Intergenerational Cycle of Obesity and Diabetes: How Can We Reduce the Burdens of These Conditions on the Health of Future Generations?

Table 2

Most important human clinical interventions trials performed in pregnant mothers to reduce or improve maternal, neonatal, and child outcomes.

Study	Population	Study design	Intervention	Maternal outcomes	Gestational or obstetrical outcomes	Neonatal outcomes	Long-term offspring outcomes
Guelinckx et al. 2010Am J Clin Nutr [103]	𝑛=122, 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	Intervention impact: similar	Intervention impact: similar birth weight	N/A
Wolff et al., 2008 Int J Obes [104]	𝑛=50, 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 (𝑃=0.002); 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	N/A
Callaway et al., 2010 Diabetes Care [105]	𝑛=50, 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 (𝑃=0.07) and similar at 28 week (𝑃=0.57); Intervention impact: at 28 weeks: ↑ EE (𝑃=0.04),; ↓ fasting glucose (𝑃=0.03), at 36 weeks: ↓ fasting insulin (𝑃=0.05)	N/A	N/A	N/A
Clapp. 1996J Pediatr [106]	𝑛=40, recruited before pregnancy, healthy (BMI not mentioned) caucasian women.; Offspring aged 5 yrs: 𝑛=12 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 (𝑃<0.01)	Intervention impact at 5 years of age: ↓ weight, skinfolds, arm area fat mass (𝑃<0.01), and ponderal index (𝑃<0.05); ↑general intelligence, language skill (𝑃<0.01), and neurodevelopmental score (𝑃<0.05)
Artal et al., 2007 Appl Physiol Nutr Metab [107]	𝑛=96, 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 (𝑃<0.05); 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]	𝑛=124, 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 (𝑃<0.001); GDM incidence: ↓ in intervention versus control (𝑃<0.04)	Intervention impact: N/A	Intervention impact: similar birth weight	N/A
Korpi-Hyovalti et al., 2011 BMC Public health [109]	𝑛=54, 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 (𝑃=0.062); GDM incidence: similar	Intervention impact: similar	Intervention impact: heavier birth weight (𝑃=0.047); similar rates of macrosomia, admissions to NICU and respiratory distress	N/A
Lindholm et al., 2010 Acta Obstet Gynecol Scand [110]	𝑛=25, overweight (BMI 30–35, 𝑛=11) or obese (BMI > 35, 𝑛=14) 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 (𝑃=0.001); GDM incidence: as expected	Intervention impact: in prepregnancy BMI > 35 versus 30–35:↑ gestational weeks (𝑃=0.04),; ↓ caesarean (𝑃=0.04)	Intervention impact: fetal growth and birth weight: as expected	N/A
Shirazian et al., 2010 Am J Perinatol [111]	𝑛=41, nondiabetic obese (BMI > 30) pregnant women	Prospective study with historical controls	Intervention group: individual counseling on healthy diet and exercise, ≥ 5 one-on-one counselling or phone calls + ≥ 1 seminar/trimester x/trimester. Weight gain goal ≤ 15 lbs.; Control group: routine care	Gestational weight gain:1/2 of control (𝑃=0.003); GDM incidence: similar	Intervention impact: similar	Intervention impact: similar birth weight and rates of fetal complications	N/A
Crowther et al., 2005 N Engl J Med [112]; Gillman et al., 2010 Diabetes Care [113]	𝑛=1000, mild GDM pregnant women (median BMI = 26); Offspring aged 4-5 yrs: 𝑛=94 (intervention group); 𝑛=105 (control group)	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 (𝑃=0.01); GDM incidence: similar; Intervention impact: ↑ postpartum quality of life	Intervention impact: ↑ induction of labor (𝑃<0.001), similar caesarean rates	Intervention impact: ↓ perinatal complications (𝑃=0.01),; ↑ admission to neonatal nursery (𝑃=0.01),; ↓ birth weight (𝑃<0.001),; ↓ macrosomia (<0.001)	Intervention impact: in offspring 4-5 y.o., similar BMI Z-score, and proportion of BMI ≥ 85th percentile
Landon et al., 2009 N Engl J Med [114]	𝑛=900, mild GDM pregnant women (median BMI = 30)	Multicenter randomized controlled trial	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 (𝑃<0.001).; GDM incidence: N/A; Intervention impact: achievement of maternal glucose targets	Intervention impact: ↓ caesarean (𝑃=0.01), shoulder dystocia (𝑃=0.02), preeclampsia, or hypertension (𝑃=0.01)	Intervention impact: ↓ birth weight (𝑃<0.001), macrosomia (𝑃<0.001), fat mass (𝑃=0.003); 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]	𝑛=300, low-risk pregnant (24–32 weeks) women with GDM; Offspring aged 7–11 yrs: 𝑛=46 (intervention group), 𝑛=25 (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 (𝑃=0.001); at 36–38 weeks: ↓ preprandial (𝑃=0.035) and 1-hour postprandial (𝑃=0.009) 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
Moses et al., 2006 Am J Clin Nutr [117]	𝑛=70, 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 (𝑃<0.001), fasting glucose (𝑃=0.034)Within low-glycemic index group: ↓ fasting glucose (𝑃=0.001)	Intervention impact: in low- versus high-glycemic index group: similar caesarean rates	Intervention impact: in low- versus high-glycemic index group: ↓birth weight (𝑃=0.051), macrosomia (𝑃=0.001), ponderal index (𝑃=0.03); 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.