Nutrition, Exercise Counseling in Early Pregnancy May Reverse Gestational Diabetes Risk in Obese Women

Results from a new pilot study show early lifestyle intervention in obese pregnant women cuts their risk of developing gestational diabetes, as well as maternal and fetal complications that can emerge with high blood sugar.

For their sample, Jessica Marcinkevage, HSPH, a PhD candidate at the Rollins School of Public Health at Emory University, in Atlanta, Ga., and clinicians recruited a group of 57 low-income, minority and overweight or obese pregnant women who received prenatal care at the nearby Grady Memorial Hospital between April 2010 and September 2012. Twenty-eight of the participants were assigned to receive a lifestyle intervention focused on increasing exercise and limiting unhealthy sugar intake shortly after their first prenatal care appointment at the hospital — or about 12 weeks into their pregnancies — while the remaining 29 participants received minimal education on weight control and healthy eating in conjunction with their regular appointments.

“We know lifestyle interventions promoting healthy diets and physical activity are effective in improving insulin sensitivity and in reducing the risk of developing type 2 diabetes, but whether the same effort would improve response to pregnancy-induced insulin resistance has been unclear,” said Guillermo E. Umpierrez, MD, director of the hospital’s diabetes clinic and a professor in the endocrinology division of Emory’s School of Medicine. “These efforts can pay off, as pregnant women who perform regular exercise and eat healthy diets can limit their risk of gaining too much weight during pregnancy, reducing their chances of developing gestational diabetes and other complications during pregnancy.”

After conducting sugar tolerance tests to gauge the patients’ diabetes development risk at 28 weeks into pregnancy and six weeks after birth — as well as assessing their physical activity levels, dietary intake and baseline body weight and blood pressure at those time intervals — the researchers observed improved insulin resistance and delivery outcomes among participants receiving individual interventions compared to their regular care counterparts.

Since 2009, the Institute of Medicine (IOM) has advised overweight women to stay within a 15- to 25-pound weight gain in pregnancy and obese women to limit gestational weight gain between 11 and 20 pounds. But Marcinkevage found those guidelines were better met by the group of women in her pilot study whose prenatal care incorporated counseling on physical activity and healthy eating, as she discovered in initial interviews with the study’s patients that they had not received fundamental nutrition information from their doctors and “they didn’t know fried chicken was bad and that soda had so much sugar.”

Marcinkevage said the pilot study’s preliminary results suggest individual lifestyle intervention could prevent pregnant women from tipping the scales of the IOM’s recommendations, as well as reverse high gestational diabetes risk in overweight populations.

“Several previous studies have focused on weight gain in pregnancy, but they haven’t included the impact on glucose and glucose metabolism and the positive outcome in women who gain weight that’s within the (IOM) guidelines,” Marcinkevage said. “The ultimate goal is to advise clinicians and nurses on what bits of information can be helpful and what things can work for this very high-risk population that can greatly benefit from these efforts.”