, nondiabetic obese (BMI > 29) pregnant (<15 weeks) women
Randomized controlled trial
Passive group: brochure on general advices at 1st prenatal visit Active group: brochure + 3 group sessions with dietitian during pregnancy on nutrition and physical activity Control group: routine care
Gestational weight gain: similar GDM incidence: N/A Intervention impact: in active group, improved nutritional habits during pregnancy and compared to other groups; similar physical activity
, nondiabetic obese (BMI = 35) pregnant (<15 weeks) women
Randomized controlled trial
Intervention group: ten individual sessions with dietitian during pregnancy to improve gestational weight gain with energy intake restriction Control group: routine care
Gestational weight gain: ↓ 6.7 kg versus controls () GDM incidence: similar Intervention impact: at 27 weeks: ↓insulin, ↓leptin versus controls at 36 weeks: ↓ insulin, ↓ glucose versus controls
Intervention impact: similar
Intervention impact: similar birth weight, placental weight, head, and abdominal circumference
, obese (BMI ≥ 30) pregnant women *participants with type 1 diabetes excluded
Randomized controlled trial
Intervention group: individual exercise program with energy expenditure (EE) goal of 900 kcal/week from 12-week gestation to delivery Control group: routine care
Gestational weight gain: N/A GDM incidence: in intervention group, 12% ↑ at 12 week () and similar at 28 week () Intervention impact: at 28 weeks: ↑ EE (), ↓ fasting glucose (), at 36 weeks: ↓ fasting insulin ()
, recruited before pregnancy, healthy (BMI not mentioned) caucasian women. Offspring aged 5 yrs: girls and 8 boys in each group
Prospective cohort study
Active women: healthy and physically active before and throughout pregnancy. Control women: healthy and physically active before and stop at initiation of pregnancy No intervention in children
Gestational weight gain: ↓ in active versus control group GDM incidence: N/A
N/A
Intervention impact: ↓ birth weight, ponderal index, fat mass, body fat %, and abdominal circumference ()
Intervention impact at 5 years of age: ↓ weight, skinfolds, arm area fat mass (), and ponderal index (); ↑general intelligence, language skill (), and neurodevelopmental score ()
, overweight or obese (BMI > 25) pregnant (<33 weeks) women with GDM (no insulin)
Randomized controlled trial No control group without intervention
Diet (D) group: individual counseling on diet and weight gain goal according to BMI Exercise and diet (ED) group: same plus individual counseling on moderate exercise All received usual GDM management
Gestational weight gain: ↓ in ED versus D group () GDM incidence: 1st trimester: similar 2nd trimester: similar in term of prescription related to insulin to maintain glucose.
Intervention impact: similar caesarean rates
Intervention impact: similar for macrosomia, small for gestational age and birth weight
N/A
Quinlivan et al., 2011Aust N Z J Obstet Gynaecol [108]
, overweight or obese (BMI > 25) pregnant women
Randomized controlled trial
Intervention group: 4 steps individual approach: (1) continuity of care provider, (2) weighting at each visit, (3) brief dietary intervention by a food technologist, and (4) psychological support Control group: routine care
Gestational weight gain: ↓ in intervention versus control () GDM incidence: ↓ in intervention versus control ()
Intervention impact: N/A
Intervention impact: similar birth weight
N/A
Korpi-Hyovalti et al., 2011 BMC Public health [109]
, high risk for GDM pregnant (8–12 weeks) women irrespective of BMI at inclusion
Open multicenter randomized controlled trial
Intervention group: individual counseling on nutrition (dietitian) and physical activity (physiotherapist) Control group: close followup
Gestational weight gain: small ↓ in intervention group () GDM incidence: similar
Intervention impact: similar
Intervention impact: heavier birth weight (); similar rates of macrosomia, admissions to NICU and respiratory distress
N/A
Lindholm et al., 2010 Acta Obstet Gynecol Scand [110]
, overweight (BMI 30–35, ) or obese (BMI > 35, ) pregnant women
Uncontrolled prospective intervention study
Individual counseling with midwife every 2 weeks + 2 group sessions from 1st trimester to delivery on diet and exercise. One initial consultation with dietitian Goal: gestational weight gain ≤ 6 kg
Gestational weight gain: 14/25 reached goals; ↓ in prepregnancy BMI > 35 versus 30–35 () GDM incidence: as expected
Intervention impact: in prepregnancy BMI > 35 versus 30–35:↑ gestational weeks (), ↓ caesarean ()
Intervention impact: fetal growth and birth weight: as expected
Multicenter randomized controlled trial ACHOIS study
Intervention group: individual dietary and lifestyle counseling, usual GDM care, insulin therapy in 20% of women; from recruitment (24–34 week gestation) to delivery Control group: routine care No intervention in children
Gestational weight gain: ↓ in intervention versus control () GDM incidence: similar Intervention impact: ↑ postpartum quality of life
Intervention impact: ↑ induction of labor (), similar caesarean rates
Intervention group: individual nutritional counseling, usual GDM care, insulin therapy (required in 37 women); from recruitment (24–31 weeks) to delivery Control group: routine care, insulin therapy (required in 2 women)
Gestational weight gain: ↓ in intervention versus control (). GDM incidence: N/A Intervention impact: achievement of maternal glucose targets
Intervention impact: ↓ birth weight (), macrosomia (), fat mass (); similar perinatal complications, small for gestational age, admissions to NICU, and respiratory distress
N/A
Garner et al., 1997 Am J Obstet Gynecol [115] And Malcolm et al., 2006 Diabet Med [116]
, low-risk pregnant (24–32 weeks) women with GDM Offspring aged 7–11 yrs: (intervention group), (control group)
Randomized controlled trial
Intervention group: individual dietary counseling by dietitian biweekly, usual GDM care, insulin therapy (required in 36 women) Control group: not seen by dietitian; recommended to eat unrestrictedly according to Canada food guide; biweekly self-glucose monitoring No intervention in children
Gestational weight gain: similar GDM incidence: similar OGTT area under the curves Intervention impact: at 28–30 weeks: ↑ preprandial glucose levels () at 36–38 weeks: ↓ preprandial () and 1-hour postprandial () glucose levels
Intervention impact: similar caesarean rates
Intervention impact: similar birth weight, perinatal complications
Intervention impact: similar mean fasting glucose, mean fasting insulin, and mean 2 hrs glucose and insulin; 5 children born to mothers from intervention group had AGT
, pregnant (12–16 weeks) women *Participants with conditions associated to abnormal glucose metabolism and insulin resistance problem were excluded
Randomized controlled trial No control group without intervention
Low-glycemic index group: individual nutritional counseling by dietitian 5 times during pregnancy on recommended nutritional intake plus low-glycemic index diet High-glycemic index group: idem except for recommendation of high- glycemic index diet
Gestational weight gain: similar GDM incidence: similar (only 1 case) Intervention impact: in low versus high-glycemic index group: ↓ glycemic index (), fasting glucose ()Within low-glycemic index group: ↓ fasting glucose ()
Intervention impact: in low- versus high-glycemic index group: similar caesarean rates
Intervention impact: in low- versus high-glycemic index group: ↓birth weight (), macrosomia (), ponderal index (); similar perinatal complications, small for gestational age, admissions to NICU, respiratory distress
N/A
ACHOIS: Australian Carbohydrate Intolerance in Pregnant Women study, AGT: abnormal glucose tolerance, BMI: body mass index, GDM: gestational diabetes mellitus, MET: metabolic equivalent task, NICU: neonatal intensive care unit, N/A: not applicable, OGTT: oral glucose tolerance test.