scholarly journals Effects of a Lifestyle Intervention in Routine Care on Prenatal Dietary Behavior—Findings from the Cluster-Randomized GeliS Trial

2019 ◽  
Vol 8 (7) ◽  
pp. 960 ◽  
Author(s):  
Julia Günther ◽  
Julia Hoffmann ◽  
Julia Kunath ◽  
Monika Spies ◽  
Dorothy Meyer ◽  
...  
Keyword(s):  
Lifestyle Intervention ◽  
Soft Drink ◽  
Intervention Group ◽  
Dietary Behavior ◽  
Late Pregnancy ◽  
Healthy Eating Index ◽  
Dietary Quality ◽  
Weight Retention ◽  
Maternal Weight ◽  
Cluster Randomized

The antenatal lifestyle and excessive gestational weight gain (GWG) modify the risk of obstetric complications, maternal weight retention, and the risk of obesity for the next generation. The cluster-randomized controlled “Healthy living in pregnancy” (GeliS) study, recruiting 2286 women, was designed to examine whether a lifestyle intervention reduced the proportion of women with excessive GWG. Trained healthcare providers gave four counseling sessions covering a healthy diet, regular physical activity, and self-monitoring of GWG in the intervention group. In this secondary analysis, the effect on maternal dietary behavior was analyzed. Dietary behavior was assessed by means of a 58-item food frequency questionnaire in early and late pregnancy. The intervention resulted in a significant reduction in soft drink intake (p < 0.001) and an increase in the consumption of fish (p = 0.002) and vegetables (p = 0.023). With the exception of higher percentage energy from protein (p = 0.018), no effects of the intervention on energy and macronutrient intake were observed. There was no evidence for an overall effect on dietary quality measured with a healthy eating index. Some dietary variables were shown to be associated with GWG. In a routine prenatal care setting in Germany, lifestyle advice modified single aspects of dietary behavior, but not energy intake or overall dietary quality.

scholarly journals Effects of a Lifestyle Intervention in Routine Care on Short- and Long-Term Maternal Weight Retention and Breastfeeding Behavior—12 Months Follow-up of the Cluster-Randomized GeliS Trial

2019 ◽  
Vol 8 (6) ◽  
pp. 876 ◽  
Author(s):  
Julia Hoffmann ◽  
Julia Günther ◽  
Lynne Stecher ◽  
Monika Spies ◽  
Dorothy Meyer ◽  
...  
Keyword(s):  
Lifestyle Intervention ◽  
Exclusive Breastfeeding ◽  
Maternal Obesity ◽  
Routine Care ◽  
Control Group ◽  
Weight Retention ◽  
Maternal Weight ◽  
Increased Risk ◽  
Postpartum Weight ◽  
Cluster Randomized

Postpartum weight retention (PPWR) is associated with an increased risk for maternal obesity and is discussed to be influenced by breastfeeding. The objective was to evaluate the effect of a lifestyle intervention delivered three times during pregnancy and once in the postpartum period on PPWR and on maternal breastfeeding behavior. In total, 1998 participants of the cluster-randomized “healthy living in pregnancy” (GeliS) trial were followed up until the 12th month postpartum (T2pp). Data were collected using maternity records and questionnaires. Data on breastfeeding behavior were collected at T2pp. At T2pp, mean PPWR was lower in women receiving counseling (IV) compared to the control group (C) (−0.2 ± 4.8 kg vs. 0.6 ± 5.2 kg), but there was no significant evidence of between-group differences (adjusted p = 0.123). In the IV, women lost more weight from delivery until T2pp compared to the C (adjusted p = 0.008) and showed a slightly higher rate of exclusive breastfeeding (IV: 87.4%; C: 84.4%; adjusted p < 0.001). In conclusion, we found evidence for slight improvements of maternal postpartum weight characteristics and the rate of exclusive breastfeeding in women receiving a lifestyle intervention embedded in routine care, although the clinical meaning of these findings is unclear.

scholarly journals The effects of insulin therapy on maternal blood pressure and weight in women with gestational diabetes mellitus

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tiange Sun ◽  
Fanhua Meng ◽  
Shufei Zang ◽  
Yue Li ◽  
Rui Zhang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Insulin Therapy ◽  
Lifestyle Intervention ◽  
Intervention Group ◽  
Maternal Blood ◽  
Maternal Weight ◽  
Short Term ◽  
Family History Of Diabetes ◽  
History Of ◽  
Maternal Blood Pressure

Abstract Background Although insulin therapy achieves effective glycemic control, it may aggravate hyperinsulinemia. Nonetheless the benefits of insulin as first-line treatment for women with GDM are controversial. This work aimed to investigate the effect of insulin on maternal GDM. Methods This retrospective cohort study recruited 708 women with GDM of whom 616 underwent lifestyle intervention and 92 were prescribed insulin therapy. Differences in variables between the two groups were analyzed by univariate analysis and multivariate analysis. Propensity score matching was used to control for age, pre-pregnancy BMI, time and BP at GDM diagnosis, and family history of diabetes and hypertension. Paired sample test was applied to evaluate the changes in BP after intervention in the two groups of women. Results There was no significant difference in mode of delivery, newborn weight or incidence of macrosomia between women prescribed insulin and those who adopted lifestyle modifications. Insulin therapy was associated with a slight increase in maternal weight compared with the lifestyle intervention group and was attributed to short-term treatment (about 12 weeks). In addition, insulin therapy remarkably increased maternal blood pressure, an effect that persisted after matching age, pre-pregnancy BMI, time and BP at GDM diagnosis, and family history of diabetes and hypertension. Between commencing insulin therapy and delivery, systolic blood pressure significantly increased by 6mmHg (P = 0.015) and diastolic blood pressure by 9 mmHg (P < 0.001). Increase in BP was significantly higher in the insulin group compared with the lifestyle intervention group (P < 0.001). Logistic regression analysis with enter selection confirmed that insulin therapy was closely correlated with development of gestational hypertension (GH). Conclusions This work suggested that short-term insulin therapy for GDM was associated with a slight increase in maternal weight but a significant risk of increasing maternal blood pressure.

scholarly journals Effects of a Prenatal Lifestyle Intervention in Routine Care on Maternal Health Behaviour in the First Year Postpartum—Secondary Findings of the Cluster-Randomised GeliS Trial

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1310
Author(s):  
Kristina Geyer ◽  
Monika Spies ◽  
Julia Günther ◽  
Julia Hoffmann ◽  
Roxana Raab ◽  
...  
Keyword(s):  
Physical Activity ◽  
Maternal Health ◽  
Lifestyle Intervention ◽  
Health Behaviour ◽  
Intervention Group ◽  
Routine Care ◽  
Healthy Eating Index ◽  
Dietary Behaviour ◽  
First Year ◽  
Cluster Randomised

Lifestyle interventions during pregnancy were shown to beneficially influence maternal dietary behaviour and physical activity, but their effect on health behaviour after delivery is unclear. The objective of this secondary analysis was to investigate the sustained effect of a lifestyle intervention in routine care on maternal health behaviour during the first year postpartum. The cluster-randomised controlled “Healthy living in pregnancy” (GeliS) study included 2286 pregnant women. Data on maternal health behaviour were collected at 6–8 weeks (T1pp) and one year postpartum (T2pp) using validated questionnaires. The intervention group showed a lower mean intake of fast food (T1pp: p = 0.016; T2pp: p < 0.001) and soft drinks (T1pp: p < 0.001), a higher mean intake of vegetables (T2pp: p = 0.015) and was more likely to use healthy oils for meal preparation than the control group. Dietary quality rated by a healthy eating index was higher in the intervention group (T1pp: p = 0.093; T2pp: p = 0.043). There were minor trends towards an intervention effect on physical activity behaviour. The proportion of smokers was lower in the intervention group (p < 0.001, both time points). The lifestyle intervention within routine care modestly improved maternal postpartum dietary and smoking behaviours.

scholarly journals Telehealth versus self-directed lifestyle intervention to promote healthy blood pressure: a protocol for a randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044292
Author(s):  
Mohamed Taher ◽  
Christina Yule ◽  
Heather Bonaparte ◽  
Sara Kwiecien ◽  
Charlotte Collins ◽  
...  
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Randomised Controlled Trial ◽  
Lifestyle Intervention ◽  
Healthy Eating ◽  
Controlled Trial ◽  
Healthy Eating Index ◽  
Dietary Quality ◽  
Web Based ◽  
Randomised Controlled

IntroductionWeight loss, consumption of a Dietary Approaches to Stop Hypertension dietary pattern, reduced sodium intake and increased physical activity have been shown to lower blood pressure (BP). Use of web-based tools and telehealth to deliver lifestyle counselling could be potentially scalable solutions to improve BP through behavioural modification though limited data exists to support these approaches in clinical practice.Methods and analysisThis randomised controlled trial will compare the efficacy of a telehealth versus self-directed lifestyle intervention in lowering 24-hour SBP in patients with overweight/obesity (body mass index ≥25 kg/m2) and 24-hour SBP 120–160 mm Hg. All participants receive personalised recommendations to improve dietary quality based on a web-based Food Frequency Questionnaire, access to an online comprehensive weight management programme and a smartphone dietary app. The telehealth arm additionally includes weekly calls with registered dietitian nutritionists who use motivational interviewing. The primary outcome is change from baseline to 12 weeks in 24-hour SBP. Secondary outcomes include changes from baseline in 24-hour diastolic BP, daytime SBP, nighttime SP, daytime diastolic BP, nighttime diastolic BP, total Healthy Eating Index-2015 score, weight, waist circumference and physical activity. Other prespecified outcomes will include change in individual components of the Healthy Eating Index-2015 score, and satisfaction with the Healthy BP research study measured on a 5-point Likert scale.Ethics and disseminationThe study has been approved by the Geisinger Institutional Review Board. Results will be disseminated through peer-reviewed publications and conference presentations.Trial registration numberNCT03700710.

scholarly journals The Impact of Lifestyle Intervention on Dietary Quality among Rural Women with Previous Gestational Diabetes Mellitus—A Randomized Controlled Study

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2642
Author(s):  
Mingshu Li ◽  
Qian Lin ◽  
Jingcheng Shi ◽  
Yue Xi ◽  
Caihong Xiang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Lifestyle Intervention ◽  
Rural Women ◽  
Intervention Group ◽  
Dietary Quality ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Previous Gestational Diabetes Mellitus ◽  
Previous Gestational Diabetes

Healthy diet is essential to type 2 diabetes mellitus (T2DM) prevention for women with previous gestational diabetes mellitus (GDM). To evaluate the effect of a lifestyle intervention program on diet quality for rural women who were previously diagnosed with GDM, we conducted a randomized controlled study in two counties located in south-central China. A total of 404 eligible women were allocated into an intervention group and control group. Participants in the intervention group received 6-month lifestyle intervention including six group seminars and eight telephone consultations. Dietary data were collected at baseline and 18 months via a 24 h dietary recall, and dietary quality was measured by two indicators, Chinese Healthy Eating Score (CHEI) and Minimum Dietary Diversity for Women (MDD-W). Baseline CHEI scores (54.4 vs. 53.5, p = 0.305) and the proportions of participants who met MDD-W (73.8% vs. 74.5%, p = 0.904) were comparable between the two groups. The intervention group achieved a higher CHEI score (62.2 vs. 58.9, p = 0.001) and higher MDD-W proportion (90.6% vs. 81.2%, p = 0.023) at 18 months. Lifestyle intervention was associated with the change of CHEI (p = 0.049) but not with MDD-W (p = 0.212). In conclusion, compared with usual care, lifestyle intervention resulted in greater improvement of dietary quality among rural women with previous GDM.

scholarly journals Associations of Circadian Eating Pattern and Diet Quality with Substantial Postpartum Weight Retention

Nutrients ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 2686 ◽  
Author(s):  
See Ling Loy ◽  
Yin Bun Cheung ◽  
Marjorelee T. Colega ◽  
Airu Chia ◽  
Chad Yixian Han ◽  
...  
Keyword(s):  
Diet Quality ◽  
Healthy Eating Index ◽  
Postpartum Weight Retention ◽  
Weight Retention ◽  
Maternal Weight ◽  
Night Time ◽  
Eating Pattern ◽  
Eating Time ◽  
Postpartum Weight ◽  
Fasting Duration

Besides food quantity and quality, food timing and frequency may contribute to weight regulation. It is unclear if these factors during pregnancy can influence maternal weight retention after childbirth. We thus aimed to examine the associations of maternal circadian eating pattern and diet quality in pregnancy with substantial postpartum weight retention (PPWR) at 18 months in an Asian cohort. We assessed circadian eating pattern and diet quality of 687 women using 24-h dietary recalls at 26–28 weeks’ gestation. We calculated PPWR by subtracting maternal weight in the first trimester from weight at 18-month postpartum and defined substantial PPWR as ≥5 kg weight retention. Multivariable binary logistic regression was performed. Overall, 16% of women had substantial PPWR. After the confounders adjustment, night eating, defined by greater night-time caloric intake (odds ratio 1.95; 95% confidence interval 1.05, 3.62), and lower diet quality, classified by median score of the Healthy Eating Index (1.91; 1.17, 3.10), were independently associated with higher odds of substantial PPWR. No associations with substantial PPWR were observed for night fasting duration and number of eating episodes. In conclusion, alignment of eating time with day–night cycles and diet quality during pregnancy may play a role in PPWR, with possible implications for long-term obesity risk.

scholarly journals Effect of prenatal lifestyle intervention on maternal postpartum weight retention and child body mass index z-score at 36 months

2021 ◽  
Author(s):  
Suzanne Phelan ◽  
Chantelle N. Hart ◽  
Elissa Jelalian ◽  
Karen Muñoz-Christian ◽  
Noemi Alarcon ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Usual Care ◽  
Lifestyle Intervention ◽  
Body Mass ◽  
Overweight And Obesity ◽  
Postpartum Weight Retention ◽  
Weight Retention ◽  
Maternal Weight ◽  
Postpartum Weight ◽  
Prenatal Intervention

Abstract Background/Objectives We previously reported results from a randomized trial showing that a behavioral intervention during pregnancy reduced excess gestational weight gain but did not impact maternal weight at 12 months. We now examine the longer-term effects of this prenatal intervention on maternal postpartum weight retention and toddler body-mass-index z scores (BMIz) over 36 months. Subjects/Methods Pregnant women (N = 264; 13.7 weeks’ gestation; 41.6% Hispanic) with overweight or obesity were randomized into usual care or prenatal intervention. Anthropometric assessments in mothers and toddlers occurred at baseline, 35 weeks’ gestation and after delivery at 6, 12, 18, 24, and 36 months. Results At 36 months, prenatal intervention vs. usual care had no significant effect on the proportion of participants who returned to their early pregnancy weight or below (33.3% vs. 39.5%; p = 0.12) and had no effect on the magnitude of weight retained (2.8 [0.8, 4.8] vs 3.0 kg [1.0, 4.9], respectively; mean difference = 0.14 [−3.0, 2.7]). There was also no statistically significant intervention vs. usual care effect on infant BMIz or skinfold changes over time; toddler BMIz increased by 1.4 [−1.7, 1.0] units in the intervention group and 1.6 [−1.2, 1.8] units in the usual care group from delivery to 36 months (difference = 0.16 [−0.32. 0.63]). The proportion of toddlers at risk for obesity at 36 months was similar in intervention and usual care groups (28/77 [36.4%] vs 30/80 [37.5%]; p = 0.77). Conclusions Compared with usual care, lifestyle intervention during pregnancy resulted in similar maternal and toddler anthropometric outcomes at 36-months postpartum in a diverse US sample of women with overweight and obesity. To sustain improved maternal weight management initiated during pregnancy, continued intervention during the postpartum years may be needed.

scholarly journals Telehealth versus Self-Directed Lifestyle Intervention to Promote Healthy Blood Pressure: A Protocol for a Randomized Controlled Trial

2020 ◽  
Author(s):  
Mohamed Taher ◽  
Christina Yule ◽  
Heather Bonaparte ◽  
Sara Kwiecien ◽  
Charlotte Collins ◽  
...  
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Randomized Controlled Trial ◽  
Systolic Blood Pressure ◽  
Lifestyle Intervention ◽  
Controlled Trial ◽  
Healthy Eating Index ◽  
Dietary Quality ◽  
Web Based ◽  
Randomized Controlled

Introduction: Weight loss, consumption of a Dietary Approaches to Stop Hypertension (DASH) dietary pattern, reduced sodium intake, and increased physical activity have been shown to lower blood pressure. Use of web-based tools and telehealth to deliver lifestyle counseling could be potentially scalable solutions to improve blood pressure through behavioral modification though limited data exists to support these approaches in clinical practice. Methods and analysis: This randomized controlled trial will compare the efficacy of a telehealth versus self-directed lifestyle intervention in lowering 24-hour systolic blood pressure in patients with body mass index ≥ 25 kg/m2 and 24-hour SBP 120-160 mmHg. All participants receive personalized recommendations to improve dietary quality based on a web-based food frequency questionnaire, access to an online comprehensive weight management program, and a smartphone dietary app. The telehealth arm additionally includes weekly calls with registered dietitian nutritionists who use motivational interviewing. The primary outcome is change from baseline to 3-months in 24-hour systolic blood pressure. Secondary outcomes include changes from baseline in Healthy Eating Index-2015 score, weight, waist circumference, and physical activity. Ethics and dissemination: The study has been approved by the Geisinger Institutional Review Board. Results will be disseminated through peer-reviewed publications and conference presentations. Trial registration number: ClinicalTrials.gov Identifier NCT03700710

scholarly journals Impact of a School-Based Gardening, Cooking, Nutrition Intervention on Diet Intake and Quality: The TX Sprouts Randomized Controlled Trial

Nutrients ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 3081
Author(s):  
Matthew J. Landry ◽  
Alexandra E. van den Berg ◽  
Deanna M. Hoelscher ◽  
Fiona M. Asigbee ◽  
Sarvenaz Vandyousefi ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Dietary Intake ◽  
Controlled Trial ◽  
Intervention Group ◽  
The United States ◽  
Healthy Eating Index ◽  
Dietary Quality ◽  
Control Group ◽  
Randomized Controlled ◽  
School Based

School gardens have become common school-based health promotion strategies to enhance dietary behaviors in the United States. The goal of this study was to examine the effects of TX Sprouts, a one-year school-based gardening, cooking, and nutrition cluster randomized controlled trial, on students’ dietary intake and quality. Eight schools were randomly assigned to the TX Sprouts intervention and eight schools to control (i.e., delayed intervention) over three years (2016–2019). The intervention arm received: formation and training of Garden Leadership Committees; a 0.25-acre outdoor teaching garden; 18 student lessons including gardening, nutrition, and cooking activities, taught weekly in the teaching garden during school hours; and nine parent lessons, taught monthly. Dietary intake data via two 24 h dietary recalls (24 hDR) were collected on a random subsample (n = 468). Dietary quality was calculated using the Healthy Eating Index 2015 (HEI-2015). The intervention group compared to control resulted in a modest increase in protein intake as a percentage of total energy (0.4% vs. −0.3%, p = 0.021) and in HEI-2015 total vegetables component scores (+4% vs. −2%, p = 0.003). When stratified by ethnicity/race, non-Hispanic children had a significant increase in HEI-2015 total vegetable scores in the intervention group compared to the control group (+4% vs. −8%, p = 0.026). Both the intervention and control groups increased added sugar intake; however, to a lesser extent within the intervention group (0.3 vs. 2.6 g/day, p = 0.050). School-based gardening, cooking, and nutrition interventions can result in significant improvements in dietary intake. Further research on ways to scale and sustain nutrition education programs in schools is warranted. The trial is registered at ClinicalTrials.gov (NCT02668744).

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