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A randomized trial of the effects of dietary counseling on gestational weight gain and glucose metabolism in obese pregnant women

Abstract

Objective:

Can gestational weight gain in obese women be restricted by 10-h dietary consultations and does this restriction impact the pregnancy-induced changes in glucose metabolism?

Design:

A randomized controlled trial with or without restriction of gestational weight gain to 6–7 kg by ten 1-h dietary consultations.

Subjects:

Fifty nondiabetic nonsmoking Caucasian obese pregnant women were randomized into intervention group (n=23, 28±4 years, prepregnant body mass index (BMI) 35±4 kg m−2) or control group (n=27, 30±5 years, prepregnant BMI 35±3 kg m−2).

Measurements:

The weight development was measured at inclusion (15 weeks), at 27 weeks, and 36 weeks of gestation. The dietary intakes were reported in the respective weeks by three 7-day weighed food records and blood samples for analyses of fasting s-insulin, s-leptin, b-glucose, and 2-h b-glucose after an oral glucose tolerance test were collected.

Results:

The women in the intervention group successfully limited their energy intake, and restricted the gestational weight gain to 6.6 kg vs a gain of 13.3 kg in the control group (P=0.002, 95% confidence interval (CI): 2.6–10.8 kg). Both s-insulin and s-leptin were reduced by 20% in the intervention group compared to the control group at week 27, mean difference: −16 pmol l−1 (P=0.04, 95% CI: −32 to −1) for insulin and −23 ng ml−1 (P=0.004, 95% CI: −39 to −8) for leptin. At 36 weeks of gestation, the s-insulin was further reduced by 23%, −25 pmol l−1 (−47 to −4, P=0.022) and the fasting b-glucose were reduced by 8% compared with the control group (−0.3 mmol l−1, −0.6 to −0.0, P=0.03).

Conclusions:

Restriction of gestational weight gain in obese women is achievable and reduces the deterioration in the glucose metabolism.

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References

  1. Galtier-Dereure F, Montpeyroux F, Bringer J, Jaffiol C . Weight excess before pregnancy: complications and cost. Int J Obes 1995; 19: 443–448.

    CAS  Google Scholar 

  2. Edwards LE, Hellerstedt WL, Alton IR, Story M, Himes JH . Pregnancy complications and birth outcomes in obese and normal-weight women: effects of gestational weight change. Obstet Gynecol 1996; 87: 389–394.

    Article  CAS  PubMed  Google Scholar 

  3. Bianco AT, Smilen SW, Davis Y, Lopez S, Lapinski R, Lockwood C . Pregnancy outcome and weight gain recommendations for the morbidly obese woman. Eu J Obstet Gynecol 1998; 91: 97–102.

    CAS  Google Scholar 

  4. Baeten JM, Bukusi EA, Lambe M . Pregnancy complications and outcomes among overweight and obese nulliparous women. Am J Public Health 2001; 91: 436–440.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Sebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Beard RW et al. Maternal obesity and pregnancy outcome: a study of 287 213 pregnancies in London. Int J Obes 2001; 25: 1175–1182.

    Article  CAS  Google Scholar 

  6. Naeye RL . Maternal body weight and pregnancy outcome. Am J Clin Nutr 1990; 52: 273–279.

    Article  CAS  PubMed  Google Scholar 

  7. Cnattingius S, Bergstrom R, Lipworth L, Kramer MS . Prepregnancy weight and the risk of adverse pregnancy outcomes. N Engl J Med 1998; 338: 147–152.

    Article  CAS  PubMed  Google Scholar 

  8. Gross T, Sokol RJ, King KC . Obesity in pregnancy: risk and outcome. Obstet Gynecol 1980; 56: 446–450.

    CAS  PubMed  Google Scholar 

  9. Perlow JH, Morgan MA, Montgomery DM, Towers CV, Porto M . Perinatal outcome in pregnancy complicated by massive obesity. Am J Obstet Gynecol 1992; 167: 958–962.

    Article  CAS  PubMed  Google Scholar 

  10. Institute of Medicine. Nutrition During Pregnancy. Part I, Weight Gain. National Academy Press: Washington, DC, 1990.

  11. Parker DP, Abrams B . Prenatal weight gain advice: an examination of the recent prenatal weight gain recommendations of the institute of medicine. Obstet Gynecol 1992; 79: 664–669.

    CAS  PubMed  Google Scholar 

  12. Rössner S, hlin A . Pregnancy as a risk factor for obesity: lessons from the Stockholm pregnancy and weight development study. Obes Res 1995; 3: 267S–275S.

    Article  PubMed  Google Scholar 

  13. Gunderson EP, Abrans B, Selvin S . The relative importance of gestational gain and maternal characteristics associated with the risk of becoming overweight after pregnancy. Int J Obes 2000; 24: 1660–1668.

    Article  CAS  Google Scholar 

  14. Linné Y, Barkeling B, Rossner S . Long-term weight development after pregnancy. Obesity Rev 2002; 3: 75–83.

    Article  Google Scholar 

  15. Rooney BL, Schauberger CW . Excess pregnancy weight gain and long-term obesity: one decade later. Obstet Gynecol 2002; 100: 245–252.

    PubMed  Google Scholar 

  16. Olson CM, Strawderman MS, Hinton PS, Pearson TA . Gestational weight gain and postpartum behaviors associated with weight change from early pregnancy to 1 y post partum. Int J Obes 2003; 27: 117–127.

    Article  CAS  Google Scholar 

  17. Abrams B, Altman SL, Pickett KE . Pregnancy weight gain: still controversial. Am J Clin Nutr 2000; 71: 1233S–1241S.

    Article  CAS  PubMed  Google Scholar 

  18. Cogswell ME, Perry GS, Schieve LA, Dietz WH . Obesity in women of childbearing age: risk, prevention, and treatment. Prim care update. Obstet Gynecol 2001; 8: 89–105.

    Google Scholar 

  19. Position of the American dietetic association. Nutrition and lifestyle for a healthy pregnancy outcome. J Am Diet Assoc 2002; 102: 1479–1490.

    Article  Google Scholar 

  20. Ryan AE . Hormones and insulin resistance during pregnancy. Lancet 2003; 362: 1777–1778.

    Article  PubMed  Google Scholar 

  21. Ning Y, Williams MA, Muy-Rivera M, Leisenring WM, Luthy DA . Relationship of maternal plasma leptin and risk of preeclampsia: a prospective study. J Maternal-Fetal and Neonatal Medicine 2004; 15: 50–56.

    Article  Google Scholar 

  22. Qiu C, Williams MA, Vadachkoria S, Frederick IO, Luthy D . Increased maternal plasma leptin in early pregnancy and risk of gestational diabetes mellitus. Obstet Gynecol 2004; 103: 519–525.

    Article  CAS  PubMed  Google Scholar 

  23. Linné Y, Barkeling B, Rössner S . Natural course of gestational diabetes mellitus: long term follow up of women in the SPAWN study. BJOG 2002; 109: 1227–1231.

    Article  PubMed  Google Scholar 

  24. Xiong X, Saunders LD, Wang FL, Demianczuk NN . Gestational diabetes mellitus: prevalence, risk factors, maternal and infant outcomes. Int J Gyn Obst 2001; 75: 221–228.

    Article  CAS  Google Scholar 

  25. Schwartz R . Hyperinsulinemia and macrosomia. NEJM 1990; 340–342.

  26. Gillman MW, Rifa-Shiman S, Berkey C, Field AE, Colditz GA . Maternal gestational diabetes, birth weight and adolescent obesity. Pediatrics 2003; 111: E221–E226.

    Article  PubMed  Google Scholar 

  27. Malee MP, Verma A, Messerlian G, Tucker R, Vohr BR . Association between maternal and child leptin levels 9 years after pregnancy complicated by gestational diabetes. Horm Metab Res 2002; 34: 212–216.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

Dietitian Anna Marie Kjellingbro, study nurse Hanne Panduro, midwife Margit Holm, MSc Janne Lorentzen, and MSc Camilla Schou Larsen are acknowledged for the skilled and excellent contributions to this study.

Source of funding: Supported by the Desireé and Niels Yde Foundation. Pharma Vinci, Denmark provided vitamins.

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Correspondence to S Wolff.

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Wolff, S., Legarth, J., Vangsgaard, K. et al. A randomized trial of the effects of dietary counseling on gestational weight gain and glucose metabolism in obese pregnant women. Int J Obes 32, 495–501 (2008). https://doi.org/10.1038/sj.ijo.0803710

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  • DOI: https://doi.org/10.1038/sj.ijo.0803710

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