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Grotenfelt NE, Rönö K, Eriksson JG, Valkama A, Meinilä J, Kautiainen H, Stach-Lempinen B, Koivusalo SB. Neonatal outcomes among offspring of obese women diagnosed with gestational diabetes mellitus in early versus late pregnancy. J Public Health (Oxf) 2020; 41:535-542. [PMID: 30260419 DOI: 10.1093/pubmed/fdy159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Maternal metabolic derangements associated with early pregnancy gestational diabetes may affect the fetus differently compared with gestational diabetes diagnosed later in pregnancy. The aim of this observational study was to assess neonatal outcomes according to timing of gestational diabetes diagnosis in obese women. METHODS Women ≥18 years of age with a pre-pregnancy body mass index ≥30 kg/m2 were grouped according to the results of a 75 g 2-h oral glucose tolerance test performed at 13.1 weeks of gestation and repeated at 23.4 weeks if normal at first testing. The main outcomes were birthweight and large for gestational age. RESULTS Out of 361 women, 164 (45.4%) were diagnosed with gestational diabetes, 133 (81.1%) of them in early pregnancy. The mean offspring birthweight was 3673 g (standard deviation (SD) 589 g) in the early and 3710 g (SD 552 g) in the late gestational diabetes group. In a multivariate logit model, the odds ratio for large for gestational age was 2.01 (95% CI: 0.39-10.39) in early compared with late gestational diabetes. CONCLUSIONS We observed no statistically significant differences in neonatal outcomes according to timing of gestational diabetes diagnosis. In addition to lack of power, early treatment of hyperglycemia may partly explain the results.
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Affiliation(s)
- N E Grotenfelt
- Folkhälsan Research Center, Helsinki, Finland.,Unit of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Finland
| | - K Rönö
- Folkhälsan Research Center, Helsinki, Finland.,Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Finland
| | - J G Eriksson
- Folkhälsan Research Center, Helsinki, Finland.,Unit of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Finland
| | - A Valkama
- Folkhälsan Research Center, Helsinki, Finland.,Unit of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Finland
| | - J Meinilä
- Folkhälsan Research Center, Helsinki, Finland.,Unit of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Finland
| | - H Kautiainen
- Folkhälsan Research Center, Helsinki, Finland.,Unit of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Finland.,Department of General Practice and Primary Health Care, University of Eastern Finland, Finland
| | - B Stach-Lempinen
- Department of Obstetrics and Gynecology, South Karelia Central Hospital, Lappeenranta, Finland
| | - S B Koivusalo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Finland
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Rönö K, Stach-Lempinen B, Eriksson JG, Pöyhönen-Alho M, Klemetti MM, Roine RP, Huvinen E, Andersson S, Laivuori H, Valkama A, Meinilä J, Kautiainen H, Tiitinen A, Koivusalo SB. Prevention of gestational diabetes with a prepregnancy lifestyle intervention - findings from a randomized controlled trial. Int J Womens Health 2018; 10:493-501. [PMID: 30214318 PMCID: PMC6118269 DOI: 10.2147/ijwh.s162061] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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] [Indexed: 12/30/2022] Open
Abstract
Purpose Lifestyle intervention studies performed during pregnancy have shown inconsistent results in relation to prevention of gestational diabetes mellitus (GDM). Therefore, the aim of this study was to assess the effect of an intervention initiated already before pregnancy in prevention of GDM in high-risk women. Patients and methods A randomized controlled trial was conducted in four Finnish maternity hospitals between the years 2008 and 2014. Altogether 228 high-risk women planning pregnancy were randomized to an intervention (n=116) or a control group (n=112). The risk factors were body mass index ≥30 kg/m2 (n=46), prior GDM (n=120), or both (n=62), without manifest diabetes at study inclusion. Trained study nurses provided individualized lifestyle counseling every 3 months in addition to a group session with a dietician. The control group received standard antenatal care. GDM was defined as one or more pathological glucose values in a 75 g 2-hour oral glucose tolerance test, performed between 12 and 16 weeks of gestation and if normal repeated between 24 and 28 weeks of gestation. Results Within 12 months, 67% of the women (n=72) in the intervention group and 63% of the women (n=71) in the control group (p=0.84) became pregnant. The cumulative incidence of GDM among the women available for the final analyses was 60% (n=39/65) in the intervention group and 54% (n=34/63) in the control group (p=0.49). GDM was diagnosed already before 20 weeks of gestation in 60% (n=44/73) of the cases. Conclusion The preconceptional lifestyle intervention applied in the present study did not reduce the incidence of GDM.
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Affiliation(s)
- Kristiina Rönö
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Women's Hospital, Helsinki, Finland,
| | - Beata Stach-Lempinen
- Department of Obstetrics and Gynecology, South Karelia Central Hospital, Lappeenranta, Finland
| | - Johan Gunnar Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Public Health Research Program, Folkhälsan Research Center, Helsinki, Finland
| | - Maritta Pöyhönen-Alho
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Women's Hospital, Helsinki, Finland,
| | - Miira Marjuska Klemetti
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Women's Hospital, Helsinki, Finland, .,Department of Obstetrics and Gynecology, South Karelia Central Hospital, Lappeenranta, Finland.,Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Risto Paavo Roine
- Department of Health and Social Management, Research Centre for Comparative Effectiveness and Patient Safety, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.,Group Administration, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Emilia Huvinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Women's Hospital, Helsinki, Finland,
| | - Sture Andersson
- University of Helsinki and Helsinki University Hospital, Children's Hospital, Pediatric Research Center, Helsinki, Finland
| | - Hannele Laivuori
- Department of Health and Social Management, Research Centre for Comparative Effectiveness and Patient Safety, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.,Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland.,Department of Obstetrics and Gynecology, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Anita Valkama
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Public Health Research Program, Folkhälsan Research Center, Helsinki, Finland
| | - Jelena Meinilä
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Public Health Research Program, Folkhälsan Research Center, Helsinki, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Eastern Finland, Kuopio, Finland
| | - Aila Tiitinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Women's Hospital, Helsinki, Finland,
| | - Saila Birgitta Koivusalo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Women's Hospital, Helsinki, Finland,
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Huvinen E, Koivusalo SB, Meinilä J, Valkama A, Tiitinen A, Rönö K, Stach-Lempinen B, Eriksson JG. Effects of a Lifestyle Intervention During Pregnancy and First Postpartum Year: Findings From the RADIEL Study. J Clin Endocrinol Metab 2018; 103:1669-1677. [PMID: 29409025 DOI: 10.1210/jc.2017-02477] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 01/26/2018] [Indexed: 02/04/2023]
Abstract
CONTEXT Women with a history of gestational diabetes (GDM) have a sevenfold risk of developing type 2 diabetes. OBJECTIVE To assess the effects of a lifestyle intervention during pregnancy and first postpartum year on glucose regulation, weight retention, and metabolic characteristics among women at high GDM risk. DESIGN In the Finnish Gestational Diabetes Prevention study, trained study nurses provided lifestyle counseling in each trimester and 6 weeks, 6 months, and 12 months postpartum. SETTING Three maternity hospitals in the Helsinki area and one in Lappeenranta. PATIENTS In total, 269 women with previous GDM and/or a prepregnancy body mass index ≥30 kg/m2 were enrolled before 20 gestational weeks and allocated to either a control or an intervention group. This study includes the 200 participants who attended study visits 6 weeks and/or 12 months postpartum. INTERVENTION The lifestyle intervention followed Nordic diet recommendations and at least 150 minutes of moderate exercise was recommended weekly. MAIN OUTCOME MEASURE The incidence of impaired glucose regulation (impaired fasting glucose, impaired glucose tolerance, or type 2 diabetes) during the first postpartum year. RESULTS Impaired glucose regulation was present in 13.3% of the women in the control and in 2.7% in the intervention group [age-adjusted odds ratio, 0.18 (95% confidence interval, 0.05 to 0.65), P = 0.009] during the first postpartum year. There were no differences between the groups in weight retention, physical activity, or diet at 12 months postpartum. CONCLUSIONS A lifestyle intervention during pregnancy and the first postpartum year successfully reduced the incidence of postpartum impairment in glucose regulation.
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Affiliation(s)
- Emilia Huvinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Saila B Koivusalo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jelena Meinilä
- Unit of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anita Valkama
- Unit of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Aila Tiitinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kristiina Rönö
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Beata Stach-Lempinen
- Department of Obstetrics and Gynecology, South Karelia Central Hospital, Lappeenranta, Finland
| | - Johan G Eriksson
- Unit of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
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Koivusalo SB, Rönö K, Klemetti MM, Roine RP, Lindström J, Erkkola M, Kaaja RJ, Pöyhönen-Alho M, Tiitinen A, Huvinen E, Andersson S, Laivuori H, Valkama A, Meinilä J, Kautiainen H, Eriksson JG, Stach-Lempinen B. Erratum. Gestational Diabetes Mellitus Can Be Prevented by Lifestyle Intervention: The Finnish Gestational Diabetes Prevention Study (RADIEL). A Randomized Controlled Trial. Diabetes Care 2016;39:24-30. Diabetes Care 2017; 40:1133. [PMID: 28615238 PMCID: PMC5521976 DOI: 10.2337/dc17-er08a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Meinilä J, Valkama A, Koivusalo SB, Rönö K, Kautiainen H, Lindström J, Stach-Lempinen B, Eriksson JG, Erkkola M. Erratum: Association between diet quality measured by the Healthy Food Intake Index and later risk of gestational diabetes—a secondary analysis of the RADIEL trial. Eur J Clin Nutr 2017; 71:913. [DOI: 10.1038/ejcn.2017.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Meinilä J, Valkama A, Koivusalo SB, Stach-Lempinen B, Lindström J, Kautiainen H, Eriksson JG, Erkkola M. Healthy Food Intake Index (HFII) - Validity and reproducibility in a gestational-diabetes-risk population. BMC Public Health 2016; 16:680. [PMID: 27475905 PMCID: PMC4967513 DOI: 10.1186/s12889-016-3303-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 01/07/2016] [Accepted: 07/13/2016] [Indexed: 02/07/2023] Open
Abstract
Background The aim was to develop and validate a food-based diet quality index for measuring adherence to the Nordic Nutrition Recommendations (NNR) in a pregnant population with high risk of gestational diabetes (GDM). Methods This study is a part of the Finnish Gestational Diabetes Prevention Study (RADIEL), a lifestyle intervention conducted between 2008 and 2014. The 443 pregnant participants (61 % of those invited), were either obese or had a history of GDM. Food frequency questionnaires collected at 1st trimester served for composing the HFII; a sum of 11 food groups (available score range 0–17) with higher scores reflecting higher adherence to the NNR. Results The average HFII of the participants was 10.2 (SD 2.8, range 2–17). Factor analysis for the HFII component matrix revealed three factors that explained most of the distribution (59 %) of the HFII. As an evidence of the component relevance 9 out of 11 of the HFII components independently contributed to the total score (item-rest correlation coefficients <0.31). Saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, sucrose, and fiber intakes (among other nutrients) showed linearity across the HFII categories (P ≤ 0.030 for all nutrients tested); the higher the HFII, the closer the nutrient intake to the recommended intake level. Educational attainment (P = 0.0045), BMI (P = 0.0098), smoking (P = 0.007), and leisure time physical exercise (P = 0.038) showed linearity across the HFII categories. Intra-class correlation coefficient for the HFII was 0.85 (CI 0.79, 0.90). Conclusions The HFII components reflect the food guidelines of the NNR, intakes of relevant nutrients, and characteristics known to vary with diet quality. It largely ignores energy intake, its components have independent contribution to the HFII, and it exhibits reproducibility. The main shortcomings are absence of red and processed meat component, and the validation in a selected study population. It is suitable for ranking participants according to the adherence to the NNR in pregnant women at high risk of GDM. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3303-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jelena Meinilä
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, P.O. Box 20, Tukholmankatu 8 B, Biomedicum Helsinki, 00014, Helsinki, Finland.
| | - Anita Valkama
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, P.O. Box 20, Tukholmankatu 8 B, Biomedicum Helsinki, 00014, Helsinki, Finland.,Folkhälsan Research Centre, University of Helsinki, Helsinki, Finland
| | - Saila B Koivusalo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Beata Stach-Lempinen
- Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland
| | - Jaana Lindström
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, P.O. Box 20, Tukholmankatu 8 B, Biomedicum Helsinki, 00014, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Eastern Finland, Kuopio, Finland
| | - Johan G Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, P.O. Box 20, Tukholmankatu 8 B, Biomedicum Helsinki, 00014, Helsinki, Finland.,Folkhälsan Research Centre, University of Helsinki, Helsinki, Finland
| | - Maijaliisa Erkkola
- Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland
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7
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Huvinen E, Grotenfelt NE, Eriksson JG, Rönö K, Klemetti MM, Roine R, Pöyhönen-Alho M, Tiitinen A, Andersson S, Laivuori H, Knip M, Valkama A, Meinilä J, Kautiainen H, Stach-Lempinen B, Koivusalo SB. Heterogeneity of maternal characteristics and impact on gestational diabetes (GDM) risk-Implications for universal GDM screening? Ann Med 2016; 48:52-8. [PMID: 26745028 DOI: 10.3109/07853890.2015.1131328] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To study the incidence of gestational diabetes mellitus (GDM) in relation to phenotypic characteristics and gestational weight gain (GWG) among women at high risk for GDM. MATERIALS AND METHODS This is a secondary analysis of a GDM prevention study (RADIEL), a randomized controlled trial conducted in Finland. 269 women with a history of GDM and/or a pre-pregnancy body mass index (BMI) ≥ 30 kg/m(2) were enrolled before 20 weeks of gestation and divided into four groups according to parity, BMI and previous history of GDM. The main outcome was incidence of GDM. RESULTS There was a significant difference in incidence of GDM between the groups (p < 0.001). Women with a history of GDM and BMI <30 kg/m(2) showed the highest incidence (35.9%). At baseline they had fewer metabolic risk factors and by the second trimester they gained more weight. There was no interaction between GWG and GDM outcome and no significant difference in the prevalence of diabetes-associated antibodies. CONCLUSION Despite a healthier metabolic profile at baseline the non-obese women with a history of GDM displayed a markedly higher cumulative incidence of GDM. GWG and the presence of diabetes-associated antibodies were not associated with GDM occurrence among these high-risk women. Key message Despite a healthier metabolic profile at baseline the non-obese women with previous gestational diabetes mellitus display a markedly higher cumulative incidence of gestational diabetes mellitus.
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Affiliation(s)
- Emilia Huvinen
- a Department of Obstetrics and Gynecology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | | | - Johan Gunnar Eriksson
- b Folkhälsan Research Centre, Helsinki, University of Helsinki , Helsinki , Finland ;,c Department of Chronic Disease Prevention , National Institute for Health and Welfare , Helsinki , Finland ;,d Unit of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Kristiina Rönö
- a Department of Obstetrics and Gynecology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Miira Marjuska Klemetti
- a Department of Obstetrics and Gynecology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,e Department of Obstetrics and Gynecology , South-Karelia Central Hospital , Lappeenranta , Finland ;,f Medical Genetics, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Risto Roine
- g Department of Health and Social Management , University of Eastern Finland , Kuopio , Finland ;,h Group Administration, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Maritta Pöyhönen-Alho
- a Department of Obstetrics and Gynecology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Aila Tiitinen
- a Department of Obstetrics and Gynecology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Sture Andersson
- j Children's Hospital, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Hannele Laivuori
- a Department of Obstetrics and Gynecology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,f Medical Genetics, University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,i Institute for Molecular Medicine Finland , Helsinki , Finland
| | - Mikael Knip
- b Folkhälsan Research Centre, Helsinki, University of Helsinki , Helsinki , Finland ;,j Children's Hospital, University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,k Research Programs Unit, Diabetes and Obesity, University of Helsinki , Helsinki , Finland ;,l Tampere Centre for Child Health Research, Tampere University Hospital , Tampere , Finland
| | - Anita Valkama
- b Folkhälsan Research Centre, Helsinki, University of Helsinki , Helsinki , Finland ;,d Unit of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Jelena Meinilä
- d Unit of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Hannu Kautiainen
- d Unit of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;,m Department of General Practice and Primary Health Care , University of Eastern Finland , Joensuu , Finland
| | - Beata Stach-Lempinen
- e Department of Obstetrics and Gynecology , South-Karelia Central Hospital , Lappeenranta , Finland
| | - Saila Birgitta Koivusalo
- a Department of Obstetrics and Gynecology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
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8
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Koivusalo SB, Rönö K, Klemetti MM, Roine RP, Lindström J, Erkkola M, Kaaja RJ, Pöyhönen-Alho M, Tiitinen A, Huvinen E, Andersson S, Laivuori H, Valkama A, Meinilä J, Kautiainen H, Eriksson JG, Stach-Lempinen B. Gestational Diabetes Mellitus Can Be Prevented by Lifestyle Intervention: The Finnish Gestational Diabetes Prevention Study (RADIEL): A Randomized Controlled Trial. Diabetes Care 2016. [PMID: 26223239 DOI: 10.2337/dc15-0511] [Citation(s) in RCA: 268] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess whether gestational diabetes mellitus (GDM) can be prevented by a moderate lifestyle intervention in pregnant women who are at high risk for the disease. RESEARCH DESIGN AND METHODS Two hundred ninety-three women with a history of GDM and/or a prepregnancy BMI of ≥30 kg/m(2) were enrolled in the study at <20 weeks of gestation and were randomly allocated to the intervention group (n = 155) or the control group (n = 138). Each subject in the intervention group received individualized counseling on diet, physical activity, and weight control from trained study nurses, and had one group meeting with a dietitian. The control group received standard antenatal care. The diagnosis of GDM was based on a 75-g, 2-h oral glucose tolerance test at 24-28 weeks of gestation. RESULTS A total of 269 women were included in the analyses. The incidence of GDM was 13.9% in the intervention group and 21.6% in the control group ([95% CI 0.40-0.98%]; P = 0.044, after adjustment for age, prepregnancy BMI, previous GDM status, and the number of weeks of gestation). Gestational weight gain was lower in the intervention group (-0.58 kg [95% CI -1.12 to -0.04 kg]; adjusted P = 0.037). Women in the intervention group increased their leisure time physical activity more and improved their dietary quality compared with women in the control group. CONCLUSIONS A moderate individualized lifestyle intervention reduced the incidence of GDM by 39% in high-risk pregnant women. These findings may have major health consequences for both the mother and the child.
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Affiliation(s)
- Saila B Koivusalo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, and Kätilöopisto Maternity Hospital, Helsinki, Finland
| | - Kristiina Rönö
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, and Kätilöopisto Maternity Hospital, Helsinki, Finland
| | - Miira M Klemetti
- Department of Obstetrics and Gynecology, South Karelia Central Hospital, Lappeenranta, Finland Medical Genetics and Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Risto P Roine
- University of Eastern Finland, Department of Health and Social Management, Research Centre for Comparative Effectiveness and Patient Safety, Kuopio, Finland Helsinki and Uusimaa Hospital District, Helsinki, Finland Kuopio University Hospital, Kuopio, Finland
| | - Jaana Lindström
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Maijaliisa Erkkola
- Division of Nutrition, Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - Risto J Kaaja
- Turku University Hospital and Turku University, Turku, Finland
| | - Maritta Pöyhönen-Alho
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Jorvi Hospital, Espoo, Finland
| | - Aila Tiitinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Women's Hospital, Helsinki, Finland
| | - Emilia Huvinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Jorvi Hospital, Espoo, Finland
| | - Sture Andersson
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannele Laivuori
- Medical Genetics and Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Anita Valkama
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland Folkhälsan Research Centre, Helsinki, University of Helsinki, Helsinki, Finland
| | - Jelena Meinilä
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland Department of General Practice and Primary Health Care, University of Eastern Finland, Kuopio, Finland
| | - Johan G Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland Folkhälsan Research Centre, Helsinki, University of Helsinki, Helsinki, Finland
| | - Beata Stach-Lempinen
- Department of Obstetrics and Gynecology, South Karelia Central Hospital, Lappeenranta, Finland
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9
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Meinilä J, Koivusalo SB, Valkama A, Rönö K, Erkkola M, Kautiainen H, Stach-Lempinen B, Eriksson JG. Nutrient intake of pregnant women at high risk of gestational diabetes. Food Nutr Res 2015; 59:26676. [PMID: 25994096 PMCID: PMC4439424 DOI: 10.3402/fnr.v59.26676] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 11/19/2014] [Revised: 04/16/2015] [Accepted: 04/17/2015] [Indexed: 01/04/2023] Open
Abstract
Background The prevalence of gestational diabetes (GDM) has been increasing along with the obesity pandemic. It is associated with pregnancy complications and a risk of type 2 diabetes. Objective To study nutrient intake among pregnant Finnish women at increased risk of GDM due to obesity or a history of GDM. Design Food records from obese women or women with GDM history (n=394) were examined at baseline (≤20 weeks of pregnancy) of the Finnish Gestational Diabetes Prevention Study. Results The pregnant women had a mean fat intake of 33 en% (SD 7), saturated fatty acids (SFA) 12 en% (SD 3), and carbohydrate 46 en% (SD 6). Sucrose intake among pregnant women with GDM history was 7 en% (SD 3), which was different from the intake of the other pregnant women, 10 en% (SD 4) (p<0.001). Median intakes of folate and vitamins A and D provided by food sources were below the Finnish national nutrition recommendation, but, excluding vitamin A, supplements raised the total intake to the recommended level. The frequency of use of dietary supplements among pregnant women was 77%. Conclusions The observed excessive intake of SFA and low intake of carbohydrates among women at high risk of GDM may further increase their risk of GDM. A GDM history, however, seems to reduce sucrose intake in a future pregnancy. Pregnant women at high risk of GDM seem to have insufficient intakes of vitamin D and folate from food and thus need supplementation, which most of them already take.
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Affiliation(s)
- Jelena Meinilä
- Group Administration, Research and Development, The Hospital District of Helsinki and Uusimaa, Helsinki, Finland;
| | - Saila B Koivusalo
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
| | - Anita Valkama
- Folkhälsan Research Centre, Helsingfors Universitet, Helsinki, Finland
| | - Kristiina Rönö
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
| | - Maijaliisa Erkkola
- Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - Hannu Kautiainen
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
| | - Beata Stach-Lempinen
- Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland
| | - Johan G Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
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Jussila K, Valkama A, Remes J, Anttonen H, Peitso A. The Effect of Cold Protective Clothing on Comfort and Perception of Performance. International Journal of Occupational Safety and Ergonomics 2015; 16:185-97. [DOI: 10.1080/10803548.2010.11076838] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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