Results From a European Multicenter Randomized Trial of Physical Activity and/or Healthy Eating to Reduce the Risk of Gestational Diabetes Mellitus: The DALI Lifestyle Pilot
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- David Simmons
- Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, U.K.
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- Judith G.M. Jelsma
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
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- Sander Galjaard
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
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- Roland Devlieger
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
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- Andre van Assche
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
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- Goele Jans
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
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- Rosa Corcoy
- Institut de Recerca de l´Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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- Juan M. Adelantado
- Institut de Recerca de l´Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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- Fidelma Dunne
- National University of Ireland, Galway, Ireland
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- Gernot Desoye
- Department of Obstetrics and Gynecology, Medizinische Universitaet Graz, Graz, Austria
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- Jürgen Harreiter
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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- Alexandra Kautzky-Willer
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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- Peter Damm
- Center for Pregnant Women with Diabetes, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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- Elisabeth R. Mathiesen
- Center for Pregnant Women with Diabetes, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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- Dorte M. Jensen
- Odense University Hospital, Odense, Denmark
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- Lise Lotte Andersen
- Odense University Hospital, Odense, Denmark
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- Annunziata Lapolla
- Universita Degli Studi di Padova, Padua, Italy
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- Maria Dalfra
- Universita Degli Studi di Padova, Padua, Italy
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- Alessandra Bertolotto
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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- Ewa Wender-Ozegowska
- Department of Obstetrics and Women's Diseases, Poznan University of Medical Sciences, Poznan, Poland
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- Agnieszka Zawiejska
- Department of Obstetrics and Women's Diseases, Poznan University of Medical Sciences, Poznan, Poland
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- David Hill
- Recherche en Santé Lawson SA, Bronschhofen, Switzerland
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- Pablo Rebollo
- BAP Health Outcomes Research SL, Oviedo, Spain
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- Frank J. Snoek
- Department of Medical Psychology, VU University Medical Center and Academic Medical Center, Amsterdam, the Netherlands
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- Mireille N.M. van Poppel
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
説明
<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Ways to prevent gestational diabetes mellitus (GDM) remain unproven. We compared the impact of three lifestyle interventions (healthy eating [HE], physical activity [PA], and both HE and PA [HE+PA]) on GDM risk in a pilot multicenter randomized trial.</jats:p> </jats:sec> <jats:sec> <jats:title>RESEARCH DESIGN AND METHODS</jats:title> <jats:p>Pregnant women at risk for GDM (BMI ≥29 kg/m2) from nine European countries were invited to undertake a 75-g oral glucose tolerance test before 20 weeks' gestation. Those without GDM were randomized to HE, PA, or HE+PA. Women received five face-to-face and four optional telephone coaching sessions, based on the principles of motivational interviewing. A gestational weight gain (GWG) <5 kg was targeted. Coaches received standardized training and an intervention toolkit. Primary outcome measures were GWG, fasting glucose, and insulin sensitivity (HOMA) at 35–37 weeks.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Among the 150 trial participants, 32% developed GDM by 35–37 weeks and 20% achieved GWG <5 kg. HE women had less GWG (−2.6 kg [95% CI −4.9, −0.2]; P = 0.03) and lower fasting glucose (−0.3 mmol/L [−0.4, −0.1]; P = 0.01) than those in the PA group at 24–28 weeks. HOMA was comparable. No significant differences between HE+PA and the other groups were observed.</jats:p> </jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>An antenatal HE intervention is associated with less GWG and lower fasting glucose compared with PA alone. These findings require a larger trial for confirmation but support the use of early HE interventions in obese pregnant women.</jats:p> </jats:sec>
収録刊行物
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- Diabetes Care
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Diabetes Care 38 (9), 1650-1656, 2015-06-25
American Diabetes Association