Summary
Lifestyle modifications incorporating healthy diet and increased physical activity in nonpregnant adults are effective for proper weight control as well as prevention of diabetes in at-risk individuals. This article reports on the results of study in pregnant women at risk for gestational diabetes in which a similar lifestyle intervention was effective in improving glucose metabolism and insulin resistance.
- Obesity
- Diabetes Mellitus
- Prevention & Screening
- Pregnancy
- Diabetes & Endocrinology Clinical Trials
- Maternal Nutrition
- Obesity
- Diabetes Mellitus
- Prevention & Screening
- Pregnancy
- Diabetes & Endocrinology Clinical Trials
- Maternal Nutrition
- Endocrinology
- Diabetes & Metabolic Syndrome
Lifestyle modifications incorporating healthy diet and increased physical activity in nonpregnant adults are effective for proper weight control as well as prevention of diabetes in at-risk individuals. Jessica Marcinkevage, PhD, MSPH, Centers for Disease Control and Prevention and Emory University, Atlanta, Georgia, USA, reported the results of study in pregnant women at risk for gestational diabetes in which a similar lifestyle intervention (LSI) was effective in improving glucose metabolism and insulin resistance.
The objective of this randomized, controlled, pilot feasibility study was to assess the effects of LSI on glucose metabolism and insulin resistance in overweight/obese (body mass index [BMI] ≥25 kg/m2) low-income African American women. Women <20 weeks gestation with singleton pregnancies were randomized to either regular/standard care (RC; n=29) or LSI (n=28) which included individualized one-on-one counseling on physical activity and dietary advice in addition to standard care. They also received biweekly booster calls and pedometers to track physical activity. Women in the RC group received written literature on physical activity and diet during pregnancy during their baseline visit only and proceeded with regular prenatal care as scheduled.
Study outcomes included physical activity determined by a self-reported Pregnancy Physical Activity Questionnaire, gestational weight gain from baseline visit, glucose metabolism (total glucose area under the curve), documented evidence of gestational diabetes, and insulin resistance (homeostatic model of insulin resistance). There were no differences in baseline characteristics between the two groups. Subjects were mean age 24 years and ∼12 weeks pregnant when recruited. About 60% of the total sample was either obese or morbidly obese and >30% were current or former smokers. The majority of women reported diabetes in a first-degree relative.
Over the duration of their pregnancies, women in the LSI group gained ∼10 kg versus 9 kg for women in the RC group. There were no differences between groups in the median weight gained at midpregnancy and prior to delivery, or in the amount of weight retained from delivery to the 6-week postpartum visit.
Women in the LSI group had higher odds of meeting physical activity recommendations at midpregnancy compared with women in the RC group (OR, 1.60; 95% CI, 0.49 to 5.38; Figure 1).
Percentage of Subjects Meeting Physical Activity Recommendations
Reproduced with permission from J Marcinkevage, PhD, MSPH.
There was improved glucose metabolism (p<0.05) at midpregnancy in the LSI group. There were trends indicating improved insulin resistance at both midpregnancy and post partum for the LSI group compared with the RC group. (Figure 2). In addition, for women in the LSI group there was a 12% decrease in the odds of developing gestational diabetes compared with those in the RC group (Figure 3).
Changes in Insulin Resistance
HOMA-IR=homeostasis model of assessment - insulin resistance.
Reproduced with permission J Marcinkevage, PhD, MSPH.
Prevalence of Gestational Diabetes Mellitus
ACOG=American Congress of Obstetricians and Gynecologists; IADPSG=International Association of Diabetes and Pregnancy Study Groups; LSI= lifestyle intervention; RC=regular care.
Reproduced with permission from J Marcinkevage, PhD, MSPH.
The study was not designed to be a definitive trial, thus larger trials are needed to confirm these results. Dr. Marcinkevage suggested that the modest but definitive effects of LSI on glucose metabolism and insulin resistance might be a factor of β-cell function and early insulin response.
- © 2013 MD Conference Express®
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