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Maternal nutrition, infants and children

Preventing excessive gestational weight gain—a secondary analysis of a cluster-randomised controlled trial

Abstract

Background:

Healthy diet, physical activity and modest weight gain during pregnancy may prevent developing gestational diabetes mellitus (GDM). We examined whether a lifestyle intervention designed to prevent GDM was effective in reducing excessive gestational weight gain (GWG).

Methods:

A cluster-randomised controlled trial (n=399) was conducted in maternity clinics in 14 municipalities in Southern Finland. Pregnant women with at least one risk factor for GDM (for example, overweight) but no pre-existing diabetes were recruited at 8–12 weeks’ gestation. The intervention included counselling on GWG, physical activity and healthy eating at five routine visits. Usual counselling practices were continued in the usual care municipalities. Statistical analyses were performed using multilevel linear and logistic regression models adjusted for weeks’ gestation at last weight measurement, pre-pregnancy body mass index and smoking status.

Results:

The intervention group had a lower mean GWG by weeks’ gestation than the usual care group (adjusted coefficient for the between-group difference −0.016 kg per day, P=0.041). There was no difference in mean (±s.d.) GWG between the intervention and the usual care groups (13.7±5.8 vs 14.3±5.0 kg, P=0.64). In total, 46.8% of the intervention group and 54.4% of the usual care group exceeded the GWG recommendations. The adjusted odds ratio for excessive GWG was 0.82 (95% CI 0.53–1.26, P=0.36) in the intervention group as compared with the usual care group.

Conclusions:

The intervention had minor effects on GWG among women who were at increased risk for GDM. In order to prevent excessive GWG, additional focus on restriction of energy intake may be needed.

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Acknowledgements

This study was funded by (Finnish) Diabetes research fund, Competitive Research Funding of the Tampere University Hospital, Academy of Finland, Ministry of Education and Ministry of Social Affairs and Health. We sincerely thank all the nurses of the participating maternity clinics for their invaluable work in implementing the study protocol.

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Correspondence to T I Kinnunen.

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The authors declare no conflict of interest.

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Contributors: TIK, MA and RL designed research and conducted research; JR and TIK performed statistical analyses; TIK wrote the paper and TIK and RL have the primary responsibility for final content. All authors read, commented and approved the final paper.

Trial registration: Current Controlled Trials ISRCTN33885819.

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Kinnunen, T., Raitanen, J., Aittasalo, M. et al. Preventing excessive gestational weight gain—a secondary analysis of a cluster-randomised controlled trial. Eur J Clin Nutr 66, 1344–1350 (2012). https://doi.org/10.1038/ejcn.2012.146

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