Lifestyle intervention for gestational diabetes mellitus prevention: A cluster-randomized controlled study

OBJECTIVE: The study was to examine whether gestational diabetes mellitus (GDM) can be prevented by early trimester lifestyle counseling in a high-risk population. METHODS: From September 2012 to January 2013, 1664 pregnancies in the Department of Obstetrics and Gynecology of First Hospital of Peking University were enrolled in the study during their first prenatal care visit before the 8 gestational weeks visit and asked to fill out a questionnaire on GDM risk evaluation. According to the questionnaire and medical records, those with at least one risk factor of GDM were included in the intervention study and randomly allocated to two groups, intervention group and control group. Routine prenatal care was offered, while standardized two-step lifestyle intervention was provided to the intervention group during 6–8 gestational weeks, and at 12–13 gestational weeks, enforcement intervention based on maternal anthropometrics were offered. Both groups were followed until 75 g oral glucose tolerance test (OGTT) testing at 24–28 gestational weeks. The weight gain after intervention and the prevalence of GDM were used to evaluate the effect. RESULTS: (1) According to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, the positive rate of GDM for the intervention group was 17.16% (23/134), lower than the control group which was 23.91% (33/138), P = 0.168. (2) The weight gain during the first and second trimester for the intervention group was (1.38 ± 2.34) kg and (5.51 ± 2.18) kg, lower than in the control group which was (1.41 ± 2.58) kg and (5.66 ± 2.25) kg, (P = 0.905, P = 0.567). (3) Positive rate of GDM for those fasting plasma glucose (FPG) ≥5.1 mmol/L during early pregnancy was 11/36 (30.55%) for the intervention group that was lower than 17/37 (45.95%) for the control group, but the statistical difference was not significant (P = 0.076). CONCLUSION: The positive rate of GDM could be reduced by a certain amount lifestyle intervention from the beginning of pregnancy. More validated effective intervention should be explored in the high-risk pregnant women.