Effect of physical activity and/or healthy eating on GDM risk: The DALI lifestyle study

David Simmons; Roland Devlieger; Andre Van Assche; Goele Jans; Sander Galjaard; Rosa Corcoy; Juan M. Adelantado; Fidelma Dunne; Gernot Desoye; Jurgen Harreiter; Alexandra Kautzky-Willer; Peter Damm; Elisabeth R. Mathiesen; Dorte M. Jensen; Liselotte Andersen; Annunziata Lapolla; Maria G. Dalfra; Alessandra Bertolotto; Ewa Wender-Ozegowska; Agnieszka Zawiejska; David Hill; Frank J. Snoek; Judith G.M. Jelsma; Mireille N.M. Van Poppel

doi:10.1210/jc.2016-3455

Effect of physical activity and/or healthy eating on GDM risk: The DALI lifestyle study

David Simmons^*, Roland Devlieger, Andre Van Assche, Goele Jans, Sander Galjaard, Rosa Corcoy, Juan M. Adelantado, Fidelma Dunne, Gernot Desoye, Jurgen Harreiter, Alexandra Kautzky-Willer, Peter Damm, Elisabeth R. Mathiesen, Dorte M. Jensen, Liselotte Andersen, Annunziata Lapolla, Maria G. Dalfra, Alessandra Bertolotto, Ewa Wender-Ozegowska, Agnieszka ZawiejskaDavid Hill, Frank J. Snoek, Judith G.M. Jelsma, Mireille N.M. Van Poppel

^*Corresponding author for this work

Department of Clinical Medicine

95 Citations (Scopus)

Abstract

Context: Lifestyle approaches for preventing gestational diabetes mellitus (GDM) have produced mixed results. Objective: The aim of the present study was to compare the effectiveness of 3 lifestyle interventions [healthy eating (HE), physical activity (PA), and both HE and PA (HE+PA)] with usual care (UC) in reducing GDM risk. Design: The present study was a multicenter randomized controlled trial conducted from 2012 to 2014 [the DALI (Vitamin D and lifestyle intervention for GDM prevention) lifestyle study]. Setting: The study occurred at antenatal clinics across 11 centers in 9 European countries. Patients: Consecutive pregnant women at ,20 weeks of gestation with a body mass index (BMI) of 29 kg/m2 and without GDM using the International Association of Diabetes and Pregnancy Study Group criteria (n = 436). For the intervention, women were randomized, stratified by site, to UC, HE, PA, or HE+PA. The women received 5 face-to-face and#4 telephone coaching sessions using the principles of motivational interviewing. A gestational weight gain (GWG) ,5 kg was targeted. The coaches received standardized training and an intervention toolkit tailored to their culture and language. Main Outcome Measures: The endpoints were the GWG at 35 to 37 weeks and the fasting glucose and insulin sensitivity [homeostasis model assessment insulin resistance (HOMA-IR)] at 24 to 28 weeks. Results: We randomized 108 women to HE+PA, 113 to HE, 110 to PA, and 105 to UC. In the HE+PA group, but not HE or PA alone, women achieved substantially lessGWGthan did the controls (UC) by 35 to 37 weeks (22.02; 95% confidence interval, 23.58 to 20.46 kg). Despite this reduction, no improvements were seen in fasting or postload glucose levels, insulin concentrations, or HOMA-IR. The birthweights and large and small for gestational age rates were similar. Conclusions: The combined HE+PA intervention was able to limit GWG but did not reduce fasting glycemia. Thus, lifestyle changes alone are unlikely to prevent GDM among women with a BMI of 29 kg/m2.

Original language	English
Journal	Journal of Clinical Endocrinology and Metabolism
Volume	102
Issue number	3
Pages (from-to)	903-913
Number of pages	11
ISSN	0021-972X
DOIs	https://doi.org/10.1210/jc.2016-3455
Publication status	Published - Mar 2017

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Simmons, D., Devlieger, R., Van Assche, A., Jans, G., Galjaard, S., Corcoy, R., Adelantado, J. M., Dunne, F., Desoye, G., Harreiter, J., Kautzky-Willer, A., Damm, P., Mathiesen, E. R., Jensen, D. M., Andersen, L., Lapolla, A., Dalfra, M. G., Bertolotto, A., Wender-Ozegowska, E., ... Van Poppel, M. N. M. (2017). Effect of physical activity and/or healthy eating on GDM risk: The DALI lifestyle study. Journal of Clinical Endocrinology and Metabolism, 102(3), 903-913. https://doi.org/10.1210/jc.2016-3455

Simmons, D, Devlieger, R, Van Assche, A, Jans, G, Galjaard, S, Corcoy, R, Adelantado, JM, Dunne, F, Desoye, G, Harreiter, J, Kautzky-Willer, A, Damm, P , Mathiesen, ER, Jensen, DM, Andersen, L, Lapolla, A, Dalfra, MG, Bertolotto, A, Wender-Ozegowska, E, Zawiejska, A, Hill, D, Snoek, FJ, Jelsma, JGM & Van Poppel, MNM 2017, 'Effect of physical activity and/or healthy eating on GDM risk: The DALI lifestyle study', Journal of Clinical Endocrinology and Metabolism, vol. 102, no. 3, pp. 903-913. https://doi.org/10.1210/jc.2016-3455

@article{2282355d559f48c8b91dd1191284c9fc,

title = "Effect of physical activity and/or healthy eating on GDM risk: The DALI lifestyle study",

abstract = "Context: Lifestyle approaches for preventing gestational diabetes mellitus (GDM) have produced mixed results. Objective: The aim of the present study was to compare the effectiveness of 3 lifestyle interventions [healthy eating (HE), physical activity (PA), and both HE and PA (HE+PA)] with usual care (UC) in reducing GDM risk. Design: The present study was a multicenter randomized controlled trial conducted from 2012 to 2014 [the DALI (Vitamin D and lifestyle intervention for GDM prevention) lifestyle study]. Setting: The study occurred at antenatal clinics across 11 centers in 9 European countries. Patients: Consecutive pregnant women at ,20 weeks of gestation with a body mass index (BMI) of 29 kg/m2 and without GDM using the International Association of Diabetes and Pregnancy Study Group criteria (n = 436). For the intervention, women were randomized, stratified by site, to UC, HE, PA, or HE+PA. The women received 5 face-to-face and#4 telephone coaching sessions using the principles of motivational interviewing. A gestational weight gain (GWG) ,5 kg was targeted. The coaches received standardized training and an intervention toolkit tailored to their culture and language. Main Outcome Measures: The endpoints were the GWG at 35 to 37 weeks and the fasting glucose and insulin sensitivity [homeostasis model assessment insulin resistance (HOMA-IR)] at 24 to 28 weeks. Results: We randomized 108 women to HE+PA, 113 to HE, 110 to PA, and 105 to UC. In the HE+PA group, but not HE or PA alone, women achieved substantially lessGWGthan did the controls (UC) by 35 to 37 weeks (22.02; 95% confidence interval, 23.58 to 20.46 kg). Despite this reduction, no improvements were seen in fasting or postload glucose levels, insulin concentrations, or HOMA-IR. The birthweights and large and small for gestational age rates were similar. Conclusions: The combined HE+PA intervention was able to limit GWG but did not reduce fasting glycemia. Thus, lifestyle changes alone are unlikely to prevent GDM among women with a BMI of 29 kg/m2.",

author = "David Simmons and Roland Devlieger and {Van Assche}, Andre and Goele Jans and Sander Galjaard and Rosa Corcoy and Adelantado, {Juan M.} and Fidelma Dunne and Gernot Desoye and Jurgen Harreiter and Alexandra Kautzky-Willer and Peter Damm and Mathiesen, {Elisabeth R.} and Jensen, {Dorte M.} and Liselotte Andersen and Annunziata Lapolla and Dalfra, {Maria G.} and Alessandra Bertolotto and Ewa Wender-Ozegowska and Agnieszka Zawiejska and David Hill and Snoek, {Frank J.} and Jelsma, {Judith G.M.} and {Van Poppel}, {Mireille N.M.}",

year = "2017",

month = mar,

doi = "10.1210/jc.2016-3455",

language = "English",

volume = "102",

pages = "903--913",

journal = "Journal of Clinical Endocrinology and Metabolism",

issn = "0021-972X",

publisher = "Oxford University Press",

number = "3",

}

TY - JOUR

T1 - Effect of physical activity and/or healthy eating on GDM risk

T2 - The DALI lifestyle study

AU - Simmons, David

AU - Devlieger, Roland

AU - Van Assche, Andre

AU - Jans, Goele

AU - Galjaard, Sander

AU - Corcoy, Rosa

AU - Adelantado, Juan M.

AU - Dunne, Fidelma

AU - Desoye, Gernot

AU - Harreiter, Jurgen

AU - Kautzky-Willer, Alexandra

AU - Damm, Peter

AU - Mathiesen, Elisabeth R.

AU - Jensen, Dorte M.

AU - Andersen, Liselotte

AU - Lapolla, Annunziata

AU - Dalfra, Maria G.

AU - Bertolotto, Alessandra

AU - Wender-Ozegowska, Ewa

AU - Zawiejska, Agnieszka

AU - Hill, David

AU - Snoek, Frank J.

AU - Jelsma, Judith G.M.

AU - Van Poppel, Mireille N.M.

PY - 2017/3

Y1 - 2017/3

N2 - Context: Lifestyle approaches for preventing gestational diabetes mellitus (GDM) have produced mixed results. Objective: The aim of the present study was to compare the effectiveness of 3 lifestyle interventions [healthy eating (HE), physical activity (PA), and both HE and PA (HE+PA)] with usual care (UC) in reducing GDM risk. Design: The present study was a multicenter randomized controlled trial conducted from 2012 to 2014 [the DALI (Vitamin D and lifestyle intervention for GDM prevention) lifestyle study]. Setting: The study occurred at antenatal clinics across 11 centers in 9 European countries. Patients: Consecutive pregnant women at ,20 weeks of gestation with a body mass index (BMI) of 29 kg/m2 and without GDM using the International Association of Diabetes and Pregnancy Study Group criteria (n = 436). For the intervention, women were randomized, stratified by site, to UC, HE, PA, or HE+PA. The women received 5 face-to-face and#4 telephone coaching sessions using the principles of motivational interviewing. A gestational weight gain (GWG) ,5 kg was targeted. The coaches received standardized training and an intervention toolkit tailored to their culture and language. Main Outcome Measures: The endpoints were the GWG at 35 to 37 weeks and the fasting glucose and insulin sensitivity [homeostasis model assessment insulin resistance (HOMA-IR)] at 24 to 28 weeks. Results: We randomized 108 women to HE+PA, 113 to HE, 110 to PA, and 105 to UC. In the HE+PA group, but not HE or PA alone, women achieved substantially lessGWGthan did the controls (UC) by 35 to 37 weeks (22.02; 95% confidence interval, 23.58 to 20.46 kg). Despite this reduction, no improvements were seen in fasting or postload glucose levels, insulin concentrations, or HOMA-IR. The birthweights and large and small for gestational age rates were similar. Conclusions: The combined HE+PA intervention was able to limit GWG but did not reduce fasting glycemia. Thus, lifestyle changes alone are unlikely to prevent GDM among women with a BMI of 29 kg/m2.

AB - Context: Lifestyle approaches for preventing gestational diabetes mellitus (GDM) have produced mixed results. Objective: The aim of the present study was to compare the effectiveness of 3 lifestyle interventions [healthy eating (HE), physical activity (PA), and both HE and PA (HE+PA)] with usual care (UC) in reducing GDM risk. Design: The present study was a multicenter randomized controlled trial conducted from 2012 to 2014 [the DALI (Vitamin D and lifestyle intervention for GDM prevention) lifestyle study]. Setting: The study occurred at antenatal clinics across 11 centers in 9 European countries. Patients: Consecutive pregnant women at ,20 weeks of gestation with a body mass index (BMI) of 29 kg/m2 and without GDM using the International Association of Diabetes and Pregnancy Study Group criteria (n = 436). For the intervention, women were randomized, stratified by site, to UC, HE, PA, or HE+PA. The women received 5 face-to-face and#4 telephone coaching sessions using the principles of motivational interviewing. A gestational weight gain (GWG) ,5 kg was targeted. The coaches received standardized training and an intervention toolkit tailored to their culture and language. Main Outcome Measures: The endpoints were the GWG at 35 to 37 weeks and the fasting glucose and insulin sensitivity [homeostasis model assessment insulin resistance (HOMA-IR)] at 24 to 28 weeks. Results: We randomized 108 women to HE+PA, 113 to HE, 110 to PA, and 105 to UC. In the HE+PA group, but not HE or PA alone, women achieved substantially lessGWGthan did the controls (UC) by 35 to 37 weeks (22.02; 95% confidence interval, 23.58 to 20.46 kg). Despite this reduction, no improvements were seen in fasting or postload glucose levels, insulin concentrations, or HOMA-IR. The birthweights and large and small for gestational age rates were similar. Conclusions: The combined HE+PA intervention was able to limit GWG but did not reduce fasting glycemia. Thus, lifestyle changes alone are unlikely to prevent GDM among women with a BMI of 29 kg/m2.

U2 - 10.1210/jc.2016-3455

DO - 10.1210/jc.2016-3455

M3 - Journal article

C2 - 27935767

AN - SCOPUS:85015247590

SN - 0021-972X

VL - 102

SP - 903

EP - 913

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

IS - 3

ER -

Effect of physical activity and/or healthy eating on GDM risk: The DALI lifestyle study

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