Is Energy Balance in Pregnancy Involved in the Etiology of Gestational Diabetes in Women with Obesity?

Lifestyle intervention with dietary counseling and increased physical activity is the first-line strategy for prevention of gestational diabetes mellitus (GDM). This approach is based on epidemiological data suggesting that the etiology of GDM is similar to type 2 diabetes, with common risk factors including an unhealthy, hypercaloric diet and a sedentary lifestyle ( Agha-Jaffar et al., 2016 Agha-Jaffar R. Oliver N. Johnston D. Robinson S. Gestational diabetes mellitus: does an effective prevention strategy exist?. Nat. Rev. Endocrinol. 2016; 12 : 533-546 Crossref PubMed Scopus (19) Google Scholar ). Preliminary studies in obese pregnant mothers at risk for GDM indeed supported the notion that lifestyle modification may reduce GDM incidence through restriction of pregnancy weight gain (e.g., Thornton et al., 2009 Thornton Y.S. Smarkola C. Kopacz S.M. Ishoof S.B. Perinatal outcomes in nutritionally monitored obese pregnant women: a randomized clinical trial. J. Natl. Med. Assoc. 2009; 101 : 569-577 Abstract Full Text PDF PubMed Google Scholar ). Based on such preliminary findings, well-powered randomized controlled lifestyle intervention trials such as LIMIT ( Dodd et al., 2014b Dodd J.M. Turnbull D. McPhee A.J. Deussen A.R. Grivell R.M. Yelland L.N. Crowther C.A. Wittert G. Owens J.A. Robinson J.S. J.M.DoddD.TurnbullA.J.McPheeA.R.DeussenR.M.GrivellL.N.YellandC.A.CrowtherG.WittertJ.A.OwensJ.S.Robinson LIMIT Randomised Trial GroupAntenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial. BMJ. 2014; 348 : g1285 Crossref PubMed Scopus (0) Google Scholar ), UPBEAT ( Poston et al., 2015 Poston L. Bell R. Croker H. Flynn A.C. Godfrey K.M. Goff L. Hayes L. Khazaezadeh N. Nelson S.M. Oteng-Ntim E. et al. L.PostonR.BellH.CrokerA.C.FlynnK.M.GodfreyL.GoffL.HayesN.KhazaezadehS.M.NelsonE.Oteng-Ntim UPBEAT Trial ConsortiumEffect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. Lancet Diabetes Endocrinol. 2015; 3 : 767-777 Abstract Full Text Full Text PDF PubMed Scopus (193) Google Scholar ), RADIEL ( Koivusalo et al., 2016 Koivusalo S.B. R？n？ K. Klemetti M.M. Roine R.P. Lindstr？m J. Erkkola M. Kaaja R.J. P？yh？nen-Alho M. Tiitinen A. Huvinen E. et al. Gestational diabetes mellitus can be prevented by lifestyle intervention: the finnish gestational diabetes prevention study (RADIEL): a randomized controlled trial. Diabetes Care. 2016; 39 : 24-30 Crossref PubMed Scopus (0) Google Scholar ), DALI ( Simmons et al., 2017 Simmons D. Devlieger R. van Assche A. Jans G. Galjaard