Lifestyle Intervention in GDM: Is Pregnancy the Opportune Time to Change Habits

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Lifestyle Intervention in GDM Is Pregnancy the
Opportune Time to Change Habits?

• Rosemary B. Catanzaro MS, RD, CDE
• Jeffrey A. Gavard PhD
• Raul Artal MD
• Department of Obstetrics, Gynecology, and Womens
  Health
• Saint Louis University
• April 22, 2008

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Gestational Diabetes MellitusBackground

• 7-14 of all pregnancies are complicated by GDM1
• 50 of women with GDM will develop type 2
  diabetes within 5-10 years2
• Excessive weight gain and maternal obesity
  increases the risk of pregnancy complications,
  GDM, fetal macrosomia, birth anomalies, and
  cesarean deliveries3,4
• Medical Nutrition Therapy and Exercise are
  primary treatment interventions5

• Link??

Physical Inactivity
Obesity
GDM
Type 2 diabetes
Adapted from Mottola MF6
1Diabetes Care. 200225(1)S94-6, 2Kim C et al.
Diabetes Care. 200225(10)1862-8, 3Johnson et.
al. Am J Obstet Gynecol 1996174254-258,4Watkins
et al. Pediatrics 20031111152-1158,5Metzger BE
et al. Diabetes Care. 200730S251-60, 6Mottola
MF. Curr Sports Med Rep 20076381-6
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Gestational Diabetes Mellitus

• Defined as any degree of glucose intolerance with
  onset or first recognition during pregnancy

International Diabetes Center
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Prevalence of GDM by BMI and Exercise
Dye TD et al. Am J Epidemiol 1997146(11)961-5
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Institute of Medicine Weight Gain Guidelines in
Pregnancy

• Recommended total
• weight gain (lbs.)
• Underweight (BMIlt19.8) 28-40 lbs.
• Normal weight (BMI 19.8-26) 25-35 lbs.
• Overweight (BMI gt26-29) 15-25 lbs.
• Obese (BMI gt29) at least 15

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GDM Nutrition and Exercise ProgramObjective

• To determine if a lifestyle intervention of diet
  and exercise would impact pregnancy outcomes and
  prevent excessive weight gain in pregnancy.

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GDM Nutrition and Exercise ProgramMaterials and
Methods

• 174 women with GDM were sequentially offered
  enrollment into the Nutrition and Exercise
  Program
• 66 enrolled into the Nutrition and Exercise Group
• 108 enrolled into the Nutrition Only Group

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Exercise Intervention

• Exercise subjects (n49)VO2 max testing on a
  cycle ergometer
• Provided an exercise prescription of 60 VO2 max
• Follow-up visits to the exercise lab 1.4 1.5
  sessions
• Physical activity was recorded daily in exercise
  logs
• Exercise 156 94 min/wk
• Routine care subjects (n17)healthcare provider
  initiated exercise
• Exercise 157 95 min/wk

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Nutrition and Exercise Prescription in GDM and
Obesity

• Small frequent meals and snacks to lower mean
  blood glucose
• Limit weight gain during pregnancy
• Encourage healthy food choicesfruits,
  vegetables, low-fat dairy, whole grains
• Choose water to drinklimit sweet drinks and
  juices
• Exercise 30-60 minutes, most days of the
  weekwalk immediately after meals
• Break the cycle of obesity and diabetesachieve a
  healthy BMIchange habits during pregnancy to
  establish healthy behaviors

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www.mypyramid.gov
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Conclusions

• Women are more motivated to make healthy
  lifestyle changes during pregnancy
• Moderate exercise during a healthy pregnancy is
  safe and effective
• Weight gain restriction results in favorable
  maternal and fetal outcomes
• Pregnancy is the most opportune time to make
  healthy lifestyle changes