. An estimated 11% of all neonatal deaths can be attributed to the consequences of maternal overweight and obesity. Nonetheless, in most randomized controlled trials, nutritional and lifestyle interventions did not bring about any clinically relevant reduction in the incidence of gestational diabetes and fetal macrosomia. CONCLUSION The risks associated with obesity in pregnancy cannot necessarily be influenced by intervention. Preventive measures aimed at normalizing body weight before a woman becomes pregnant are, therefore, all the more important.
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Affiliation(s)
- Johannes Stubert
- Department of Gynecology and Obstetrics, Rostock University Medical Center, Rostock, Germany; Department of Gynecology and Obstetrics, Ulm University Medical Center, Ulm, Germany
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11
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Di Biase N, Balducci S, Lencioni C, Bertolotto A, Tumminia A, Dodesini AR, Pintaudi B, Marcone T, Vitacolonna E, Napoli A. Review of general suggestions on physical activity to prevent and treat gestational and pre-existing diabetes during pregnancy and in postpartum. Nutr Metab Cardiovasc Dis 2019; 29:115-126. [PMID: 30642790 DOI: 10.1016/j.numecd.2018.10.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 10/21/2018] [Accepted: 10/27/2018] [Indexed: 12/16/2022]
Abstract
The aim of this review is to provide general suggestions on physical activity (PA) in pre-gestational and gestational diabetes mellitus (GDM) and encourage women to take part in safe and effective activities throughout pregnancy, in the absence of other contraindications. PA before and during pregnancy and in postpartum has many positive effects on the mother, as it could reduce the risk of GDM, excessive weight gain and lower back pain and also prevents, in the postpartum, diabetes mellitus. It may also reduce the duration of labour and complications at childbirth, fatigue, stress, anxiety and depression, thereby leading to an improved sense of wellbeing. Clinically, it is thought to help prevent preeclampsia and premature birth even though RCTs provide conflicting evidence with regard to the prevention of GDM. The main reason for this rests on the fact that the majority of clinical trials have not been able to replicate the preventive effect of PA on the onset of GDM, such as the different adherence of the patient to PA. Herein, we survey the literature regarding exercise and PA on GDM prevention and treatment as well as on clinical outcomes in pre-GDM in pregnancy. On the basis of the current literature, we also present a series of general recommendations and suggestions on PA and exercise training in pregnancy among both diabetic patients and those at risk for GDM.
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Affiliation(s)
| | - S Balducci
- Metabolic Fitness Association, Monterotondo, Rome, Italy; Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy
| | - C Lencioni
- Diabetes Unit, USL Toscana Nord Ovest, Lucca, Italy
| | - A Bertolotto
- Diabetes and Metabolic Disease Section, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - A Tumminia
- Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania, Garibaldi-Nesima Hospital, Catania, Italy
| | - A R Dodesini
- U.S.C. Malattie endocrine, Diabetologia ASST Papa Giovanni XXIII, Bergamo, Italy
| | - B Pintaudi
- Diabetes Unit, ASST Niguarda Ca Granda Hospital, Milan, Italy
| | - T Marcone
- SSD Diabetology, University Hospital OORR Foggia, Foggia, Italy
| | - E Vitacolonna
- Department of Medicine and Aging, School of Medicine and Health Sciences, "G. D'Annunzio" University, Chieti-Pescara, Chieti, Italy
| | - A Napoli
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy
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12
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Ming WK, Ding W, Zhang CJP, Zhong L, Long Y, Li Z, Sun C, Wu Y, Chen H, Chen H, Wang Z. The effect of exercise during pregnancy on gestational diabetes mellitus in normal-weight women: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2018; 18:440. [PMID: 30419848 PMCID: PMC6233372 DOI: 10.1186/s12884-018-2068-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 10/19/2018] [Indexed: 02/06/2023] Open
Abstract
Background Gestational diabetes mellitus (GDM) is one of the most common complications during pregnancy, and it has both short- and long-term adverse effects on the health of mothers and fetuses. To investigate the effect of exercise during pregnancy on the occurrence of GDM among normal-weight pregnant women. Methods We searched for studies published between January 1994 and June 2017 that appeared in the Web of Science, Scopus, ClinicalTrials.gov or Cochrane library databases. Randomized controlled trials that investigated the preventive effect of exercise on GDM in normal-weight women were included. Interventions including any confounding factors (e.g., dietary) were excluded. We extracted maternal characteristics, the diagnostic criteria of GDM, and basic information for intervention and obstetric outcomes. The primary outcome was the occurrence of GDM, and the secondary outcomes included gestational weight gain, gestational age at birth, birth weight, and the odds of cesarean section. A meta-analysis was conducted based on calculations of pooled estimates using the random-effects model. Results Eight studies were included in this systematic review and meta-analysis. Exercise during pregnancy was shown to decrease the occurrence of GDM [RR = 0.58, 95% CI (0.37, 0.90), P = 0.01 and RR = 0.60, 95% CI (0.36, 0.98), P = 0.04 based on different diagnosis criteria, respectively] in normal-weight women. Regarding secondary outcomes, exercise during pregnancy can decrease gestational weight gain [MD = − 1.61, 95% CI (− 1.99, − 1.22), P<0.01], and had no significant effects on gestational age at birth [MD = − 0.55, 95% CI (− 1.57, 0.47), P = 0.29], birth weight [MD = − 18.70, 95% CI (− 52.49, 15.08), P = 0.28], and the odds of caesarean section [RR = 0.88, 95% CI (0.72, 1.08), P = 0.21], respectively. Conclusions Exercise during pregnancy can ostensibly decrease the occurrence of GDM without reducing gestational age at delivery and increasing the odds of cesarean section in normal-weight women. Electronic supplementary material The online version of this article (10.1186/s12884-018-2068-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wai-Kit Ming
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Harvard Medical School, Harvard University, Boston, MA, USA.,Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA
| | - Wenjing Ding
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Casper J P Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Lieqiang Zhong
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuhang Long
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhuyu Li
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Cong Sun
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanxin Wu
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hanqing Chen
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haitian Chen
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zilian Wang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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13
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Davenport MH, Kathol AJ, Mottola MF, Skow RJ, Meah VL, Poitras VJ, Jaramillo Garcia A, Gray CE, Barrowman N, Riske L, Sobierajski F, James M, Nagpal T, Marchand AA, Slater LG, Adamo KB, Davies GA, Barakat R, Ruchat SM. Prenatal exercise is not associated with fetal mortality: a systematic review and meta-analysis. Br J Sports Med 2018; 53:108-115. [PMID: 30337346 DOI: 10.1136/bjsports-2018-099773] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To perform a systematic review of the relationship between prenatal exercise and fetal or newborn death. DESIGN Systematic review with random-effects meta-analysis and meta-regression. DATA SOURCES Online databases were searched up to 6 January 2017. STUDY ELIGIBILITY CRITERIA Studies of all designs were included (except case studies) if they were published in English, Spanish or French and contained information on the population (pregnant women without contraindication to exercise), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone ["exercise-only"] or in combination with other intervention components [eg, dietary; "exercise + co-intervention"]), comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and outcome (miscarriage or perinatal mortality). RESULTS Forty-six studies (n=2 66 778) were included. There was 'very low' quality evidence suggesting no increased odds of miscarriage (23 studies, n=7125 women; OR 0.88, 95% CI 0.63 to 1.21, I2=0%) or perinatal mortality (13 studies, n=6837 women, OR 0.86, 95% CI 0.49 to 1.52, I2=0%) in pregnant women who exercised compared with those who did not. Stratification by subgroups did not affect odds of miscarriage or perinatal mortality. The meta-regressions identified no associations between volume, intensity or frequency of exercise and fetal or newborn death. As the majority of included studies examined the impact of moderate intensity exercise to a maximum duration of 60 min, we cannot comment on the effect of longer periods of exercise. SUMMARY/CONCLUSIONS Although the evidence in this field is of 'very low' quality, it suggests that prenatal exercise is not associated with increased odds of miscarriage or perinatal mortality. In plain terms, this suggests that generally speaking exercise is 'safe' with respect to miscarriage and perinatal mortality.
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Affiliation(s)
- Margie H Davenport
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Amariah J Kathol
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle F Mottola
- R Samuel McLaughlin Foundation, Exercise and Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Children's Health Research Institute, The University of Western Ontario, London, Ontario, Canada
| | - Rachel J Skow
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Victoria L Meah
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | | | - Casey E Gray
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Nick Barrowman
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Laurel Riske
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Frances Sobierajski
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Marina James
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport, and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Taniya Nagpal
- R Samuel McLaughlin Foundation, Exercise and Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Children's Health Research Institute, The University of Western Ontario, London, Ontario, Canada
| | - Andree-Anne Marchand
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Linda G Slater
- John W Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Kristi B Adamo
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Gregory A Davies
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada
| | - Ruben Barakat
- Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | - Stephanie-May Ruchat
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
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14
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Chan RSM, Tam WH, Ho ICH, Kwan MWC, Li LS, Sea MMM, Woo J. Randomized trial examining effectiveness of lifestyle intervention in reducing gestational diabetes in high risk Chinese pregnant women in Hong Kong. Sci Rep 2018; 8:13849. [PMID: 30218012 PMCID: PMC6138708 DOI: 10.1038/s41598-018-32285-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 09/05/2018] [Indexed: 11/09/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is of public health concern. This trial examined whether a clinically proven lifestyle modification program (LMP) in early pregnancy was superior to routine antenatal care in improving GDM, maternal and infant outcomes. Chinese pregnant women at risk of GDM (n = 220) were recruited at or before 12-week gestation and randomized to either a LMP group or a routine care control group. Eighty subjects completed a dietitian-led LMP including dietary and exercise components from early pregnancy till 24-week gestation. Data were compared with those of 86 control subjects. Twenty three (26.7%) control subjects and 20 (25.0%) LMP subjects developed GDM (p = 0.798). The proportion of infants born large for gestational age and macrosomia was similar between groups. The LMP group showed a lower proportion of excessive gestational weight gain (GWG). Subgroup analysis suggested that those with higher LMP adherence showed more desirable dietary composition and energy intake, and lower proportion of excessive GWG compared with the low LMP adherence group and the control group. The potential effect of LMP on GDM and other maternal and infant outcomes, in particular GWG, as well as barriers for making lifestyle changes warrant further investigations (ClinicalTrials.gov NCT02368600).
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Affiliation(s)
- Ruth Suk-Mei Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
| | - Wing-Hung Tam
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | - Ivan Chak-Hang Ho
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Macy Wai-Chi Kwan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Liz Sin Li
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Mandy Man-Mei Sea
- Centre for Nutritional Studies, The Chinese University of Hong Kong, Hong Kong, China
| | - Jean Woo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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15
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Hillesund ER, Bere E, Sagedal LR, Vistad I, Seiler HL, Torstveit MK, Øverby NC. Pre-pregnancy and early pregnancy dietary behavior in relation to maternal and newborn health in the Norwegian Fit for Delivery study - a post hoc observational analysis. Food Nutr Res 2018; 62:1273. [PMID: 30108471 PMCID: PMC6085578 DOI: 10.29219/fnr.v62.1273] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 12/16/2022] Open
Abstract
Background Randomized controlled trials targeting maternal dietary and physical activity behaviors during pregnancy have generally failed to accomplish reductions in the prevalence of adverse maternal and neonatal outcomes. Interventions carried out during pregnancy could thus be missing the mark in maximizing intervention health benefit. Objective To investigate whether pre-pregnancy and early pregnancy dietary behavior as reported at inclusion into the Norwegian Fit for Delivery (NFFD) trial was associated with maternal and neonatal outcomes irrespective of subsequent randomization assignment. Design The study is a post-hoc observational analysis of data from a randomized controlled lifestyle intervention. We constructed two diet scores from participant responses to a 43-item questionnaire that addressed dietary behavior in retrospect (pre-pregnancy diet score) and dietary behavior at inclusion (early pregnancy diet score), respectively. The diet scores ranged from 0 to 10, with higher score reflecting healthier dietary behavior. Associations between diet scores and maternal and neonatal health outcomes were estimated in multivariate logistic regression models. Results A total of 591 women were eligible for analysis. A one-point increase in pre-pregnancy diet score was associated with lower odds of excessive gestational weight gain (GWG) (odds ratio [OR]adj: 0.92; 95% confidence interval [CI]: 0.84-1.00, p = 0.050), preterm delivery (ORadj: 0.81; 95% CI: 0.68-0.97, p = 0.019), and birthweight ≥ 4,000 g (ORadj: 0.88; 95% CI: 0.78-0.99, p = 0.038). A one-point increase in early pregnancy diet score was associated with lower odds of excessive GWG (ORadj: 0.88; 95% CI: 0.79-0.97, p = 0.009), preterm delivery (ORadj: 0.82; 95% CI: 0.67-0.99, p = 0.038), and preeclampsia (ORadj: 0.78; 95% CI: 0.62-0.99, p = 0.038). Discussion Higher diet score either pre-pregnancy or in early pregnancy was protectively associated with excessive GWG and preterm delivery, whereas the protective association with high birthweight was confined to pre-pregnancy diet and with preeclampsia to early pregnancy diet. Conclusions Both pre-pregnancy and early pregnancy dietary behavior was associated with important maternal and neonatal health outcomes in the NFFD dataset.
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Affiliation(s)
- Elisabet R Hillesund
- Department of Public Health, Sports and Nutrition, University of Agder, Kristiansand, Norway
| | - Elling Bere
- Department of Public Health, Sports and Nutrition, University of Agder, Kristiansand, Norway
| | - Linda R Sagedal
- Department of Obstetrics and Gynecology, Sørlandet Hospital HF, Kristiansand, Norway.,Department of Research, Sørlandet Hospital HF, Kristiansand, Norway
| | - Ingvild Vistad
- Department of Obstetrics and Gynecology, Sørlandet Hospital HF, Kristiansand, Norway.,Department of Research, Sørlandet Hospital HF, Kristiansand, Norway
| | - Hilde L Seiler
- Department of Public Health, Sports and Nutrition, University of Agder, Kristiansand, Norway
| | - Monica K Torstveit
- Department of Public Health, Sports and Nutrition, University of Agder, Kristiansand, Norway
| | - Nina C Øverby
- Department of Public Health, Sports and Nutrition, University of Agder, Kristiansand, Norway
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16
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Sanda B, Vistad I, Sagedal LR, Haakstad LA, Lohne-Seiler H, Torstveit MK. What is the effect of physical activity on duration and mode of delivery? Secondary analysis from the Norwegian Fit for Delivery trial. Acta Obstet Gynecol Scand 2018; 97:861-871. [DOI: 10.1111/aogs.13351] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 03/20/2018] [Indexed: 01/26/2023]
Affiliation(s)
- Birgitte Sanda
- Faculty of Health and Sport Sciences; University of Agder; Kristiansand Norway
- Department of Obstetrics and Gynecology; Southern Norway Hospital Trust; Kristiansand Norway
| | - Ingvild Vistad
- Department of Obstetrics and Gynecology; Southern Norway Hospital Trust; Kristiansand Norway
| | - Linda R. Sagedal
- Department of Obstetrics and Gynecology; Southern Norway Hospital Trust; Kristiansand Norway
| | | | - Hilde Lohne-Seiler
- Faculty of Health and Sport Sciences; University of Agder; Kristiansand Norway
| | - Monica K. Torstveit
- Faculty of Health and Sport Sciences; University of Agder; Kristiansand Norway
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17
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Ferrari N, Bae-gartz I, Bauer C, Janoschek R, Koxholt I, Mahabir E, Appel S, Alejandre Alcazar MA, Grossmann N, Vohlen C, Brockmeier K, Dötsch J, Hucklenbruch-rother E, Graf C. Exercise during pregnancy and its impact on mothers and offspring in humans and mice. J Dev Orig Health Dis 2018; 9:63-76. [DOI: 10.1017/s2040174417000617] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Exercise during pregnancy has beneficial effects on maternal and offspring’s health in humans and mice. The underlying mechanisms remain unclear. This comparative study aimed to determine the long-term effects of an exercise program on metabolism, weight gain, body composition and changes in hormones [insulin, leptin, brain-derived neurotrophic factor (BDNF)]. Pregnant women (n=34) and mouse dams (n=44) were subjected to an exercise program compared with matched controls (period I). Follow-up in the offspring was performed over 6 months in humans, corresponding to postnatal day (P) 21 in mice (period II). Half of the mouse offspring was challenged with a high-fat diet (HFD) for 6 weeks between P70 and P112 (period III). In period I, exercise during pregnancy led to 6% lower fat content, 40% lower leptin levels and an increase of 50% BDNF levels in humans compared with controls, which was not observed in mice. After period II in humans and mice, offspring body weight did not differ from that of the controls. Further differences were observed in period III. Offspring of exercising mouse dams had significantly lower fat mass and leptin levels compared with controls. In addition, at P112, BDNF levels in offspring were significantly higher from exercising mothers while this effect was completely blunted by HFD feeding. In this study, we found comparable effects on maternal and offspring’s weight gain in humans and mice but different effects in insulin, leptin and BDNF. The long-term potential protective effects of exercise on biomarkers should be examined in human studies.
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