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Nutritional Lifestyle Intervention in Obese Pregnant Women, Including Lower Carbohydrate Intake, Is Associated With Increased Maternal Free Fatty Acids, 3-β-Hydroxybutyrate, and Fasting Glucose Concentrations: A Secondary Factorial Analysis of the European Multicenter, Randomized Controlled DALI Lifestyle Intervention Trial.

Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria. Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, England. Macarthur Clinical School, Western Sydney University, Sydney, New South Wales, Australia. Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria. Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Biomaterials and Nanotechnology, CIBER Bioengineering, Instituto de Salud Carlos III, Madrid, Spain. Department of Development and Regeneration, KU Leuven, University Leuven, Leuven, Belgium. Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium. Department of Obstetrics, Gynecology, and Fertility, GZA Sint-Augustinus Wilrijk, Antwerpen, Belgium. Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands. Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Copenhagen, Denmark. The Clinical Institute of Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark. Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark. Department of Clinical Research, Faculty of Health, University of Southern Denmark, Sønderborg, Denmark. Galway Diabetes Research Centre and National University of Ireland, Galway, Ireland. Universita Degli Studi di Padova, Padua, Italy. Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy. Division of Reproduction, Medical Faculty I, Poznan University of Medical Sciences, Poznan, Poland. Recherche en Santé Lawson SA, St. Gallen, Switzerland. Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands. Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands. Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands. Department for Health Promotion and Prevention, SPORTUNION, Vienna, Austria. Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria. Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria. Institute of Sport Science, University of Graz, Graz, Austria. Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria alexandra.kautzky-willer@meduniwien.ac.at.

Diabetes care. 2019;(8):1380-1389
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Abstract

OBJECTIVE In our randomized controlled trial, we investigated the impact of healthy eating (HE) aiming for restricted gestational weight gain (GWG) and physical activity (PA) interventions on maternal and neonatal lipid metabolism. RESEARCH DESIGN AND METHODS Obese pregnant women (n = 436) were included before 20 weeks' gestation and underwent glucose testing (oral glucose tolerance test) and lipid profiling at baseline and 24-28 and 35-37 gestational weeks after an at least 10-h overnight fast. This secondary analysis had a factorial design with comparison of HE (n = 221) versus no HE (n = 215) and PA (n = 218) versus no PA (n = 218). Maternal changes in triglycerides (TG), LDL cholesterol, HDL cholesterol, free fatty acids (FFAs), and leptin from baseline to end of pregnancy and neonatal outcomes were analyzed using general linear models with adjustment for relevant parameters. RESULTS At 24-28 weeks' gestation, FFAs (mean ± SD, 0.60 ± 0.19 vs. 0.55 ± 0.17 mmol/L, P < 0.01) were increased after adjustment for FFA at baseline, maternal age, BMI at time of examination, gestational week, insulin resistance, self-reported food intake, self-reported physical activity, and maternal smoking, and GWG was lower (3.3 ± 2.6 vs. 4.3 ± 2.8 kg, P < 0.001, adjusted mean differences -1.0 [95% CI -1.5; -0.5]) in HE versus no HE. Fasting glucose levels (4.7 ± 0.4 vs. 4.6 ± 0.4 mmol/L, P < 0.05) and 3-β-hydroxybutyrate (3BHB) (0.082 ± 0.065 vs. 0.068 ± 0.067 mmol/L, P < 0.05) were higher in HE. Significant negative associations between carbohydrate intake and FFA, 3BHB, and fasting glucose at 24-28 weeks' gestation were observed. No differences between groups were found in oral glucose tolerance test or leptin or TG levels at any time. Furthermore, in PA versus no PA, no similar changes were found. In cord blood, elevated FFA levels were found in HE after full adjustment (0.34 ± 0.22 vs. 0.29 ± 0.16 mmol/L, P = 0.01). CONCLUSIONS HE intervention was associated with reduced GWG, higher FFAs, higher 3BHB, and higher fasting glucose at 24-28 weeks of gestation, suggesting induction of lipolysis. Increased FFA was negatively associated with carbohydrate intake and was also observed in cord blood. These findings support the hypothesis that maternal antenatal dietary restriction including carbohydrates is associated with increased FFA mobilization.

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MeSH terms : Diet, Healthy ; Prenatal Care