title: Effect of Physical Activity and/or Healthy Eating on GDM Risk: The DALI Lifestyle Study.
abstract: BACKGROUND
  Lifestyle approaches for preventing gestational diabetes mellitus (GDM) have produced mixed results.
  
  
  OBJECTIVE
  The aim of the present study was to compare the effectiveness of 3 lifestyle interventions [healthy eating (HE), physical activity (PA), and both HE and PA (HE+PA)] with usual care (UC) in reducing GDM risk.
  
  
  METHODS
  The present study was a multicenter randomized controlled trial conducted from 2012 to 2014 [the DALI (vitamin D and lifestyle intervention for GDM prevention) lifestyle study].
  
  
  METHODS
  The study occurred at antenatal clinics across 11 centers in 9 European countries.
  
  
  METHODS
  Consecutive pregnant women at <20 weeks of gestation with a body mass index (BMI) of ≥29 kg/m2 and without GDM using the International Association of Diabetes and Pregnancy Study Group criteria (n = 436). For the intervention, women were randomized, stratified by site, to UC, HE, PA, or HE+PA. The women received 5 face-to-face and ≤4 telephone coaching sessions using the principles of motivational interviewing. A gestational weight gain (GWG) <5 kg was targeted. The coaches received standardized training and an intervention toolkit tailored to their culture and language.
  
  
  METHODS
  The endpoints were the GWG at 35 to 37 weeks and the fasting glucose and insulin sensitivity [homeostasis model assessment insulin resistance (HOMA-IR)] at 24 to 28 weeks.
  
  
  RESULTS
  We randomized 108 women to HE+PA, 113 to HE, 110 to PA, and 105 to UC. In the HE+PA group, but not HE or PA alone, women achieved substantially less GWG than did the controls (UC) by 35 to 37 weeks (-2.02; 95% confidence interval, -3.58 to -0.46 kg). Despite this reduction, no improvements were seen in fasting or postload glucose levels, insulin concentrations, or HOMA-IR. The birthweights and large and small for gestational age rates were similar.
  
  
  CONCLUSIONS
  The combined HE+PA intervention was able to limit GWG but did not reduce fasting glycemia. Thus, lifestyle changes alone are unlikely to prevent GDM among women with a BMI of ≥29 kg/m2.
authors.affiliation: Western Sydney University, Campbelltown, New South Wales 2560, Australia.|Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, CB2 0QQ England.
authors.forename: David
authors.initials: D
authors.lastname: Simmons
authors.affiliation: Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Roland
authors.initials: R
authors.lastname: Devlieger
authors.affiliation: Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: André
authors.initials: A
authors.lastname: van Assche
authors.affiliation: Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Goele
authors.initials: G
authors.lastname: Jans
authors.affiliation: Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium.|Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Sander
authors.initials: S
authors.lastname: Galjaard
authors.affiliation: Institut de Recerca de l´Hospital de la Santa Creu i Sant Pau, Barcelona, 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.|CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Zaragoza, Spain.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Adelantado
authors.affiliation: Galway Diabetes Research Centre and College of Medicine Nursing and Health Sciences, 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, 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, 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, Departments of Endocrinology and Obstetrics, Rigshospitalet, Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Damm
authors.affiliation: Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Elisabeth R
authors.initials: ER
authors.lastname: Mathiesen
authors.affiliation: Department of Endocrinology and Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.|Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
authors.forename: Dorte M
authors.initials: DM
authors.lastname: Jensen
authors.affiliation: Department of Endocrinology and Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.|Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
authors.forename: Liselotte
authors.initials: L
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 G
authors.initials: MG
authors.lastname: Dalfrà
authors.affiliation: Azienda Ospedaliero Universitaria-Pisa, Pisa Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bertolotto
authors.affiliation: Medical Faculty I, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Wender-Ozegowska
authors.affiliation: Medical Faculty I, 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: Department of Medical Psychology, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.|Department of Medical Psychology, Academic Medical Centre, 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 Centre, Amsterdam, The Netherlands; and.
authors.forename: Judith G M
authors.initials: JG
authors.lastname: Jelsma
authors.affiliation: Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands; and.|Institute of Sport Science, University of Graz, Graz, Austria.
authors.forename: Mireille N M
authors.initials: MN
authors.lastname: van Poppel
mesh_terms: D000328:Adult; D001724:Birth Weight; D001786:Blood Glucose / Q000378:metabolism; D016640:Diabetes, Gestational / Q000517:prevention & control*; D004035:Diet Therapy / Q000379:methods*; D000072001:Diet, Healthy; D005060:Europe; D015444:Exercise; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology; D005951:Glucose Tolerance Test; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D007328:Insulin / Q000378:metabolism; D007333:Insulin Resistance; D008019:Life Style; D055686:Metabolic Equivalent; D062405:Motivational Interviewing / Q000379:methods*; D009765:Obesity; D016017:Odds Ratio; D050177:Overweight; D011247:Pregnancy; D011248:Pregnancy Complications; D011295:Prenatal Care; D015430:Weight Gain
chemical_list: D001786:Blood Glucose; D007328:Insulin