Abstract
Obesity during pregnancy is associated with the development of gestational diabetes (GDM). This study aimed to assess if the result of an oral glucose tolerance test (OGTT) for GDM influences health (diet and physical activity) behaviours of pregnant women with obesity. In total, 1031 women who participated in the UK Pregnancies Better Eating and Activity Trial (UPBEAT) of a lifestyle intervention from early pregnancy were included. Changes in weight gain, dietary intake and physical activity following an OGTT undertaken between 27+0 and 28+6 weeks’ and 34 and 36 weeks’ gestation were examined using linear regression with appropriate adjustment for confounders. Obese women without GDM (IADPSG criteria) gained 1.9 kg (95% CI −2.2, −1.5, p < 0.001) more weight than women with GDM. Women with GDM demonstrated greater reductions in energy (–142kcal, 95%CI −242.2, −41.9, p = 0.006), carbohydrate intake (−1.5%E 95%CI –2.8, −0.3, p = 0.016) and glycaemic load (–15.2, 95%CI −23.6, –6.7, p < 0.001) and a greater increase in protein intake (2%E, 95%CI 1.3, 2.7, p < 0.001), compared to women without GDM. Trial intervention allocation did not influence any associations observed. The findings emphasise the need for strategies to optimise the health behaviours of pregnant women with obesity, following a negative OGTT for GDM.
Highlights
The recent increase in obesity in the UK population [1] is mirrored amongst women in antenatal care, with estimates suggesting that 23% have a body mass index (BMI) ≥ 30 kg/m2 [2]
UK Pregnancies Better Eating and Activity Trial (UPBEAT) assessed whether a behavioural intervention of diet and physical activity advice reduced the incidence of GDM and the delivery of large-for-gestational-age (LGA) infants in pregnant women with obesity [16]
This study found that a higher proportion of pregnant women with obesity who were not diagnosed with GDM gained weight in excess of recommended gestational weight gain in their last diagnosed with GDM gained weight in excess of recommended gestational weight gain in their last trimester of pregnancy
Summary
The recent increase in obesity in the UK population [1] is mirrored amongst women in antenatal care, with estimates suggesting that 23% have a BMI ≥ 30 kg/m2 [2]. Obesity in pregnancy increases the risk of complications [3], most notably, gestational diabetes (GDM), defined by new-onset hyperglycaemia in pregnancy, which affects up to 30% of pregnancies worldwide [4]. Obesity in pregnancy is related to a 4–9-fold greater risk of GDM compared to pregnant women with a normal weight [5]. The long-term morbidities associated with GDM include progression to type 2 diabetes in approximately. The UK national guidelines for the management of GDM following diagnosis include the provision of advice on diet and physical activity. For women who do not gain adequate glycaemic control through changes in these behaviours, pharmacotherapy with metformin or insulin is prescribed [7]
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