title: 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.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Pregnant women at risk for GDM (BMI ≥29 kg/m2) 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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, U.K. University of Western Sydney, Campbelltown, NSW, Australia da.simmons@uws.edu.au.
authors.forename: David
authors.initials: D
authors.lastname: Simmons
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Judith G M
authors.initials: JG
authors.lastname: Jelsma
authors.affiliation: KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Sander
authors.initials: S
authors.lastname: Galjaard
authors.affiliation: KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Roland
authors.initials: R
authors.lastname: Devlieger
authors.affiliation: KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Andre
authors.initials: A
authors.lastname: van Assche
authors.affiliation: KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Goele
authors.initials: G
authors.lastname: Jans
authors.affiliation: Institut de Recerca de l´Hospital de la Santa Creu i Sant Pau, Barcelona, Spain CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Corcoy
authors.affiliation: Institut de Recerca de l´Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Adelantado
authors.affiliation: National University of Ireland, Galway, Ireland.
authors.forename: Fidelma
authors.initials: F
authors.lastname: Dunne
authors.affiliation: Department of Obstetrics and Gynecology, Medizinische Universitaet Graz, Graz, Austria.
authors.forename: Gernot
authors.initials: G
authors.lastname: Desoye
authors.affiliation: Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Harreiter
authors.affiliation: Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kautzky-Willer
authors.affiliation: Center for Pregnant Women with Diabetes, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Damm
authors.affiliation: Center for Pregnant Women with Diabetes, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Elisabeth R
authors.initials: ER
authors.lastname: Mathiesen
authors.affiliation: Odense University Hospital, Odense, Denmark.
authors.forename: Dorte M
authors.initials: DM
authors.lastname: Jensen
authors.affiliation: Odense University Hospital, Odense, Denmark.
authors.forename: Lise Lotte
authors.initials: LL
authors.lastname: Andersen
authors.affiliation: Universita Degli Studi di Padova, Padua, Italy.
authors.forename: Annunziata
authors.initials: A
authors.lastname: Lapolla
authors.affiliation: Universita Degli Studi di Padova, Padua, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Dalfra
authors.affiliation: Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bertolotto
authors.affiliation: Department of Obstetrics and Women's Diseases, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Wender-Ozegowska
authors.affiliation: Department of Obstetrics and Women's Diseases, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Zawiejska
authors.affiliation: Recherche en Santé Lawson SA, Bronschhofen, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Hill
authors.affiliation: BAP Health Outcomes Research SL, Oviedo, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Rebollo
authors.affiliation: Department of Medical Psychology, VU University Medical Center and Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Snoek
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Mireille N M
authors.initials: MN
authors.lastname: van Poppel
mesh_terms: D000328:Adult; D016640:Diabetes, Gestational / Q000453:epidemiology / Q000517:prevention & control*; D005060:Europe; D005247:Feeding Behavior / Q000502:physiology*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance; D008019:Life Style; D062405:Motivational Interviewing; D009043:Motor Activity; D009765:Obesity / Q000150:complications / Q000517:prevention & control*; D010865:Pilot Projects; D011247:Pregnancy; D040242:Risk Reduction Behavior; D015430:Weight Gain