Angela C Flynn, Paul T Seed, Nashita Patel, Suzanne Barr, Ruth Bell, Annette L Briley, Keith M Godfrey, Scott M Nelson, Eugene Oteng-Ntim, Sian M Robinson, Thomas A Sanders, Naveed Sattar, Jane Wardle, Lucilla Poston, Louise M Goff
Journal: The international journal of behavioral nutrition and physical activity 2017;13(1):124
PMID: 27894316
Obesity in pregnant women increases their risk of insulin resistance and gestational diabetes, as well as an increased long-term risk for their babies to develop metabolic disease later in life. This study investigated whether behavioural interventions might have a beneficial effect on clinical outcomes on obese pregnant women with a BMI of 30 or over. Subjects were divided randomly into two groups: one group were allocated an intervention that addressed diet and physical activity and the other group had standard ante-natal care. The intervention included a series of group or 1 to 1 coaching sessions, set and reviewed SMART goals, provided advice on self-monitoring of barriers to changing behaviours and importance of social support. A handbook was provided with information about the intervention, recommended foods, recipes and suggestions for exercise. In addition, they were given an exercise DVD, a pedometer and log book. The diet aimed to promote healthy eating, but did not restrict food, although it recommended restricting saturated fat, and swapping high glycaemic carbohydrates for those lower on the index. The standard care group attended routine antenatal appointments, where they would have been advised on a healthy diet and activity at the first appointment, but not at any other time. The study concluded that the incidence of gestational diabetes in both the intervention group and the standard care group was very similar (25% and 27%). In the intervention groups, women had diets with a lower glycaemic index and higher levels of activity. They also had less gestational weight gain over the entire pregnancy, however it was not a substantial amount (0.55kg). It was noted that intervention that addresses diet and activity in obese, pregnant women is effective at improving quality of diet and exercise, it did not prevent the development of gestational diabetes, nor change the fact that babies born to those women were large for their gestational age.
BACKGROUND
Understanding dietary patterns in obese pregnant women will inform future intervention strategies to improve pregnancy outcomes and the health of the child. The aim of this study was to investigate the effect of a behavioral intervention of diet and physical activity advice on dietary patterns in obese pregnant woman participating in the UPBEAT study, and to explore associations of dietary patterns with pregnancy outcomes.
METHODS
In the UPBEAT randomized controlled trial, pregnant obese women from eight UK multi-ethnic, inner-city populations were randomly assigned to receive a diet/physical activity intervention or standard antenatal care. The dietary intervention aimed to reduce glycemic load and saturated fat intake. Diet was assessed using a food frequency questionnaire (FFQ) at baseline (15-18 weeks' gestation), post intervention (27-28 weeks) and in late pregnancy (34-36 weeks). Dietary patterns were characterized using factor analysis of the baseline FFQ data, and changes compared in the control and intervention arms. Patterns were related to pregnancy outcomes in the combined control/intervention cohort (n = 1023).
RESULTS
Four distinct baseline dietary patterns were defined; Fruit and vegetables, African/Caribbean, Processed, and Snacks, which were differently associated with social and demographic factors. The UPBEAT intervention significantly reduced the Processed (-0.14; 95% CI -0.19, -0.08, P <0.0001) and Snacks (-0.24; 95% CI -0.31, -0.17, P <0.0001) pattern scores. In the adjusted model, baseline scores for the African/Caribbean (quartile 4 compared with quartile 1: OR = 2.46; 95% CI 1.41, 4.30) and Processed (quartile 4 compared with quartile 1: OR = 2.05; 95% CI 1.23, 3.41) patterns in the entire cohort were associated with increased risk of gestational diabetes.
CONCLUSIONS
In a diverse cohort of obese pregnant women an intensive dietary intervention improved Processed and Snack dietary pattern scores. African/Caribbean and Processed patterns were associated with an increased risk of gestational diabetes, and provide potential targets for future interventions.
TRIAL REGISTRATION
Current controlled trials; ISRCTN89971375.
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