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

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

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. Pregnant women at risk for GDM (BMI ≥29 kg/m(2)) 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. 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. 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.